North West Hip & Knee Clinic - Hip Arthroscopy - Arthroscopic Surgery


Mr Aslam Mohammed FRCS, FRCS (Orth)
Consultant Hip & Knee Surgeon

Specialising in:
Lower Limb Arthroplasty & Sports Injury
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arthroscopic surgery in the UK


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Hip arthroscopy is a minimally invasive technique whereby it is possible to look inside the hip joint with the aid of a fibre optic telescope and carry out a number of surgical procedures using this technique. Most people are familiar with knee arthroscopy for the treatment of cartilage and ligament disorders.

Hip arthroscopy is a much less widely performed. This is because it has taken time for the technique and instruments to be developed.

Mr Aslam Mohammed developed instruments, The Pathfinder System to give safe and reproducible access to the hip joint in 1995 (http://www.arthrocaresportsmedicine.com). He has been treating patients with non arthritic pathology of the hip joint since then and has been teaching and training other surgeons in this technique both in the UK and abroad. He is involved with hands on teaching with cadaver workshops.

This procedure is now more widely performed with the availability of training, instruments and recognition of new pathology which is amenable to this procedure. 

The hip is a much deeper joint than the knee and for that reason it is much harder to introduce the arthroscope and instruments into the joint. In order to do this the hip joint has to be distracted by traction to produce a space between the joint surfaces to introduce the instruments into the joint without causing damage to the articular cartilage and the labrum. It is now possible to examine the joint and determine the cause of specific symptoms and in treat their cause.

Pathfinder Hip Arthroscopy access system Pathfinder Hip Arthroscopy access system - a guide wire and set of dilators to give safe access to the hip


 hip arthroscopy operation -Operation

The surgery is undertaken under a general anaesthetic. After the joint has been distracted to create a space the instruments are then introduced into the hip joint. Usually two or three small incisions are used (0.5 to 1cm). After surgery patients can mobilise and usually go home the same day. The postoperative recovery programme will depend on what type of surgery is performed on the joint and this will be clarified following the operation. Patients are seen by the physiotherapist before and after surgery to advise on and manage the rehabilitation.

 hip arthroscopy complications -Complications

Most commonly there may be a little numbness around the small incisions which usually improves with time. Because the hip has to be distracted there is a chance that there will be some numbness in the perineal area. This usually recovers quite quickly but occasionally can persist for a few weeks. Pressure sores, instrument breakage and failure access the hip joint have been reported. There is a 5% chance of making symptoms worse. These will be discussed with you in detail with you at the time of your consultation with Mr Aslam Mohammed.

 hip arthroscopy complications -Outcome

In general good outcomes are achieved with this operation, recovery is relatively slow over months and is dependent on the underlying pathology/condition being treated and the surgery that is performed.



_Conditions that can be managed by hip arthroscopy

 hip arthroscopy complications -Torn labrum

The labrum of the acetabulum is the cartilage rim of the joint that makes it deeper and helps provide a suction seal for the fluid in the joint. Sometimes this can get torn and lead to episodes of acute pain in the hip with a feeling of catching, clicking and giving way. There is usually a background ache in the hip joint and at times sleep can be disturbed. The torn segment of the labrum can be trimmed back to healthy tissue and in some cases it can be repaired.

Acetabulum and labrum
MRI Arthrogram showing a tear in the labrum with a paralabral cyst
Partial thickness tear of labrum
Acetabulum and labrum
MRI Arthrogram showing a tear in the labrum with a paralabral cyst
Partial thickness tear of labrum


 hip arthroscopy complications -Loose bodies


Loose pieces of cartilage or bone can sometimes form in the joint for a variety of reasons such as; Synovial Chondromatosis, Osteochondral lesions and loose articular cartilage. These can get caught between the joint surfaces leading to pain and cause damage to the articular cartilage. These can be very effectively removed by hip arthroscopy.

loose body in hip
loose bodies in hip
Loose body in hip Loose body in hip
Removed loose body


 hip arthroscopy hip ligament injury -Ligamentum Teres injury


This is a strong and important ligament within the hip joint can get torn leading to pain. This commonly occurs in dancers who have done the splits accidentally and are left with a painful hip joint, it can cause clicking with giving way. They also have a restricted range of movement of the hip and are unable to dance. This can be treated at hip arthroscopy by taking away the torn part of the ligament to stop it catching and giving symptoms.

