When Is Keyhole Surgery Best for Hip Pain?

Hip pain can have a significant impact on daily life, affecting everything from walking and exercise to sleep and work. For some people, conservative treatments such as physiotherapy, medication, or injections provide enough relief. For others, ongoing pain may point to a structural problem within the hip joint that requires surgical intervention.

Keyhole surgery, also known as hip arthroscopy, is a minimally invasive procedure that allows surgeons to diagnose and treat a range of hip conditions using small incisions and specialised instruments. While it is not suitable for everyone, keyhole surgery can be highly effective when used for the right patient and the right condition.

Understanding when keyhole surgery is appropriate, what procedures are commonly performed, and what outcomes can be expected is essential when considering this treatment option.

Understanding Keyhole Surgery for the Hip

Keyhole hip surgery involves inserting a small camera (arthroscope) into the hip joint through tiny incisions. This allows the surgeon to view the joint in detail on a screen and perform corrective procedures without the need for large open incisions.

Because the hip is a deep and complex joint, hip arthroscopy is a highly specialised procedure. When performed for suitable conditions, it can reduce pain, improve joint function, and help prevent further damage.

Key advantages of keyhole surgery include:

• Smaller incisions and less tissue disruption
• Reduced post-operative pain compared to open surgery
• Shorter hospital stays
• Faster initial recovery and rehabilitation

However, the success of keyhole surgery depends heavily on patient selection and accurate diagnosis.

Ideal Candidates for Keyhole Hip Surgery

Not all hip pain can or should be treated with arthroscopy. The best candidates typically meet a combination of clinical, imaging, and lifestyle criteria.

People Who May Benefit Most Include:

• Adults with persistent hip pain that has not improved with conservative treatment
• Patients with mechanical symptoms such as clicking, locking, or catching
• Individuals with hip pain during movement, especially twisting or deep flexion
• Active people who wish to return to sport or physical activity
• Patients with early-stage joint damage, rather than advanced arthritis

Key Factors Surgeons Consider:

• Age and activity level
• Severity and duration of symptoms
• Imaging results such as MRI or X-rays
• Presence or absence of osteoarthritis
• Overall joint alignment and stability

Who May Not Be Suitable:

• Patients with advanced hip arthritis
• Those with significant joint space narrowing
• Individuals whose pain is coming from outside the hip joint, such as the lower back
• Patients unable to commit to post-operative rehabilitation

Proper assessment is essential, as keyhole surgery is most effective when used before irreversible joint damage occurs.

Common Conditions Treated with Keyhole Hip Surgery

Hip arthroscopy is commonly used to treat a range of intra-articular hip conditions. These problems often cause pain during movement and may worsen over time if left untreated.

Femoroacetabular Impingement (FAI)

FAI occurs when abnormal bone shapes on the hip joint cause friction during movement. Over time, this can damage cartilage and the labrum.

Keyhole surgery may involve:

• Reshaping excess bone
• Improving joint clearance
• Reducing ongoing joint damage

Labral Tears

The labrum is a ring of cartilage that helps stabilise the hip joint. Tears can cause pain, clicking, or instability.

Surgical treatment may include:

• Repairing the labrum
• Removing damaged tissue
• Restoring joint stability

Cartilage Damage

Cartilage injuries can lead to pain and reduced joint function.

Procedures may involve:

• Smoothing damaged cartilage
• Stimulating healing in early-stage defects

Loose Bodies in the Joint

Small fragments of bone or cartilage can float within the joint and cause mechanical symptoms.

Keyhole surgery allows for:

• Identification of loose fragments
• Safe removal with minimal disruption

Hip Synovitis and Inflammation

Inflammation of the joint lining can contribute to pain and stiffness.

Treatment may include:

• Removing inflamed tissue
• Improving joint mobility

What Happens During the Procedure?

Keyhole hip surgery is usually performed under general anaesthetic. Small incisions are made around the hip, allowing the surgeon to insert the camera and instruments.

The procedure generally involves:

• Careful joint access using specialised equipment
• Visual assessment of cartilage, labrum, and bone
• Targeted treatment of identified problems

Most procedures take between one and two hours, depending on complexity. Many patients are able to go home the same day or after a short hospital stay.

Expected Outcomes and Recovery

Outcomes following keyhole hip surgery are generally positive when the procedure is performed for the right reasons.

Short-Term Recovery

• Crutches may be needed for one to two weeks
• Pain and swelling gradually improve over several weeks
• Early physiotherapy focuses on mobility and gentle strengthening

Medium to Long-Term Outcomes

• Improved hip function and movement
• Reduction in pain during daily activities
• Return to sport or exercise within three to six months for many patients

Factors That Influence Results:

• Accuracy of diagnosis
• Surgical technique
• Commitment to rehabilitation
• Overall joint health

It is important to understand that while keyhole surgery can relieve symptoms and improve function, it is not a cure for degenerative joint disease.

Risks and Limitations to Consider

As with any surgical procedure, hip arthroscopy carries some risks.

Possible risks include:

• Infection
• Nerve irritation
• Persistent pain
• Stiffness or delayed recovery

Discussing potential risks and realistic expectations with a specialist is a vital part of the decision-making process.

Frequently Asked Questions

How long does recovery from keyhole hip surgery take?

Recovery varies, but most patients return to daily activities within six to eight weeks. Full recovery, especially for sport, may take several months.

Is keyhole surgery painful?

Post-operative discomfort is expected but usually manageable with medication and physiotherapy. Pain typically decreases steadily over the first few weeks.

Will keyhole surgery prevent arthritis?

While it may slow joint damage in some cases, keyhole surgery does not prevent arthritis entirely. Early intervention can help preserve joint health.

Can hip pain return after surgery?

Some patients may experience recurring symptoms, particularly if arthritis progresses or rehabilitation is incomplete.

Is physiotherapy necessary after surgery?

Yes. Rehabilitation is essential for restoring strength, movement, and long-term success.