Abstract Hip arthroscopy by the supine approach has proven to be an effective and reproducible procedure. Patientpositioning is easy and time-efficient. It utilizes standard operating room (OR) equipment. The OR layout is user-friendly, and the orientation is familiar to orthopedic surgeons. Additionally, there may be less concern for intra-abdominal fluid extravasation. Specialized instrumentation facilitates access to the joint. Standard portal placements allow optimal visualization and instrumentation, thus accommodating diagnostic and operative arthroscopy for a variety of conditions. Specific considerations regarding the anatomy of this region include the ball and socket architecture of the joint, the dense surrounding soft tissue envelope, and limits on distractibility. Each of these presents unique challenges to arthroscopy but are overcome by understanding and applying the basic principles necessary for successfully performing this procedure.