Hip arthroscopy or hip replacement: which one fits your hip?

Is hip arthroscopy or hip replacement the right surgery for hip pain?

Hip arthroscopy and hip replacement treat different problems. Arthroscopy repairs labral tears and reshapes bone in femoroacetabular impingement through small incisions, and works well only when the cartilage is still healthy. Hip replacement replaces a joint damaged by moderate to severe arthritis. When significant arthritis is present, arthroscopy rarely helps and replacement is usually the better choice.

The deciding factor is the condition of the cartilage, not the patient's age. Dr. Stride performs both procedures, so the recommendation follows what your X-rays and exam show rather than which surgery is offered.

Written and medically reviewed by Dr. Stride, MD, board-certified orthopedic surgeon
Last reviewed October 2026

Runner on a park trail holding the outside of his hip

Side by side

	Hip arthroscopy	Hip replacement
What it does	Repairs labrum, reshapes bone	Replaces the worn ball and socket
Good fit for	Labral tears, FAI, loose bodies	Moderate to severe arthritis, osteonecrosis
Arthritis on X-ray	Little or none	Moderate to severe
Incisions	2 to 3 small portals	One incision, several inches
Crutches	Typically 2 to 6 weeks	Walker or cane for a few days to weeks
Full return to sport	Often 4 to 6 months	Low-impact activities by about 3 months
Main limitation	Poor results in arthritic hips	Long-term limits on high-impact running

When arthroscopy is the right call

Arthroscopy suits active adults with impingement or a labral tear whose X-rays show well-preserved joint space. It addresses the cause of pain and may help protect the joint. Recovery takes patience, with structured therapy for several months.

When replacement is the better answer

Once the cartilage is significantly worn, cleaning up the joint arthroscopically rarely brings lasting relief, and studies show many of these patients go on to a replacement within a few years. A hip replacement gives dependable pain relief and lets most patients return to walking, golf, cycling and doubles pickleball.

The gray zone

Some patients in their 40s and 50s have mild arthritis plus a labral tear. For them, Dr. Stride often recommends a period of therapy and possibly a diagnostic injection first, then reviews the options together with clear expectations.

The bottom line

Arthroscopy is for structurally sound hips with a fixable problem; replacement is for hips worn by arthritis. Honest X-ray reading decides which one fits, and a surgeon who does both can give you an unbiased recommendation.

Frequently asked questions

How young is too young for a hip replacement?

There is no strict age cutoff. Modern implants last many years, and younger patients with severe arthritis often do very well. The decision rests on pain, function and X-rays rather than age alone.

Can arthroscopy delay a hip replacement?

In hips with little or no arthritis, treating impingement and labral tears may help protect the joint. In hips that already have moderate arthritis, arthroscopy is unlikely to delay a replacement meaningfully.

Is hip arthroscopy outpatient surgery?

Yes, hip arthroscopy is almost always done as outpatient surgery, and most patients go home the same day on crutches. Many hip replacements are now outpatient too.

Preservation

Hip Arthroscopy

Hip arthroscopy is an outpatient surgery that uses a small camera and slim instruments, placed through two or three small incisions, to treat problems inside the hip joint.

FAI Surgery

FAI surgery is an arthroscopic procedure that reshapes extra bone on the ball (cam) or rim of the socket (pincer) so the hip stops pinching when it bends and rotates.

Total Hip Replacement

Total hip replacement replaces the worn ball and socket of an arthritic hip with a metal, ceramic and medical-grade plastic implant.

Hip X-ray & MRI

Hip X-rays and MRI answer different questions.

From the Hip Health Library

Questions patients ask about this

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Dr. Stride walking a patient through a pelvis X-ray on the screen

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Arthritis & Hip Replacement

Do I Need a Hip Replacement? Signs It Is Time

You may be ready for a hip replacement when arthritis pain limits walking, sleep and daily activities, and non-surgical treatments such as therapy, medicine and injections no longer give enough relief.

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SourcesReferences used for this page3

Medically reviewed by Dr. Stride, MD against current guidance from these sources. Last reviewed October 2026. How we write and review content

Diagnosis & Evaluation

Non-Surgical Care

Injections & Orthobiologics

Hip Arthroscopy & Preservation

Hip Replacement

Fracture & Tendon Surgery

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