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Hip arthroscopy

218 citationsUpdated Oct 2026

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Overview

Hip arthroscopy has evolved rapidly from a diagnostic tool into a therapeutic modality, allowing surgeons to treat conditions that historically required large open surgeries in a minimally invasive fashion [18]. Although many indications remain undefined [3], the procedure has clear indications today, and orthopaedic surgeons interested in sports medicine should learn it [9]. The main indication for hip arthroscopy is femoroacetabular impingement (FAI) [6], with incidence increasing dramatically over the past five years, particularly for FAI and osteoarthritis [45]. Procedures increased substantially between 2005 and 2013, though approximately 20% of patients required a subsequent hip arthroscopy or total hip arthroplasty within two years, suggesting a need for further refinement of appropriate indications [36].

Successful outcomes are most dependent on patient selection, with patient expectations being a paramount criterion [189]. With proper surgical indication, both male and female patients achieve significant postoperative improvement and demonstrate comparable survival rates [39]. At mid- to long-term follow-up, patients who underwent primary hip arthroscopy demonstrated improvement in several patient-reported outcomes [5] and favorable outcomes with variable rates of secondary surgeries [13]. Athletes specifically demonstrated favorable outcomes and high rates of clinical benefit at five-year follow-up [64]. For FAI, the procedure yields significant improvements in patient outcomes within two years [50], and bilateral cases show improved modified Harris Hip Score and North American Hip Score at two years compared to baseline [48]. In older patients, outcomes can equal those in younger patients when degenerative articular cartilage changes are absent [167]. When performed in patients with appropriate indications, hip arthroscopy can lead to comparably excellent outcomes as total hip arthroplasty with significant pain relief at short-term follow-up [171].

Predictors of clinical outcomes may prove useful to clinicians in refining indications and guiding patients on expected outcomes [29]. In certain cases, the procedure is cost-effective given a long enough duration of benefit and appropriate patient selection [46]. Hip arthroscopy after hip arthroplasty is supported by a systematic review for a variety of indications [43]. The most common indications for revision hip arthroscopy include unaddressed femoroacetabular impingement and new labral tears [194], with residual impingement remaining the most common indication in the treatment of FAI [202]. Labral tears and femoroacetabular impingement are also cited as the most common indications for revision [62]. Following revision hip arthroscopy, minimum two-year follow-up thresholds for achieving significant clinical benefit have been established for multiple outcome measures [56, 58].

Anatomy & Pathophysiology

Bony Anatomy

The hip is a multiaxial joint formed by the articulation between the pelvis and femur, connecting the axial skeleton and the lower extremity [87]. The hemipelvis comprises three bones: the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [87]. The ilium is a large flat bone forming the majority of the coxal bone, with the iliac crest terminating anteriorly at the anterior superior iliac spine (ASIS) and posteriorly at the posterior superior iliac spine (PSIS) [87]. Inferior to these spines lie the anterior and posterior inferior iliac spines (AIIS and PIIS), which serve as clinically important attachment points for various muscles [87]. Directly below the PIIS, the greater sciatic notch serves as the passage for the large sciatic nerve exiting the pelvis [87]. The ischium is a small L-shaped bone forming the posteroinferior margin of the pelvis, with its thickened body, the ischial tuberosity, easily palpable posteriorly and serving as a large attachment site for multiple muscle groups [87]. The pubis consists of a body and two rami that connect superiorly to the ilium and inferiorly to the ischium to form the obturator foramen, which is covered by a strong membrane providing surface area for muscle attachments [87]. The hemipelvises unite anteriorly at the pubic symphyses and articulate posteriorly with the sacral ala to form the sacroiliac (SI) joint [87].

The acetabulum comprises an articular crescent-moon–shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [87]. It is incomplete inferiorly, forming a notch through which vital blood vessels and nerves pass to supply the joint [87]. The shape and depth of the acetabulum are formed by the appearance of ossification centers around the end of the first decade of life, with complete fusion occurring around 18 to 19 years of age [87]. The femoral head forms two-thirds of a sphere, with a small depression at its center from which the ligamentum teres extends to connect to the acetabular notch [87]. Covered with articular cartilage, the femoral head is connected to the shaft by the femoral neck [87]. The long axis of the femoral head and neck projects superomedially at an angle to that of the obliquely oriented shaft [87]. The neck-shaft angle averages 125°, which allows for greater mobility by placing the head and neck more perpendicular to the acetabulum in a neutral position [87]. Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [87]. This angular projection of the femoral head and neck in relation to the obliquely placed acetabulum allows for rotary movements at the hip and prevents impingement [87]. The greater and lesser trochanters are located at the junction of the neck and shaft, connected by the intertrochanteric line anteriorly and the intertrochanteric crest posteriorly [87].

In the adult, the mean femoral neck-shaft angle is 130° ± 7°, and the mean anteversion of the femoral neck is 10° ± 7° [95]. The proximal femur contains two prime trabecular groups: the principal tensile group and the principal compressive group, along with secondary compressive and tensile trabecular groups [95]. These trabecular bone patterns are the result of bone’s response to stress, expressed as Wolff’s law [95]. The weakest area in the femoral neck is located in the Ward triangle [95]. The calcar femorale is a medial area of dense trabecular bone that transfers stress from the femoral shaft to the inferior portion of the femoral neck [95]. Fractures of the proximal femur follow the path of least resistance, with the degree of comminution determined by the amount of energy absorbed by the bone [95]. In a standing position, the center of gravity is located at the midpoint between the two hips, and the weight of the body is supported equally by both hips [95]. The force vector acting on the hip is vertical in a standing position, and minimal muscle forces are required for balance in a symmetric stance [95]. The Y ligament of Bigelow resists hyperextension [95].

Ligaments and Soft Tissue Anatomy

The acetabular labrum is a triangular fibrocartilaginous ring attached firmly to the acetabular rim, encompassing nearly the entire acetabulum except for the most inferior aspect, which is bridged by the transverse acetabular ligament [87, 208]. This ligament serves as the continuation of the labrum, connecting the anterior and posterior lunate surfaces of the acetabulum [87]. The triangular cross-section of the labrum contributes to its ability to create a pressurized seal of the central compartment of the hip during loading [87]. Only the external one-third of the labrum contains blood vessels, leaving the majority of the structure avascular and limiting its healing ability following injury [87]. The labrum is highly innervated, with the presence of both mechanoreceptors and nociceptors [87]. The labrum deepens the acetabulum, increases coverage of the femoral head, and plays a role in shock absorption, joint lubrication, and pressure distribution [208]. Its most critical role may be the creation of a negative pressure seal with the femoral head, which aids in joint stability [208]. Labral functions also include load transmission, maintenance of vacuum seal, regulation of synovial fluid hydrodynamics, and joint lubrication [84]. Removal of the labrum leads to a shift in the femoral contact point toward the acetabular rim, a decrease in intra-articular fluid pressurization, and a loss of lateral restraint to femoral head motion [208]. Furthermore, removal of the labrum increases contact stresses between the articular cartilage of the femoral head and the acetabulum by 92% [208].

The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck [87]. The capsule enhances joint stability by preventing translation of the femoral head in the acetabulum [87]. The hip joint capsule extends anteriorly to the intertrochanteric crest but posteriorly only partially across the femoral neck [84]. Specifically, the capsule attaches anteriorly and posteriorly along the periphery of the acetabulum outside the labrum, and inferiorly to the acetabular labrum [88]. On the femur, it attaches anteriorly along the intertrochanteric crest [88]. On the posterior side, the capsule attaches only partially, such that the basicervical region of the femoral neck and the intertrochanteric region of the femur are not intracapsular [88]. The basicervical and intertrochanteric crest regions are extracapsular [84]. The iliofemoral and pubofemoral ligaments reinforce the anterior hip capsule, while the ischiofemoral ligament reinforces the posterior capsule [88].

The Y-shaped iliofemoral ligament, also known as the Y ligament of Bigelow, is the thickest and strongest of the three main ligaments supporting the hip [87]. It is considered the strongest ligament in the body [84]. The medial portion connects the anterior inferior iliac spine to the anterior intertrochanteric line, while the lateral portion originates slightly superior to the medial arm and attaches to the anterior greater trochanter [87]. It attaches the AIIS to the intertrochanteric line in an inverted Y manner [84]. The iliofemoral ligament functions to limit external rotation [87]. In isolation, the lateral arm limits extension of the joint [87]. The ligament becomes taut in full extension, preventing anterior dislocation and hyperextension of the hip [88]. It may become very contracted in severe hip arthritis and may require release at surgery to relieve an internal and flexion contracture of the hip [88].

The ischiofemoral ligament extends from the ischial margin of the acetabulum to the greater trochanter of the femur [87]. It provides support posteriorly and restricts internal rotation motion [87], providing a check to internal rotation of the hip [88]. The pubofemoral ligament extends from the obturator crest of the pubic bone to the femoral neck [87]. It attaches to the inferior and medial part of the capsule [88] and acts to limit abduction of the joint [87]. The pubofemoral ligament may cause a hip adduction contracture [88]. Deep fibers from all three ligaments merge to form the zona orbicularis, which circumvents the femoral neck [87]. The ischiofemoral and pubofemoral ligaments are weaker but provide additional stability [84]. The twisted orientation of the hip ligaments provides a screw mechanism for the hip in full extension [88]. The capsule is tight in extension and internal rotation, and relaxed in flexion and external rotation [84].

