Short answerIn large trials, keyhole surgery improved hip symptoms more than physiotherapy, though both groups improved.
Probably helps a little
What it is
Hip impingement, or femoroacetabular impingement, is a mismatch in the shape of the ball and socket. The bones pinch against each other during movement, which causes groin pain and stiffness, mainly in young and middle aged adults. Hip arthroscopy is a keyhole operation that reshapes the bone. Physiotherapy builds hip strength and control, and teaches ways to avoid pinching positions.
What the research shows
enrolled 348 people at 23 hospitals. Half had hip arthroscopy and half had a personalised physiotherapy program. Both groups improved on a hip quality of life score, but surgery improved it more, by a difference that the authors judged clinically significant.
enrolled 222 adults aged 18 to 60 at seven English hospitals. At eight months, the score for daily activities was 10 points higher with surgery, on a 100 point scale. The range of likely values was 6.4 to 13.6 points, and the smallest difference judged to matter was 9 points. Assessors did not know which treatment people had had, and no serious side effects were reported.
found better short term results with surgery on the iHOT-33 hip score. On the daily activities score, the gap depended on how the analysis counted people who switched treatment. In FASHIoN, people could not be blinded to their treatment, so some of the gap may be due to expectation.
enrolled 99 people. At 12 months, surgery improved the hip quality of life score more than physiotherapy, by 14 points.
Risks and effort
Serious problems were uncommon, but most of those reported in FASHIoN were linked to surgery. , 24 in 100 people in the physiotherapy group had chosen to have surgery, and 12 in 100 who had surgery needed a repeat arthroscopy. Recovery takes weeks to months, and physiotherapy is still needed after surgery.
What usually works instead
A supervised physiotherapy program is the usual first step, and it helped many people in the trials. See Femoroacetabular Impingement and Hip Arthroscopy.
Questions people ask
Will surgery prevent arthritis?
The trials followed people for one to three years. They cannot tell us about arthritis in later life. In the Australian trial, MRI scans of hip cartilage at one year were no better after surgery than after physiotherapy.
Who is most likely to gain?
The trials did not settle this. People with a clear impingement shape and symptoms that have not eased with physiotherapy are the usual candidates. found no feature that picked who would do better with surgery rather than physiotherapy. People who started with worse symptoms improved more with either treatment.
Can I try physiotherapy first?
Yes. Many people in the physiotherapy group did well, and surgery stayed available.
Is it worth getting hip impingement surgery?
In the trials it improved hip symptoms more than physiotherapy, and in one blinded trial the gain only just passed the size that matters. Both groups improved. By three years, about 1 in 4 people who started with physiotherapy had chosen surgery, and about 1 in 8 who had surgery needed a repeat arthroscopy. Trying physiotherapy first is reasonable.
When is it too late for hip arthroscopy?
The trials included adults up to about 60 with impingement, not established arthritis. They did not test an upper age limit. Ask your surgeon how the state of your hip cartilage affects the choice.
Sources
Select a source to read what the study or guideline found, in plain words, with a link to the original.
Last reviewed 24 October 2026. Next review due October 2028.