hip Ligamentum Teres injury Partial tear
Complete of Ligamentum teres
Enlarge picture
Hip joint Partial tear
Complete of Ligamentum teres


 hip arthroscopy hip ligament injury Femoro Actabular Impingement (FAI) -Femoro Actabular Impingement (FAI)

This is a condition which has been recently recognised and may be a precursor / initiator of damage to the articular cartilage of the acetabulum (socket) and development of future arthritis. It also damages the labrum. There is an abnormal shape to the femoral head (anterior bump osteophyte - Cam) and /or abnormal acetabulum (Pincer osteophyte). As the hip moves the ball move into the socket and scuffs the labrum and the articular cartilage eventually causing severe and permanent damage giving rise to symptoms.

The symptoms are usually reduced range of movement difficulty in bringing the hip up to wards the chest, aching in the groin on sitting at a desk, there can be pain at night, a click may be noticed with acute pain on getting up and walking, also catching and giving way of the hip. Patients experience a reduced level of activity and exercise tolerance to a point of having to give up sports and exercises. In some cases patients have been misdiagnosed with the groin pain and have had operations on the groin performed before the correct diagnosis is made and treated. It is possible at arthroscopy to remove the lesions which causing the symptoms by trimming the abnormal bump off bone from the femoral head/neck junction and from the rim of the acetabulum as well as treating the torn labrum.

Acetabular osteophytes causing Pincer type FAI

X ray of femoral head neck junction “Bump” causing Cam type FAI

Acetabular osteophytes causing Pincer type FAI

X ray of femoral head neck junction “Bump” causing Cam type FAI

At hip arthroscopy “Bump” shown
After removal of “Bump” allowing clear entry 
of femoral head into the acetabulum
At arthroscopy “Bump” shown
After removal of “Bump” allowing clear entry
of femoral head into the acetabulum


 hip arthroscopy hip ligament injury

-Open Surgical Dislocation of the Hip Joint


In certain situations where there are extensive combined Cam and Pincer femoro acetabular impingement lesions (FAI), it safer and more effective to perform the procedure through and open incision rather than arthroscopically.


Mr Aslam Mohammed utilises the Ganz approach with a trochanteric osteotomy to preserve the blood supply to the femoral head. This gives an excellent view of the pathology and allows the removal of both impingement lesions and repair of the labrum if required.

Pre operative X rays showing extensive Pincer and Cam type impingement
Pre operative X rays showing extensive Pincer and Cam type impingement

Pre operative X rays showing extensive Pincer and Cam type impingement

femoral head and acetabulum exposed after dislocation of hip joint

At surgery femoral head and acetabulum exposed after dislocation of hip joint



hip arthroscopy  Pincer and Cam impingement lesions.


hip arthroscopy  Pincer and Cam impingement lesions

X rays in two plane showing removal of the “extra bone” of the Pincer and Cam impingement lesions. Screws in place to secure the Ganz osteotomy


 hip arthroscopy hip arthritis -Arthritis

Early stages of arthritis can be associated with loose bodies or flaps of articular cartilage. Smoothing and removing these flaps can often improve symptoms for an undetermined period of time. Although it does not get rid of the underlying condition, it can delay the need for a hip replacement for a variable period of time.

 hip arthroscopy diagnostic hip investigation -Diagnostic

Sometimes, even after a number of other investigations such as X rays, CT scans and MRI arthrogram, it is not possible to a definitive diagnosis for the cause of the hip pain.

In these cases it can be helpful to perform a hip arthroscopy but is only performed as a last resort as the cause may still not be apparent at the time of surgery.

 hip arthroscopy hip biopsy -Biopsy

There are some conditions of the hip that need a sample of tissue taken to be analysed. Hip arthroscopy allows this to be done quite easily. Synovitis especially a condition called Pigmented Villonodular Synovitis (PVNS) which can give pain and mechanical symptoms.

Synovial nodule entrapping in hip joint not seen on investigation

Synovial nodule entrapping in hip joint not seen on investigation

MRI Scans
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North West Hip & Knee Clinic -Hip Arthroscopy - Arthroscopic Surgery
© Copyright Mr Aslam Mohammed 2009