The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [88]. It arises from the apex of the cotyloid notch [84]. The ligamentum teres transmits an arterial branch of the posterior division of the obturator artery to the femoral head, which is less significant in adults [84]. The function of the ligamentum teres remains unclear [317]. The presence of arteries around the ligamentum suggests a role in providing a blood supply to the developing hip [317]. The ligamentum teres plays a biomechanical role, contributing significantly to the stabilization of the hip [317]. Its mechanism of action involves tightening in hip adduction, flexion, and external rotation [317]. Direct observation during dynamic hip arthroscopy reveals clear tightening of the ligament with the hip in 10° of flexion and external rotation [317]. Analysis of the material properties of the ligamentum teres has demonstrated similarities to other ligaments and confirms its ability to resist dislocation forces applied to the femoral head [317]. Animal studies have demonstrated significantly greater dislocation rates after surgical transection of the ligamentum teres [317].

The sacrospinous and sacrotuberous ligaments create the boundaries of the greater and lesser sciatic foramina [88]. The sacrospinous ligament creates the upper border of the lesser sciatic foramen and the lower border of the greater sciatic foramen, while the sacrotuberous ligament creates the inferior border of the lesser sciatic foramen [88]. The piriformis muscle and the sciatic nerve exit from the greater sciatic foramen, whereas the short external rotator muscles exit from the lesser sciatic foramen [88].

The hip joint is a ball-and-socket diarthrodial joint [84]. Stability of the hip is based primarily on the bony architecture [84]. The fibrocartilaginous labrum deepens the acetabulum, enhancing stability [84]. The hip joint is relatively stable not only because of the ball and socket bony anatomy but also because of the presence of various soft-tissue constraints such as the labrum, the capsule, and the ligamentum teres [102]. Acetabular hip dysplasia can contribute to hip instability because of a shallow acetabular component [102]. Hip microinstability refers to the femoral head micromotion within the acetabulum, which is a prolonged phenomenon that leads to cartilage damage and eventually osteoarthritis of the hip [102]. Motion of the femur relative to the acetabulum is the result of the absolute biomechanical force acting on the hip joint, which is affected by numerous factors including the bones (acetabulum, femur) and soft tissues (labrum, capsule, ligamentum teres, muscles) [102].

Lateral-sided hip pain is a common condition that has been reported to be as debilitating as end-stage degenerative joint disease and is now more commonly recognized as a conglomerate of conditions (snapping hip, trochanteric bursitis, and gluteal tendinopathy) lumped together as greater trochanteric pain syndrome (GTPS) [98]. In patients between 50 and 79 years of age, GTPS was found in 15% of women and 6.6% of men in one hip [98]. Lateral hip anatomy is more complex than it seems, with most people having three to four bursae surrounding the side of their hips [98]. The bursae allow improved muscle mechanics over the lateral part of the proximal femur [98]. The largest bursa is found between the gluteus maximus muscle and the gluteus medius tendon, which is located directly lateral to the greater trochanter [98]. Coupled with the bursa, the muscular sheaths and tendinous attachments of the gluteus maximus, ITB, tensor fascia lata, gluteus medius, and gluteus minimus contribute to a complex local environment that is susceptible to overuse injuries, direct trauma, and gait alterations [98]. Despite being a common diagnosis, trochanteric bursitis is often related to the other conditions of GTPS and not true inflammation of the local bursa [98].

Muscular Anatomy

The average range of motion of a normal hip that is unaffected by arthritis is approximately 120° of flexion, 30° of extension, 45° of abduction, 20° to 30° of adduction, 35° of internal rotation, and 45° of external rotation [92]. Normal gait function requires hip flexion of 30°, hyperextension of 10°, abduction and adduction of 5°, and internal and external rotation of 5° [92]. The primary hip flexor muscles are the iliopsoas, rectus femoris, and sartorius muscles [92]. The iliopsoas muscle has a large origin along the iliac crest, the iliac fossa, the sacra ala, the iliolumbar ligaments, and the sacroiliac ligaments [92]. It also has origins along the bodies of the T12 through L4 thoracic lumbar vertebra, the transverse process of the first through fifth lumbar vertebra, and the intervertebral disks [92]. The rectus femoris crosses the hip joint and the knee joint [92]. The straight head of the rectus femoris originates from the AIIS, whereas the reflected head originates from the supra-acetabular tubercle at the superior-anterior edge of the acetabulum [92]. The rectus femoris flexes the hip joint and extends the knee joint [92]. Simultaneous hip flexion and knee extension significantly shorten the rectus femoris muscle across both joints [92]. The sartorius muscle originates on the ASIS, crosses the hip and knee joints, and inserts on the medial aspect of the tibia and the pes anserine complex [92]. The tensor fasciae latae muscle originates laterally on the anterolateral edge of the iliac crest [92]. The muscle fibers of the tensor fasciae latae combine with the fasciae latae to form the iliotibial band [92]. The action of the tensor fasciae latae is to flex, abduct, and rotate the hip [92]. Other flexors of the hip muscle include the pectineus, adductor longus, adductor brevis, magnus [92].

Classification

MAHORN: The Multicenter Arthroscopic Hip Outcome Research Network (MAHORN) group was developed to elucidate and uniformly classify the definition of labral and chondral injuries of the femoral head and acetabulum, as well as ligament and capsular deformities in and about the hip [264]. The International Society of Hip Arthroscopy is working toward an international registry that will allow development of prospective studies using the same classification systems [264].

Ligamentous-Fossa-Foveolar Complex (LFFC): The modified Ligamentous-Fossa-Foveolar Complex (LFFC) grading system demonstrated satisfactory intraobserver and interobserver reliability for patients undergoing hip arthroscopy [196].

Beck: Intraoperative assessment of femoral and acetabular articular cartilage and labral tears during diagnostic hip arthroscopy is performed using the classification reported by Beck et al. [244]. In a study of patients with symptomatic labral tears secondary to femoroacetabular impingement, the Beck classification of transition zone cartilage was used to grade chondrolabral junction damage, stratifying patients into mild (grades 0 to 2) and severe (grades 3 and 4) cohorts [289]. In a study of patients undergoing hip arthroscopy for symptomatic labral tears, the Beck classification of labral damage included categories of normal, degeneration, full-thickness tear, detachment, and ossification [285]. In the same study, the Beck classification of transition zone cartilage injury included categories of normal, malacia, debonding, cleavage, and defect [285]. Grading of acetabular cartilage according to the Beck cartilage classification at the time of arthroscopy showed no statistically significant differences between groups with regard to mean score or those with a score 4 versus 3 in a study of patients with acetabular retroversion [203].

Schmaranzer: According to the tear patterns described by Schmaranzer et al., acetabular labrum tears are categorized into 5 grades from mild to severe: no lesions, partial tear, full tear, intrasubstance tear, and hypoplastic labrum [250]. A partial acetabular labral tear is defined as a hyperintense signal extending between the labral base and acetabular rim [250]. A full acetabular labral tear is defined as complete interposition of a hyperintense signal between the labral base and acetabular rim [250]. An intrasubstance acetabular labral tear is defined as a focal, hyperintense signal extending into the labral surface [250]. A hypoplastic acetabular labrum is described as a nearly absent labrum [250]. The Schmaranzer grading system for acetabular labral tears was originally validated using direct traction magnetic resonance arthrography, but its morphological criteria are not contrast-exclusive [250]. The Schmaranzer grading system has been applied to nonarthrographic 3T MRI, showing its feasibility in routine clinical settings without intra-articular contrast administration [250].

Outerbridge: The Outerbridge classification was used to grade femoral head and acetabular cartilage in a study of patients undergoing hip arthroscopy for symptomatic labral tears [285]. In a study of patients with borderline developmental dysplasia of the hips, both groups had similar distributions of acetabular labral articular disruption and Outerbridge grades [41].

Other Considerations: A systematic approach to diagnostic hip arthroscopy ensures identification of all intra-articular pathology and provides necessary intraoperative information to effectively treat the patient [8]. In a study of patients undergoing hip arthroscopy for femoroacetabular impingement, patients were classified into cohorts based on the change in labral injury grades from preoperative to postoperative MRI: unchanged, improvement, healed, and worsening [250]. The "healed" group in postoperative labral assessment is defined as a postoperative grade that is lower than the preoperative grade and equal to the first grade (no lesions) [250]. The "improvement" group in postoperative labral assessment is defined as a postoperative grade that is lower than the preoperative grade and greater than the first grade [250]. The "worsening" group in postoperative labral assessment is defined as a postoperative grade that is higher than the preoperative grade [250]. Arthroscopy-based classification of tuberculosis hip indicates that the disease process spreads from the periphery to the center [168]. In a systematic review of hips with acetabular dysplasia, significant heterogeneity was found in the reporting of disease classification and intraoperative findings [272].

Clinical Presentation

History and Symptom Onset

Patients with symptomatic femoroacetabular impingement (FAI) frequently present with activity-related groin pain exacerbated by hip flexion activities [21]. These patients often report difficulty with prolonged sitting, walking, running, or pivoting [21]. The onset of symptoms is typically insidious or follows minor trauma [21]. Mechanical symptoms secondary to labral and articular cartilage disease are common in this population [21]. When plain radiographs are within normal limits, a history of mechanical symptoms such as clicking, catching, locking, or buckling gives reasonable suspicion for an intra-articular hip problem [150]. Similarly, restricted range of motion in the setting of normal plain radiographs raises suspicion for intra-articular pathology [150].

Patients with hip microinstability often describe hip or groin pain that has increased over time [274]. They frequently report a feeling of instability or giving way in the hip during activity [274]. A thorough history is essential to differentiate between common causes of hip pain [17]. Assessing the onset, duration, and location of symptoms, along with factors that exacerbate or alleviate pain, is important to determining the cause of hip pain [270]. For many patients with hip pain, there may not be a known precipitating event, and the presentation of symptoms occurs gradually over months or years [270]. Identifying changes to activity type or training regime can help differentiate between conditions in patients with gradual onset of hip pain [270]. Documenting any family history of hip conditions is important, as certain genetic conditions such as Ehlers-Danlos syndrome can affect the hip [270].

