Hip arthroscopy performed with the patient in the supine position is an effective, reproducible procedure. Advantages include ease and simplicity of patient positioning, use of a standard fracture table, operating room layout that is user friendly, familiar joint orientation, and optimal access for all portal placements. All technical aspects of performing the procedure are detailed, including necessary equipment, patient positioning, landmarks, portal placement, and arthroscopic anatomy. Effective and safe performance of this procedure is dependent on careful attention to every detail of the operation.