Pain Localization

Anterior groin pain is most associated with intra-articular pathologies which may include labral tears, degenerative changes, synovial pathologies, loose bodies, and osteonecrosis [270]. Anterior groin pain can also be the result of extra-articular conditions such as hip flexor strains, iliopsoas snapping syndrome, or femoral stress fractures [270]. Pain along the lateral thigh is often associated with greater trochanteric bursitis, iliotibial band syndrome, or abductor tendon tears or tendinitis [270]. Pain in the posterior region of the hip and pelvis could be the result of muscle pathologies such as piriformis syndrome and hamstring muscle tears [270]. Posterior hip pain can often be the result of referred pain from the sacroiliac joint or low back [270].

In adolescent hip dysplasia, lateral hip pain is most often attributed to decreased hip abductor muscle strength [277]. Lateral hip pain in this population is often the initial symptom, occurring later in the day as fatigue develops [277]. Deep anterior groin pain in adolescent hip dysplasia generally indicates pain originating from the joint itself [277]. Deep groin pain can occur from joint overload, edge-loading of the acetabulum, labral irritation or injury, or labral chondral injury [277]. Deep groin pain in adolescent hip dysplasia occurs later than lateral pain, is reported to be more common, is activity-related, and improves when activity restriction is instituted [277].

Physical Examination

A comprehensive clinical examination is required to determine a differential diagnosis because many hip conditions present with similar symptoms [17]. Clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [17]. Patients with FAI will exhibit restricted hip internal rotation in 90° of flexion [21]. The impingement test (flexion, adduction, internal rotation) will elicit pain in patients with FAI, but the test is not specific for FAI [21]. Groin pain, clicking, pinching pain with sitting, lateral thigh pain, flexion abduction external rotation test, flexion–internal rotation–adduction test, and trochanteric tenderness were not useful in identifying those with greater than 50% pain reduction from an anesthetic intra-articular injection [55].

The physical examination for adolescent hip dysplasia should include observation of ambulation to assess for an antalgic gait or a subtle Trendelenburg gait [277]. The hip range of motion should be examined for restriction in motion as well as to determine relative femoral version in adolescent hip dysplasia [277]. The impingement test should be performed to determine the likelihood of true symptomatic labral pathology in adolescent hip dysplasia [277]. Persons with chronic hip joint pain exhibit reduced hip muscle strength [15]. Patients with FAI demonstrate decreased hip flexion and extension strength when compared with reference persons and their contralateral hip [15]. Hip strength deficits are common in patients presenting with unilateral symptomatic FAI and occurred most commonly in hip abduction and flexion [15]. Strength deficits in hip flexion were associated with decreased function, loss of motion, and larger labral tears in patients with FAI and labral tears [15]. Persons with FAI syndrome exhibit altered pelvifemoral coordination during weightbearing and non-weightbearing tasks [15]. Decreased hip and/or lumbopelvic mobility may contribute to altered movement patterns at the hip in persons with FAI syndrome [15].

Diagnostic Imaging and Evaluation

The AP pelvis view is used to assess acetabular anatomy, including version, acetabular coverage, and femoral head sphericity [21]. Various lateral views, most commonly the 45° Dunn view and frog-leg lateral, can be used to assess femoral head sphericity and head-neck offset [21]. MRI or magnetic resonance arthrography provides information regarding the integrity of the acetabular labrum and articular cartilage [21]. The anatomy of the proximal femur as well as the version of the acetabulum and femur may be assessed with MRI or magnetic resonance arthrography [21]. Sensitivity to acetabular rim chondral lesions is limited with MRI or magnetic resonance arthrography [21]. Low-dose CT with three-dimensional reformats is particularly useful in surgical planning of complex or borderline deformities [21]. Findings from imaging studies should complement clinical examination findings to provide the most accurate diagnosis [17].

Diagnostic arthroscopy has defined elusive causes of disabling hip pain in an athletic population including occult labral and chondral damage and rupture of the ligamentum teres [100]. Diagnostic arthroscopy is not a substitute for clinical diagnostic skills and an appropriate evaluation [97]. Arthroscopy has defined many elusive, and often treatable, causes of hip pain [97]. Having an accurate diagnosis before hip arthroscopy improves the likelihood a good outcome [19]. A diagnosis before arthroscopy is critical to improved outcome in the investigation and treatment of the painful hip resurfacing arthroplasty [34]. Successful revision hip arthroscopy requires accurate diagnosis of the cause of failure [25]. One-size-fits-all surgery is not appropriate for hip arthroscopy [25].

The Warwick Agreement defined FAI syndrome as a diagnosis related to the triad of symptoms, clinical signs, and imaging findings [15]. Chondrolabral damage was found in 80% of asymptomatic volunteers and 57% of symptomatic patients with FAI, indicating degenerative changes exist in the absence of symptoms [61]. Not all chondrolabral injury is symptomatic [61]. Progressive degenerative changes on MRI were demonstrated in young athletes after five years in those with limited internal rotation in flexion (<10°) and radiographic findings of FAI, compared with those with normal internal rotation [61]. The majority of young athletes with limited internal rotation and radiographic FAI were asymptomatic at final follow-up [61]. Cam deformities above 55° were found in only 31% of hips in asymptomatic patients with no history of prior hip pathology [61]. Abnormal femoral version (<10° or >25°) was found in 52% of symptomatic patients, with severe abnormalities in 17% [61]. The incidence of labral pathology in patients with hip dysplasia is reported to occur in two-thirds of patients [277]. The incidence of labral pathology in asymptomatic young adults is approximately 40% [277]. Acetabular cartilage lesions were found in 69% of adult hip dysplasia patients and combined labral/cartilage lesions in 59%, most commonly seen on the anterior and superolateral acetabulum [277].

Investigations

Clinical Examination: A thorough clinical examination is required to establish a differential diagnosis for hip pain, as many conditions present with similar symptoms [17]. An accurate diagnosis prior to hip arthroscopy improves the likelihood of a good outcome [19]. Successful revision hip arthroscopy requires accurate diagnosis of the cause of failure, as one-size-fits-all surgery is not appropriate for hip arthroscopy [25]. In a study of 105 subjects, groin pain, clicking, pinching pain with sitting, lateral thigh pain, flexion abduction external rotation test, flexion–internal rotation–adduction test, and trochanteric tenderness were not useful in identifying those with greater than 50% pain relief from anesthetic intra-articular injection [55].

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [33]. A complete hip series usually consists of an anterior-posterior (AP) pelvis, a centered AP hip, a lateral view (frog-leg, cross-table, Dunn 45° or 90°), and a false-profile (Lequesne) view [33]. Radiographs can diagnose fractures, developmental dysplasia of the hip (DDH), femoroacetabular impingement (FAI), and osteoarthritis [33]. Osteoarthritis of the hip can be categorized using the Kellgren-Lawrence or Tönnis classifications [33]. Radiographic and clinical severity do not necessarily correlate, particularly if the radiographs are non-weight-bearing or if false-profile views are not included [33].

The femoral head-neck junction morphology is often assessed using the alpha angle [33]. Some studies have shown that radiographs, in particular the Dunn 45° view, may be more accurate for determining the alpha angle measurement than CT or MRI [33]. The "crossover" sign on AP pelvis radiographs indicates acetabular retroversion related to lateralization of the anterior acetabular wall relative to the posterior acetabular wall [33]. Pelvic tilt or rotation may lead to false-positive and false-negative "crossover" signs on AP pelvis radiographs [33]. For neutral pelvic tilt on an AP pelvis radiograph, the sacrococcygeal joint should be between 3 and 5 cm above the superior border of the symphysis pubis [33].

Specific measurements include the Tönnis angle, defined by the angle of the acetabular sourcil and a line parallel to the transverse pelvis axis, with values between 0° and 10° considered normal [33]. The lateral center-edge angle, or center-edge angle of Wiberg, is the angle between a line from the center of the femoral head perpendicular to the transverse pelvis axis and a second line from the center of the femoral head to the superolateral most point of the acetabulum [33]. Center-edge angles of 20°–40° are considered normal, while angles from 20° to 25° are considered borderline [33]. The femoral head extrusion index is defined by the length of the femoral head that lies beyond the acetabulum as a percentage of the total horizontal width of the femoral head, with values greater than 25% considered abnormal [33]. Coxa profunda is diagnosed when the fossa line touches or is medial to the ilioischial line on AP pelvis radiographs [33].

Radiographs remain integral to the assessment of fractures and can be supplemented with CT to further investigate suspected occult fractures, define fracture morphology, and assist in preoperative planning [33]. Radiographs can serially assess hardware positioning and evaluate symptomatic hardware related to open reduction and internal fixation and total hip arthroplasty [33]. In a study of 70 patients, plain X-ray diagnosed 26 of 39 cases of chondral degeneration and 0 of 26 cases of labral tears, whereas arthroscopy diagnosed all 39 cases of chondral degeneration and all 26 cases of labral tears [54].

MRI: MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology, given its superior sensitivity and specificity [107]. The soft-tissue contrast of MRI is superior to other imaging modalities in assessing both intra-articular and extra-articular hip pathology [90]. Conventional MRI is effective at identifying osteochondral injuries, musculotendinous pathologies, and inflammation [107]. MRI provides information regarding the integrity of the acetabular labrum and articular cartilage [21]. The anatomy of the proximal femur as well as the version of the acetabulum and femur may be assessed using MRI or magnetic resonance arthrography [21].

Magnetic resonance arthrography (MRA) is more appropriate to determine injuries to the labrochondral structures and the ligamentum teres and identify the presence of loose bodies and synovial chondromatosis [107]. Direct MR arthrography is critical for evaluating intra-articular pathology such as labral tears and cartilage defects due to its superior sensitivity and accuracy compared to nonarthrogram MR [258]. However, the utility of MRA in the accurate detection and staging of articular cartilage lesions is reduced, with sensitivity reported to be less than 50% compared with arthroscopic findings [107]. Noncontrast 3T MRI and 1.5T MRA have similar accuracies for the evaluation of femoroacetabular impingement [124]. The accuracy of noncontrast 3T MRI for labral tears and acetabular cartilage lesions was 98% and 90%, respectively, when evaluated against hip arthroscopy [124].

Recent advances in MRI imaging techniques, such as delayed gadolinium-enhanced MR imaging and T2 mapping, allow for a more in-depth analysis of the structure of articular cartilage [107]. Delayed gadolinium-enhanced MR imaging and T2 mapping were effective at detecting early changes to the articular cartilage surfaces of patients with hip dysplasia and femoroacetabular impingement [107]. MRI-positive acetabular cystic changes are predictive of advanced cartilage lesions in the hip [276]. Hips with degenerative change do not perform as well following hip arthroscopy when compared with hips without degenerative change [276].

For patients aged 40 years and younger with a history, physical examination findings, and radiographs concordant with FAIS, preoperative MRI did not alter indications for primary hip arthroscopy [175]. Preoperative MRI for patients with FAIS aged 40 or under undergoing primary hip arthroscopy provides little to no actionable clinical information with respect to the labrum or cartilage [239]. Preoperative MRI may negatively impact outcomes by delaying access to care unnecessarily by at least two weeks in patients aged 40 or under with FAIS [239]. Once indicated for surgery based on history, physical examination, and radiographs, preoperative MRI did not alter the surgical plan for patients aged ≤40 years with FAIS undergoing primary hip arthroscopy [246]. Routine preoperative MRI for hip arthroscopy is unnecessary for patients with typical symptoms and findings, as it delays surgical intervention and increases costs without altering surgical decision-making [204]. Gadolinium intra-articular contrast magnetic resonance imaging is not required for every patient undergoing hip arthroscopy [205].

MRI is helpful in assessing complications of conventional and resurfacing hip arthroplasties, particularly those with metal-on-metal bearing systems [146]. Major findings that help predict histologic ALVAL scores include synovial thickening, synovitis, synovial volume, abductor disruption, and soft-tissue edema [146]. MRI is helpful in identifying femoral neck stress fracture in athletes and predicting patients that may require surgical intervention [146]. MR arthrography is useful to assist in the diagnosis and treatment of patients with ongoing or recurrent symptoms who have had prior hip arthroscopy [195]. MRA may be more helpful in identifying capsular defects in patients presenting with hip instability symptoms who have had a previous hip arthroscopy [249].

CT: CT scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [107]. Measurements of femoral head coverage and acetabular and femoral impingement can also be performed reliably using CT images [107]. CT overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology and, to some degree, assessment of soft-tissue abnormalities [90]. Combined with arthrography, CT can evaluate chondrolabral abnormalities, specifically in patients with contraindications to MRI [90].

CT is helpful in fracture evaluation, particularly in the setting of negative radiographs, or for further defining fracture morphology in patients requiring surgical reduction [90]. In cases of suspected fracture with normal or equivocal plain radiographs, CT scanning is a more accurate investigation than technetium bone scan but exposes the patient to further radiation [156]. MRI scanning is the current additional imaging modality recommended where there is uncertainty about the presence of an intracapsular fracture [156]. MRI is more accurate than CT in detecting occult hip fractures in patients with normal radiographs [156]. MRI will demonstrate soft tissue problems that may be causing hip pain in the absence of a fracture [156].

Three-dimensional CT with pelvic remodeling may be indicated for preoperative planning for reconstruction associated with dysplasia surgery, femoroacetabular impingement (FAI), posttraumatic arthritis, or other complex primary total hip arthroplasty (THA) [157]. The multiplanar and 3D capabilities of CT make it an invaluable tool for assessing bone morphology, but at higher cost and radiation dose [146]. 3D volume renderings are useful to aid in preoperative planning in FAI and subspine impingement [146]. Contrast magnetic resonance imaging plus computed tomography with 3-dimensional reconstruction are essential for patients requiring revision hip arthroscopy [205].

Ultrasonography: Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint, and to a lesser degree, within the hip joint itself [90]. Ultrasonography is particularly useful in providing real-time guidance during diagnostic and therapeutic procedures [90]. Although ultrasonography is a valuable tool to examine pediatric hip conditions, its utility in evaluating the adult hip is limited [107]. Ultrasonography can be an effective modality to identify musculotendinous disruptions, effusions associated with intra-articular pathology, or inflammatory conditions, such as bursitis [107]. Ultrasonography is also being increasingly used for targeted injections into muscles, tendons, or intra-articularly around the hip, for use with corticosteroids or biologic treatments emerging as a more recognized modality [107]. Ultrasonography allows bedside evaluation of the hip and can be used to guide interventions in the office setting [146].

Other Considerations: Many imaging modalities are available to assist with identifying causes of hip pain [17]. Imaging of the hip is continually evolving [90]. Patient-reported outcome measures and diagnostic imaging are the most frequently reported outcomes in femoroacetabular impingement syndrome studies, while measures of hip strength and range of motion are underreported [77]. Studies of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome demonstrated increased radiographic progression of hip osteoarthritis over time [52]. A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years [32]. Although the majority of participants with features of femoroacetabular impingement remained asymptomatic, those with features of femoroacetabular impingement had radiographic findings consistent with early osteoarthritis [275].

Treatment

Non-Operative

Conservative management serves as a prerequisite for surgical intervention in symptomatic femoroacetabular impingement (FAI), where hip arthroscopy is indicated when conservative treatment fails [184]. While specific conservative modalities such as weight loss, physical therapy, NSAIDs, or injections are not detailed in the provided evidence base, the failure of non-operative management is the established threshold for proceeding to arthroscopic intervention [184].

Operative

Indications: Hip arthroscopy is a standard element of the armamentarium for the diagnosis and treatment of hip pathology [1]. Current indications address pathology in the central, peripheral, and peritrochanteric compartments of the hip joint [20]. Central compartment pathology includes labral tears, loose bodies, ligamentum teres tears, chondral defects, and pincer lesions associated with FAI [20]. Peripheral compartment pathology includes cam lesions associated with FAI, capsular laxity associated with hip instability, loose bodies, and recalcitrant internal snapping hip secondary to chronic iliopsoas bursitis [20]. Peritrochanteric compartment pathology includes recalcitrant trochanteric bursitis, tears of the gluteus medius and minimus, and painful external snapping hip [20]. The procedure has evolved from a diagnostic tool to a therapeutic procedure with expanding indications for intra-articular and extra-articular hip disorders [11]. Hip arthroscopy is supported for a variety of indications after hip arthroplasty [43]. Age over 45 is not a contraindication for periacetabular osteotomy (PAO) or hip arthroscopy if articular cartilage status is normal [147].

Surgical Approach / Technique: Hip arthroscopy is performed on a traction table by carefully distracting the joint with the minimum force required, as traction injuries are known complications [267]. The vast majority of intra- and extra-articular procedures are performed using two or three common portals [267]. Fluoroscopy facilitates joint access for guidance and for proper osseous resection during acetabuloplasty or femoroplasty [267]. The anterolateral portal is typically the first portal established, using anatomic landmarks and fluoroscopy to determine the appropriate trajectory [20]. The anterior portal is typically made next, using a spinal needle for localization via an inside-out technique through the anterior triangle [20]. Remaining lateral to a line parallel to the femur extending distal from the anterior superior iliac spine minimizes the risk to the femoral neurovascular bundle [20]. The more lateral the anterior portal is, the farther away it is from the lateral femoral cutaneous nerve (LFCN) [20]. The distal anterolateral portal is typically 4 to 5 cm distal to the anterolateral portal and provides a safe trajectory for anchor placement in the acetabulum and easy access for cam resection in FAI [20]. The Dienst portal is placed a few centimeters proximal to the anterolateral portal and offers a different trajectory into the central and peripheral compartments [20]. The trochanteric space can be accessed via the anterolateral portal as well as via a posterolateral portal, which is 2 cm posterior and 2 cm distal to the greater trochanter [20]. A third portal distal to the vastus ridge insertion of the vastus lateralis provides a good viewing angle for gluteus medius and minimus repairs [20].

Technique modifications aim to mitigate iatrogenic injury. The PIPA (Percutaneous Intraarticular Peripheral Access) technique mitigates risks of iatrogenic damage to the labrum and femoral head by allowing for safer access without the need for continuous excessive distraction [284]. The air-lift technique increases the space available for portal creation and reduces the risk of chondrolabral injury when entering the hip joint [331]. The air-lift technique requires use of a dry scope technique and adds a small amount of operative time to the case [331]. The modified midanterior portal (MMAP) is a safe, surgeon-friendly portal that facilitates the performance of hip arthroscopy and offers advantages for dual-portal hip arthroscopy including extended reach [312]. Hip arthroscopy without a perineal post is described as a safer technique for hip distraction [322].

For combined procedures, combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes [178]. Current evidence is unclear as to whether hip arthroscopy is needed when performing PAO for hip dysplasia, and the chosen approach often depends on surgeon training and logistical issues [118]. Performing femoral head neck osteochondroplasty through an open arthrotomy rather than arthroscopically helps to mitigate any increased risk of complications from a prolonged arthroscopy in combined PAO cases [333]. Open surgical hip dislocation can benefit patients with complex pathology who are not candidates for hip arthroscopy, demonstrating high survivorship and improvements in patient-reported outcomes [310]. When bony deformity is excessive, difficult to access, or multiple procedures are to be performed, the surgical hip dislocation becomes the procedure of choice [267].

Capsular management is a critical operative decision. The authors recommend consistently closing the capsule during hip arthroscopy for femoroacetabular impingement, as restoring capsular integrity improves patient-reported outcomes, decreases revision rates, and potentially reduces the need for total hip arthroplasty conversion [301]. This approach facilitates the restoration of capsular integrity and hip biomechanics at the conclusion of the case [42]. Further studies are needed to better define the biomechanical properties of the capsular closure construct [31].

Pain Management: Perioperative nerve blocks provide effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques [165]. However, perioperative nerve blocks must be used with caution to decrease risk of falls [176]. Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared with general anesthesia [177, 180]. Neuraxial anesthesia is an effective alternative to general anesthesia for hip arthroscopy patients [230]. Specifically, epidural anesthesia provides superior early postoperative analgesia and reduces intraoperative opioid use in hip arthroscopic surgery for femoroacetabular impingement syndrome [231].

Peripheral nerve block for hip arthroscopy has no clinical advantage regarding pain management after surgery when compared with the group that received the local infiltration of analgesics without peripheral nerve block [198]. Quadratus lumborum blocks are an effective component of multimodal analgesia options for patients undergoing elective hip arthroscopy [186]. A pre-operative femoral nerve block is a safe procedure that may decrease the requirement for intraoperative morphine while providing effective post-operative pain control in patients undergoing hip arthroscopy [236]. Pericapsular injection is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy [162]. Lumbar plexus block is a safe, time-saving intervention that allows for efficient post-operative analgesia for patients undergoing hip arthroscopy [179].

Opioid utilization remains a concern. More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively [227]. Hip arthroscopy patients used on average less than 50% of their postoperative opioid prescription at one institution [235]. Immersive virtual reality (iVR) was associated with improved immediate pain control, decreased use of postoperative opioids, and less anxiety, serving as a useful adjunct for multimodal pain therapy in the setting of hip arthroscopy [228].

Adjuncts: Hip arthroscopy–assisted surgery significantly reduced perioperative morbidity and achieved equivalent, excellent clinical function compared with the anterior approach in the short- to mid-term for Pipkin Type I and II femoral head fractures, despite a higher rate of imperfect radiographic reductions [103].

Other Considerations: Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis [132, 133]. Hip arthroscopy for the treatment of FAI syndrome in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups [49]. In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues [59]. At a minimum 10-year follow-up, workers' compensation patients demonstrated sustained improvement and outcomes comparable to non-workers' compensation patients after primary hip arthroscopy [60]. Hip arthroscopy in the obese patient population leads to improved short- to mid-term patient-reported outcomes similar to those seen in nonobese patients [71]. Obese patients showed substantial benefit from hip arthroscopy and demonstrated a degree of improvement that was similar to that of the control non-obese group [232]. While smokers can still derive significant improvement from hip arthroscopy, their ultimate functional outcome and rate of secondary surgeries are inferior to those of nonsmokers [74]. In a large series of hip arthroscopies performed under the NHS in England, the survival of hip arthroscopy at eight years with joint replacement as the point of failure is 82% [303, 304]. Hip arthroscopy has been successfully used as a less invasive treatment option for symptomatic FAI when conservative treatment fails, providing excellent outcomes with pain relief and return to sports comparable with or better than open treatment [184].

The amount of pain relief from intra-articular anesthetic injection does not correlate with minimum 1 year clinical and functional outcomes after hip arthroscopy for FAI, even when adjusting for Tonnis grade [233]. Lack of relief after preoperative intra-articular corticosteroid injection does not rule out the potential for successful long-term outcomes after hip arthroscopy [234]. Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up [286]. Patients undergoing hip arthroscopy with minimal or no arthritis have significant short-term improvement whether the capsule is closed or left unrepaired [237].

Complications associated with hip arthroscopy occur between 1.6% and 5%, with the incidence declining due to greater understanding of causes and advancements in techniques and equipment [82]. Iatrogenic chondrolabral injury can occur while the surgeon is gaining access to the central compartment; it was the most reported complication in one systematic review [20]. Neurapraxia is a common but transient complication following hip arthroscopy, with an incidence approaching 50% in one series [20]. The LFCN is most commonly involved in neurapraxia following hip arthroscopy [20]. Permanent nerve injury following hip arthroscopy is less than 5% [20]. Pudendal neurapraxia can occur, even with short traction times, especially in stiff, prearthritic hips [20]. Traction injuries related to the post include skin and soft-tissue necrosis [20].

Inadequate resection in FAI surgery, more commonly on the femoral side, is the most common reason for revision hip preservation surgery [20]. The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement [149]. Persistent structural disease is the most common cause of repeat hip preservation surgery [16]. The leading cause of failure after hip arthroscopy is inadequate bony resection of cam (majority) or pincer deformities [267]. Excessive resection has recently been proposed as a potential reason for failure as well [267]. Hip arthroscopy has a unique set of complications that differ from those of other joints because of the steep learning curve, techniques required to access the deep, highly congruent joint through its thick soft-tissue envelope, and longer surgical times [20]. Although hip arthroscopy is a valid and widely used procedure, the surgeon requires a high level of technical skill and experience if serious complications are to be avoided [117].

The most alarming complication of hip arthroscopy is intra-abdominal or retroperitoneal fluid extravasation, which can be life-threatening in extreme cases [326]. The reported incidence of intra-abdominal or retroperitoneal fluid extravasation varies widely amongst surgeons, with one report citing an incidence of 1% [326]. Extreme cases of fluid extravasation all occurred in longer procedures, 2 hours or more [326]. Hip arthroscopy acutely following an acetabular fracture is a risk factor for fluid extravasation [326]. Post-operative dislocation and subluxation have been reported, particularly relevant in dysplastic hips with an already reduced centre-edge angle [326]. Femoral neck fracture has been reported in association with femoral cam lesion excision [326].

There are numerous definitions of the term failure of hip arthroscopy used by authors in the peer-reviewed literature [14]. About 20% of patients treated with either a subsequent hip arthroscopy or total hip arthroplasty within 2 years, suggesting the need for further refinement of appropriate indications [36]. Prior ipsilateral hip arthroscopy does not appear to compromise subsequent total hip arthroplasty in most patients [80]. Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes [307].

An individual physiotherapy treatment and rehabilitation program may augment improvements in patient-reported outcomes following arthroscopy for FAI syndrome [15]. A FAI syndrome–specific physical therapy program has the potential for a moderate to large positive effect on hip pain, function, and hip adductor strength [15]. Significant variability exists in return-to-play (RTP) protocols among institutions because of a lack of standardization [15]. Most rehabilitation protocols are not evidence based and rely on expert opinion [15]. There are both modifiable and non-modifiable pre-operative factors that have the potential to predict a return to high functional status after hip arthroscopy for FAI [191]. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown [73]. Hip manipulation under anesthesia can be a viable treatment option when post-hip arthroscopy pericapsular scarring is diagnosed [214].

Hip arthroscopy is an increasingly common procedure, with a 25-fold increase from 2006 to 2013 [27]. Hip arthroscopy procedures increased substantially between 2005 and 2013 [36]. The incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for the indication of FAI/OA [45]. Hip arthroscopy has become increasingly common worldwide with advances in understanding pathophysiology and technology [2]. Hip arthroscopy continues to evolve at a rapid rate with expansion of indications and advancement in technique, allowing surgeons to effectively treat hip conditions that historically required large open surgeries in a minimally invasive fashion [18]. Hip arthroscopy is an evolving surgical technique that has recently increased in popularity [94]. Many surgeons can perform advanced arthroscopic hip procedures, but only a few should, as most cases involve complex bony deformities requiring advanced skills and experience to treat safely and effectively [136]. The learning curve to become proficient in hip arthroscopy is steep, and joint entry is arguably one of the most difficult aspects of the procedure [300]. Originally, competency was estimated at approximately 30 cases on the basis of expert opinion from the International Society for Hip Arthroscopy Meeting in 2006 [300]. More recent evidence suggests optimal outcomes require 519 cases, with competency achieved after 388 cases [300]. Unintended cartilage injuries are occurring in approximately 73% of videos taken during arthroscopic treatment of femoroacetabular impingement [300]. Despite the growing popularity of hip arthroscopy, resident exposure to this highly technical procedure remains limited, with about a third of residents performing 2 or fewer cases upon graduation [298]. Hip arthroscopy experts agree with non-experts on most aspects of patient care, but surgical expertise is associated with the performance of advanced techniques and recommendation of a longer period of restricted weight bearing following microfractures [183]. Continued long-term follow-up and rigorous research are essential to refine surgical indications and techniques for hip preservation [308].

Complications

Overall Incidence and Reporting: Primary hip arthroscopy is generally a safe procedure with low major complication rates, reported between 0.41% and 0.58% [330, 346]. Minor complications occur in approximately 4.1% of cases [346]. However, overall complication rates have been reported as high as 6.9%, exceeding previous literature [363, 364]. In primary hip arthroscopy, 90-day adverse events are low at 1.28%, while the 5-year secondary surgery rate is 4.9% [93, 340]. Database studies indicate significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations [355]. The incidence of post-related complications is five times greater in prospective versus retrospective literature [380]. Surgeons must remain vigilant for unintended results, as complications may be more common than recognized in growing procedural volumes [359].

Nerve Injury and Neurapraxia: The lateral femoral cutaneous nerve (LFCN) is the most commonly involved nerve in neurapraxia following hip arthroscopy [20]. The sciatic and pudendal nerves are most frequently injured by traction when using a perineal post, with maximum traction weight, rather than duration, associated with sciatic nerve injury [69, 70]. The anterior portal places the LFCN, ascending branch of the lateral femoral circumflex artery, and femoral neurovascular bundle at risk [69, 70]. The anterolateral portal is associated with superior gluteal nerve injury, while the posterolateral portal places the sciatic nerve at risk, particularly with external rotation [69, 70]. Neurapraxia incidence may be markedly higher than previously reported [281]. No association was found between increased traction time and nerve injury risk in one study [281]. Patients undergoing hip arthroscopy have significantly greater nerve injury rates at 6, 12, and 24 months compared with knee cohorts, with rates of 0.21%, 0.35%, and 0.54% respectively [328]. Limiting traction time to 1 hour, with an absolute maximum of no greater than 2 hours, likely reduces neurapraxia and skin breakdown incidence [324].

Iatrogenic and Structural Injuries: Careful instrument insertion helps avoid traumatic injuries to intraarticular structures and chondral surfaces [324]. Traction injuries related to the post, including skin and soft-tissue necrosis, are substantial but avoidable [20]. Acute iatrogenic dislocation following hip impingement arthroscopic surgery has been reported [16]. Hip subluxation has been reported as a complication of arthroscopic debridement [16]. Anterior dislocation after arthroscopy in patients with capsular laxity has been reported [16]. Femoral neck fracture after arthroscopic management of femoroacetabular impingement has been reported [16]. Sequelae of FAI overresection include iatrogenic instability and femoral neck fracture [20].

Venous Thromboembolism (VTE): The incidence of symptomatic postoperative VTE following hip arthroscopy is low [245]. Thromboembolic complications do occur after elective hip arthroscopy [254]. A systematic review found a 2.0% incidence of VTE events, suggesting prophylaxis may not be necessary in low-risk patients, though the true rate may be under-reported [260]. Hip arthroscopy carries a low risk of VTE, but risk stratification based on individual factors is necessary to determine which patients require prophylaxis [316]. Obesity, smoking, and age >45 years are significant risk factors for postoperative VTE [339]. Routine thromboprophylaxis may not be indicated in all patients but can be considered based on patient-specific risk factors [354]. A patient-specific approach to VTE prevention is essential, with risk factors including oral contraceptive use, prior malignancy, and obesity [345]. Incidence of VTE is low with or without prophylaxis, but risk factors include oral contraceptive use, obesity, and malignancy [354].

Infection: The overall rate of surgical site infections is low following hip arthroscopy [375]. The risk of infection increased when preoperative intra-articular hip injections were given within 3 months of surgery [382]. Postoperative infection following intraarticular hip injection ≤3 months prior to hip arthroscopy is rare (<0.5%) and no more common than in patients who did not undergo preoperative injection [387].

Heterotopic Ossification and Other Local Complications: Heterotopic ossification occurs following hip arthroscopy; NSAIDs have been shown to reduce the incidence [69, 70]. A greater proportion of heterotopic ossification was found in the hip cohort compared with the knee cohort, with rates of 0.07% at 6 months, 0.15% at 12 months, and 0.21% at 24 months [328]. Stiffness was significantly greater in the hip cohort compared with the knee cohort, with rates of 3.24% at 6 months, 3.54% at 12 months, and 3.99% at 24 months [328]. The hip cohort exhibited significantly greater incidence of osteoarthritis compared with the knee cohort, with rates of 4.54% at 6 months, 6.79% at 12 months, and 9.94% at 24 months [328]. Incidences of avascular necrosis were greater in the hip cohort compared with the knee cohort, with rates of 0.51% at 6 months, 0.74% at 12 months, and 0.98% at 24 months [328]. Abdominal compartment syndrome after hip arthroscopy has been reported [16].

Revision and Secondary Surgery: The reoperation rate after revision hip arthroscopy is 5% within 2 years, including further arthroscopy or conversion to hip arthroplasty [352]. Overall failure rate was 9.6%, with 3.7% requiring revision hip arthroscopy and 5.9% converting to THA [365]. The rate of total hip arthroplasty after hip arthroscopy was 9.3% at 2 years [374]. Patients undergoing revision hip arthroscopy achieve inferior functional outcomes, reflected in patient reported outcome measures and PASS achievement rates, compared to the primary setting [65]. Second-time revision hip arthroscopy results in clinically significant improvement in patient-reported outcomes; however, outcomes for repeat revision cases are similar to first-time revision cases but inferior to those obtained following primary surgeries [334]. The likelihood of requiring a subsequent hip arthroscopy was 4.83 times higher for the revision group compared with the primary group in adolescents [358]. Capsular repair is associated with lower revision rates yet similar clinical outcomes and arthroplasty conversion 5 years after hip arthroscopy [378]. Routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules [353]. Patients with unhealed or partially healed anterior capsules after hip arthroscopy for borderline developmental dysplasia of the hips have inferior patient-reported outcome measures [41].

Surgeon Experience and Learning Curve: There is a substantial learning curve for hip arthroscopy, and receiving specialized training likely helps reduce the duration of this curve [324]. The nature of complications changed with experience, but no significant variation in incidence was observed over a 9-year period [344]. Complication rates and revision arthroscopy did not differ significantly, whereas conversion to total hip arthroplasty was lower in late cases (odds ratio [OR] 0.10) [360]. Resident involvement in hip arthroscopy procedures was not a risk factor for 30-day complications between 2006 and 2012 [386].

Recovery

Light activity (weeks): Patients may return to driving as early as 2 weeks after a right-sided hip arthroscopy procedure [153], with driving performance comparable to individuals with normal hips and braking parameters normalizing to the preoperative state at 1 week after simple arthroscopy and 2 weeks after femoroacetabular impingement surgery [193]. Return to driving is likely safe as early as 2 to 4 weeks after right-sided hip arthroscopy, and 2 weeks after a left-sided procedure, as driving performance returns to the preoperative level [83]. It would be safe to recommend a return to driving at 4 weeks after hip arthroscopic procedures [116].

Full activity (months): The overall rate of reported return to play was high after hip arthroscopy for femoroacetabular impingement [221]. Hip arthroscopy yields a high rate of return to sport, in addition to marked improvement in pain and function in the majority of patients [229]. Athletes returned to sport at a high rate (92%; 46/50) after hip arthroscopy and perform activities at near preinjury levels [207]. Reported return-to-sport rates for elite athletes undergoing hip arthroscopy were high [210]. Primary hip arthroscopy results in favorable midterm outcomes in high-level athletes [222]. Master athletes demonstrated favorable outcomes after primary hip arthroscopy [292]. Master athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome achieve comparable patient-reported outcomes, achievement of clinically significant outcomes, and reoperation-free time-dependent survivorship to nonmaster athletes at long-term follow-up [318]. Professional athletes with borderline hip dysplasia who underwent hip arthroscopy for femoroacetabular impingement demonstrated a 79% return-to-sport rate in the primary setting [325]. High-level athletes with borderline hip dysplasia undergoing primary hip arthroscopy may expect favorable midterm outcomes and high return to sport rates [336]. Both female and male athletes undergoing primary hip arthroscopy with labral reconstruction had significant improvements in all patient-reported outcomes at the minimum 2-year follow-up, high return-to-sport rates, and similar rates of achieving the minimal clinically important difference and patient acceptable symptom state [337]. High-level athletes who undergo staged bilateral primary hip arthroscopy for femoroacetabular impingement syndrome may expect favorable patient-reported outcomes and return-to-sport rates at minimum 2-year follow-up [341]. Athletes undergoing staged bilateral hip arthroscopy showed favorable return to sports rates, continuation of sports and patient-reported outcomes at minimum 5-year follow-up [319]. Professional athletes who underwent hip arthroscopy with microfracture procedure were able to return to the same high level of competition after surgery at a high rate [342]. Competitive athletes undergoing primary hip arthroscopy with symptoms for less than 1 year demonstrated superior 2-year patient-reported outcomes compared to a propensity-matched control group with symptoms for over 1 year, but the rates achieving minimal clinically important difference and return to sport were similar between groups [343]. Hip arthroscopy has a high success rate and allows elite athletes to return to play, but timing of intervention is critical as outcomes are driven by the extent of hip pathology at the time of surgery [51]. Orthopaedic surgeons should warn athletes of the potential long-term detrimental effects of returning to high-impact sports following hip arthroscopy, yet they should also support athletes as they return to play after overcoming injury [215]. Using more precise return-to-sport definitions that evaluate continued participation and integrate level of competition with sport- and sex-specific considerations are essential to better define long-term success following hip arthroscopy in athletes [329].

Complete recovery / outcome plateau (months): At mid- to long-term follow-up, patients who underwent primary hip arthroscopy demonstrated improvement in several patient-reported outcomes [5]. Hip arthroscopy for femoroacetabular impingement results in increased patient-reported outcome measures at interval follow-up, with most patients reaching critical thresholds of minimal and satisfactory clinical improvement [362]. Early improvements in patient-reported outcome measures following hip arthroscopy, assessed by 6-month minimal clinically important difference, predicted clinically meaningful outcomes at 5-year follow-up [379]. The risk for secondary procedures after primary hip arthroscopy may be evaluated with the modified Harris Hip Score at 1 year [63].

Rehabilitation protocol: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome returned to baseline levels in step count, step length, and walking speed after phase 1 (6 weeks) of rehabilitation [154]. Patients following a comprehensive five-phase rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes [159]. Rehabilitation after hip arthroscopy should be tailored to the specific functional demands of the patient, with exercise progressions monitored closely to prevent complications such as persistent soft tissue irritation [163]. For patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement, formal physical therapy and home exercise programs are similarly efficacious in terms of patient-reported outcomes of hip function, with both rehabilitation options resulting in significant patient improvement at short term follow-up from their preoperative baseline [166]. The current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a specific protocol [225]. There is considerable variability in postoperative physical therapy protocols available online for hip arthroscopy for femoroacetabular impingement, including postoperative restrictions, rehabilitation activities, and time points for activities [201].

Functional milestones: After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery [187]. Patients with workers' compensation claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up [172].

Other Considerations: Patients undergoing revision hip arthroscopy achieve inferior functional outcomes, reflected in patient reported outcome measures and patient acceptable symptomatic state achievement rates, compared to the primary setting [65]. The current evidence supports revision hip arthroscopy as a successful intervention to improve functional outcomes and relieve pain in patients with residual symptoms after primary femoroacetabular impingement surgery, although outcomes are inferior compared with primary hip arthroscopy [226]. Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients [369]. Former smokers who underwent primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up [209]. At 1-year follow-up, there were no differences in patient-reported outcomes in young active patients undergoing hip arthroscopy with labral repair versus labral augmentation [224]. Simultaneous bilateral hip arthroscopy is a viable option for select patients and experienced surgical teams, enabling potentially expedited recovery and return to work or sport with inherent cost savings [169]. Staged bilateral hip arthroscopy is not a compromise in care and offers advantages in managing patient expectations and adapting surgical strategies based on the response to the initial surgery [218].

Key Evidence

• [L5] Hip arthroscopy has become a standard element of the armamentarium for the diagnosis and treatment of hip pathology, offering an option for many patients who would have previously been forced to live with their symptoms. [1] (10.5435/00124635-200607000-00006)
• [L5] Hip arthroscopy has become increasingly common worldwide with advances in understanding pathophysiology and technology. [2] (10.1136/jisakos-2015-000004)
• [L5] Hip arthroscopy has gained interest as a diagnostic and therapeutic tool, though many indications remain undefined. [3] (10.1016/j.csm.2005.12.003)
• [L4] At mid- to long-term follow-up, patients who underwent primary hip arthroscopy demonstrated improvement in several PROs. [5] (10.1016/j.arthro.2020.10.001)
• [L4] The main indication for hip arthroscopy today is FAI. [6] (10.1177/2325967114s00133)
• [Paper] A systematic approach to diagnostic hip arthroscopy ensures identification of all intra-articular pathology and provides necessary intraoperative information to effectively treat the patient. [8] (10.1016/j.eats.2017.01.013)
• [L5] Hip arthroscopy has clear indications for its use today, and orthopaedic surgeons interested in sports medicine should learn it. [9] (10.1007/s00167-006-0145-3)
• [L5] Hip arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanding indications for intra-articular and extra-articular hip disorders. [11] (10.1016/j.csm.2016.02.001)
• [L4] At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. [13] (10.1016/j.arthro.2022.10.040)
• [L1] There are numerous definitions of the term failure of hip arthroscopy used by authors in the peer-reviewed literature. [14] (10.1016/j.asmr.2024.100962)
• [L5] Hip arthroscopy continues to evolve at a rapid rate with expansion of indications and advancement in technique, allowing surgeons to effectively treat hip conditions that historically required large open surgeries in a minimally invasive fashion with promising results. [18] (10.1016/j.csm.2016.04.001)
• [L4] Having an accurate diagnosis before hip arthroscopy improves the likelihood a good outcome. [19] (10.1016/j.arthro.2015.08.029)
• [L5] Successful revision hip arthroscopy requires accurate diagnosis of the cause of failure, as one-size-fits-all surgery is not appropriate for hip arthroscopy. [25] (10.1016/j.arthro.2022.03.034)
• [L3] Hip arthroscopy is an increasingly common procedure, with a 25-fold increase from 2006 to 2013. [27] (10.1016/j.arthro.2016.01.042)
• [L3] These may prove useful to clinicians in refining indications and guiding patients on expected outcomes of hip arthroscopy. [29] (10.1177/03635465241254076)
• [Paper] Further studies are needed to better define the biomechanical properties of the capsular closure construct. [31] (10.1016/j.eats.2016.04.024)
• [L3] A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years. [32] (10.1186/s12891-019-2646-5)
• [L5] Whereas hip arthroscopy plays a role in the investigation and treatment of the painful hip resurfacing arthroplasty, a diagnosis before arthroscopy is critical to improved outcome. [34] (10.1016/j.arthro.2015.12.039)
• [L3] Hip arthroscopy procedures increased substantially between 2005 and 2013, with about 20% of patients treated with either a subsequent hip arthroscopy or total hip arthroplasty within 2 years, suggesting the need for further refinement of appropriate indications. [36] (10.1016/j.arth.2016.09.004)
• [L4] With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. [39] (10.1016/j.arthro.2024.12.031)
• [L3] [41] (10.1016/j.arthro.2023.01.024)
• [L5] This approach facilitates the restoration of capsular integrity and hip biomechanics at the conclusion of the case. [42] (10.1016/j.eats.2023.102893)
• [L4] Hip arthroscopy after hip arthroplasty is supported by this systematic review for a variety of indications. [43] (10.1007/s00167-014-3379-5)
• [L3] The incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for the indication of FAI/OA. [45] (10.1016/j.arth.2013.02.039)
• [L3] In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. [46] (10.1177/2325967120987538)
• [L3] Bilateral hip arthroscopy for the indication of FAI has improved mHHS and NAHS at 2 years of follow up compared to baseline. [48] (10.1016/j.arthro.2020.02.025)
• [L3] Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. [49] (10.1177/0363546519885359)
• [L4] Hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery. [50] (10.1177/0363546518795696)
• [L5] Hip arthroscopy has a high success rate and allows elite athletes to return to play, but timing of intervention is critical as outcomes are driven by the extent of hip pathology at the time of surgery. [51] (10.1016/j.arthro.2019.01.001)
• [L4] Studies of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome demonstrated increased radiographic progression of hip osteoarthritis over time. [52] (10.1177/23259671251326116)
• [L3] [54] (10.1007/s00264-004-0585-7)
• [L3] [55] (10.1016/j.arthro.2008.04.075)
• [L3] Following revision hip arthroscopy, the minimum 2-year follow-up thresholds for achieving the significant clinical benefit were established for multiple outcome measures. [56] (10.1016/j.arthro.2024.11.015)
• [L3] Following revision hip arthroscopy, the minimum 2-year follow-up thresholds for achieving the clinically significant benefit were established for multiple outcome measures. [58] (10.1016/j.arthro.2024.11.014)
• [L3] In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues. [59] (10.1177/2325967115s00083)
• [L3] At a minimum 10-year follow-up, WC patients demonstrated sustained improvement and outcomes comparable to non-WC patients after primary hip arthroscopy. [60] (10.1177/03635465261449801)
• [L1] The most common indications for revision hip arthroscopy were labral tears and femoroacetabular impingement. [62] (10.1016/j.arthro.2020.02.028)
• [L3] The risk for secondary procedures may be evaluated with mHHS at 1 year after primary hip arthroscopy. [63] (10.1177/0363546520974374)
• [L4] Athletes who underwent primary hip arthroscopy demonstrated favorable outcomes and high rates of clinical benefit at 5-year follow-up. [64] (10.1016/j.arthro.2022.11.008)
• [L2] Patients undergoing revision hip arthroscopy achieve inferior functional outcomes, reflected in patient reported outcome measures and PASS achievement rates, compared to the primary setting. [65] (10.1016/j.arthro.2025.07.014)
• [L4] Hip arthroscopy in the obese patient population leads to improved short- to mid-term patient-reported outcomes similar to those seen in nonobese patients. [71] (10.1016/j.arthro.2014.07.013)
• [L1] There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. [73] (10.1177/0363546520956292)
• [L3] While smokers can still derive significant improvement from hip arthroscopy, their ultimate functional outcome and rate of secondary surgeries are inferior to those of nonsmokers. [74] (10.1177/23259671221075642)
• [L4] Patient-reported outcome measures and diagnostic imaging are the most frequently reported outcomes, while measures of hip strength and range of motion are underreported, and current surgical outcomes are limited to mid-term follow-up time frames with inconsistent reporting. [77] (10.1016/j.arthro.2017.11.037)
• [L3] Prior ipsilateral hip arthroscopy does not appear to compromise subsequent THA in most patients. [80] (10.1186/s12891-026-10094-7)
• [L4] Complications associated with hip arthroscopy occur between 1.6% and 5%, with the incidence declining due to greater understanding of causes and advancements in techniques and equipment. [82] (10.1016/s0278-5919(05)70288-x)
• [L3] Return to driving is likely safe as early as 2 to 4 weeks after right-sided hip arthroscopy, and 2 weeks after a left-sided procedure, as driving performance returns to the preoperative level. [83] (10.1177/23259671221128281)
• [L4] In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the 5-year secondary surgery rate was 4.9%. [93] (10.1016/j.arthro.2023.01.100)
• [L4] Hip arthroscopy is an evolving surgical technique that has recently increased in popularity. [94] (10.1302/2058-5241.2.150041)
• [L5] [97] (10.1016/s0278-5919(05)70280-5)
• [L4] Diagnostic arthroscopy has defined elusive causes of disabling hip pain in an athletic population including occult labral and chondral damage and rupture of the ligamentum teres. [100] (10.1016/s0278-5919(05)70282-9)
• [L3] Hip arthroscopy–assisted surgery significantly reduced perioperative morbidity and achieved equivalent, excellent clinical function compared with the anterior approach in the short- to mid-term, despite a higher rate of imperfect radiographic reductions. [103] (10.1016/j.injury.2026.113177)
• [L1] On the basis of these results, it would be safe to recommend a return to driving at 6 weeks after knee arthroscopic procedures and 4 weeks after hip arthroscopic procedures. [116] (10.1016/j.asmr.2021.08.015)
• [L4] Although hip arthroscopy is a valid and widely used procedure, the surgeon requires a high level of technical skill and experience if serious complications are to be avoided. [117] (10.1016/j.arthro.2011.02.012)
• [L5] Current evidence is unclear as to whether hip arthroscopy is needed when performing PAO for hip dysplasia, and the chosen approach often depends on surgeon training and logistical issues; further studies are needed to determine the optimal surgical approach. [118] (10.1016/j.arthro.2024.08.007)
• [L3] Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. [132] (10.1177/03635465241232154)
• [L3] Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. [133] (10.1177/2325967124s00058)
• [L5] Many surgeons can perform advanced arthroscopic hip procedures, but only a few should, as most cases involve complex bony deformities requiring advanced skills and experience to treat safely and effectively. [136] (10.1016/j.arthro.2009.04.069)
• [L5] Age over 45 is not a contraindication for PAO/hip arthroscopy if articular cartilage status is normal. [147] (10.1016/j.arthro.2024.11.074)
• [L4] The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement. [149] (10.1177/03635465251381775)
• [L5] [150] (10.1097/01.blo.0000195057.27653.93)
• [L4] This study's findings suggest that patients may return to driving 2 weeks postoperatively from a right sided hip arthroscopy procedure. [153] (10.1016/j.arthro.2017.08.185)
• [L4] Patients undergoing hip arthroscopy for FAIS returned to baseline levels in step count, step length, and walking speed after phase 1 (6 weeks) of rehabilitation. [154] (10.1016/j.asmr.2023.100779)
• [L4] Patients following this rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes, validating its implementation. [159] (10.1007/s00167-013-2664-z)
• [L1] It is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy. [162] (10.1177/0363546520943580)
• [Paper] Rehabilitation after hip arthroscopy should be tailored to the specific functional demands of the patient, with exercise progressions monitored closely to prevent complications such as persistent soft tissue irritation. [163] (10.1016/j.csm.2016.02.012)
• [L1] The use of perioperative nerve blocks provides effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques. [165] (10.1016/j.arthro.2015.12.022)
• [L3] For patients undergoing hip arthroscopy for the treatment of FAI, formal physical therapy and home exercise programs are similarly efficacious in terms of patient-reported outcomes of hip function, with both rehabilitation options resulting in significant patient improvement at short term follow-up from their preoperative baseline. [166] (10.1177/2325967123s00091)
• [L5] Hip arthroscopy outcomes in older patients can equal outcomes in younger patients with proper surgical indications, specifically in the absence of degenerative articular cartilage changes. [167] (10.1016/j.arthro.2023.03.006)
• [L4] Arthroscopy-based classification of tuberculosis hip indicates that the disease process spreads from the periphery to the center. [168] (10.1016/j.arthro.2013.09.042)
• [Paper] Simultaneous bilateral hip arthroscopy is a viable option for select patients and experienced surgical teams, enabling potentially expedited recovery and return to work or sport with inherent cost savings. [169] (10.1016/j.eats.2017.03.002)
• [L3] Our results show that hip arthroscopy, when performed in patients with the appropriate indications, can lead to comparably excellent outcomes as total hip arthroplasty with significant pain relief at short term follow-up. [171] (10.1016/j.asmr.2022.06.013)
• [L3] Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. [172] (10.1177/03635465221078620)
• [L3] Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged 40 years and younger with a history, physical examination findings, and radiographs concordant with FAIS. [175] (10.1177/23259671221144776)
• [L2] Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. [176] (10.1177/0363546517734518)
• [L3] Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared with general anesthesia. [177] (10.1016/j.arthro.2020.08.032)
• [L4] Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. [178] (10.1177/2325967117s00015)
• [L1] It is a safe, time-saving intervention that allows for efficient post-operative analgesia for patients undergoing hip arthroscopy. [179] (10.1177/2325967120s00350)
• [L3] Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia. [180] (10.1177/2325967121s00032)
• [L5] Hip arthroscopy experts agree with non-experts on most aspects of patient care, but surgical expertise is associated with the performance of advanced techniques and recommendation of a longer period of restricted weight bearing following microfractures. [183] (10.1007/s00167-018-5289-4)
• [L5] Hip arthroscopy has been successfully used as a less invasive treatment option for symptomatic FAI when conservative treatment fails, providing excellent outcomes with pain relief and return to sports comparable with or better than open treatment. [184] (10.1302/2058-5241.3.170041)
• [L1] Our findings support the growing evidence that quadratus lumborum blocks are an effective component of multimodal analgesia options for patients undergoing elective hip arthroscopy. [186] (10.1016/j.arthro.2021.07.029)
• [L4] After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. [187] (10.1177/03635465211064271)
• [L5] Successful hip arthroscopy is most dependent on patient selection, with patient expectations being a paramount criterion. [189] (10.1016/j.arthro.2019.02.011)
• [L3] There are both modifiable and non-modifiable pre-operative factors that have the potential to predict a return to high functional status after hip arthroscopy for FAI. [191] (10.1177/2325967118s00070)
• [L3] Driving performance of patients who underwent right hip arthroscopy is comparable to that of individuals with normal hips, and braking parameters normalize to the preoperative state at 1 week after simple arthroscopy and 2 weeks after FAI surgery. [193] (10.1186/s12891-020-03662-y)
• [L1] The most common indications for revision hip arthroscopy include unaddressed femoroacetabular impingement and new labral tears. [194] (10.1016/j.arthro.2025.07.024)
• [L3] Our study showed the utility of MR arthrography to assist in the diagnosis and treatment of patients with ongoing or recurrent symptoms who have had prior hip arthroscopy. [195] (10.1007/s11999-013-3202-5)
• [L3] The modified LFFC grading system demonstrated satisfactory intraobserver and interobserver reliability for patients undergoing hip arthroscopy. [196] (10.1177/23259671251340986)
• [L1] Peripheral nerve block for hip arthroscopy has no clinical advantage regarding pain management after surgery when compared with the group that received the local infiltration of analgesics without peripheral nerve block. [198] (10.1016/j.arthro.2021.12.011)
• [L4] There is considerable variability in postoperative physical therapy protocols available online for hip arthroscopy for FAI, including postoperative restrictions, rehabilitation activities, and time points for activities. [201] (10.1016/j.arthro.2017.06.045)
• [L4] The most common indication for revision hip arthroscopy in the treatment of FAI remains residual impingement. [202] (10.1177/2325967121s00279)
• [L3] [203] (10.1177/2325967117737479)
• [L5] The author argues that routine preoperative MRI for hip arthroscopy is unnecessary for patients with typical symptoms and findings, as it delays surgical intervention and increases costs without altering surgical decision-making. [204] (10.1016/j.arthro.2022.04.009)
• [L5] Gadolinium intra-articular contrast magnetic resonance imaging is not required for every patient undergoing hip arthroscopy, but contrast magnetic resonance imaging plus computed tomography with 3-dimensional reconstruction are essential for patients requiring revision. [205] (10.1016/j.arthro.2022.12.008)
• [L4] Athletes returned to sport at a high rate (92%; 46/50) after hip arthroscopy and perform activities at near preinjury levels. [207] (10.1016/j.arthro.2017.03.011)
• [L3] Former smokers who underwent primary hip arthroscopy for FAIS demonstrated significant improvement in PROs at minimum 2-year follow-up. [209] (10.1177/23259671221097372)
• [L4] Reported return-to-sport rates for elite athletes undergoing hip arthroscopy were high. [210] (10.1002/arj.70165)
• [L4] When diagnosed, hip manipulation under anesthesia can be a viable treatment option. [214] (10.1016/j.eats.2023.02.036)
• [L5] Orthopaedic surgeons should warn athletes of the potential long-term detrimental effects of returning to high-impact sports following hip arthroscopy, yet they should also support athletes as they return to play after overcoming injury. [215] (10.1016/j.arthro.2019.01.007)
• [L5] Staged bilateral hip arthroscopy is not a compromise in care and offers advantages in managing patient expectations and adapting surgical strategies based on the response to the initial surgery. [218] (10.1002/arj.70099)
• [L4] The overall rate of reported return to play was high after hip arthroscopy for FAI. [221] (10.1177/03635465211038959)
• [L3] Primary hip arthroscopy results in favorable midterm outcomes in high-level athletes. [222] (10.1177/03635465211041763)
• [L3] At 1-year follow-up, there were no differences in patient-reported outcomes in young active patients undergoing hip arthroscopy with LR versus LA. [224] (10.1016/j.asmr.2025.101175)
• [L2] The current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a specific protocol. [225] (10.3389/fsurg.2015.00021)
• [L1] The current evidence supports revision hip arthroscopy as a successful intervention to improve functional outcomes and relieve pain in patients with residual symptoms after primary FAI surgery, although outcomes are inferior compared with primary hip arthroscopy. [226] (10.1016/j.arthro.2015.03.039)
• [L3] More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively. [227] (10.1016/j.arthro.2018.03.016)
• [L3] iVR was associated with improved immediate pain control, decreased use of postoperative opioids, and less anxiety. iVR served as a useful adjunct for multimodal pain therapy the setting of hip arthroscopy. [228] (10.1016/j.jisako.2025.100472)
• [L1] Hip arthroscopy yields a high rate of return to sport, in addition to marked improvement in pain and function in the majority of patients. [229] (10.1007/s00167-018-4929-z)
• [L3] Neuraxial anesthesia is thus an effective alternative to general anesthesia for hip arthroscopy patients. [230] (10.1002/arj.70603)
• [L3] Epidural anesthesia provides superior early postoperative analgesia and reduces intraoperative opioid use in hip arthroscopic surgery for femoroacetabular impingement syndrome. [231] (10.1016/j.jisako.2026.101207)
• [L3] However, obese patients showed substantial benefit from hip arthroscopy and demonstrated a degree of improvement that was similar to that of the control non-obese group. [232] (10.2106/jbjs.n.00625)
• [L3] The amount of pain relief from intra-articular anesthetic injection does not correlate with minimum 1 year clinical and functional outcomes after hip arthroscopy for FAI, even when adjusting for Tonnis grade. [233] (10.1177/2325967114s00091)
• [L2] Lack of relief after injection does not rule out the potential for successful long-term outcomes after hip arthroscopy. [234] (10.1016/j.arthro.2025.07.013)
• [L4] Hip arthroscopy patients used on average less than 50% of their postoperative opioid prescription at our institution. [235] (10.1016/j.arthro.2025.04.040)
• [L3] A pre-operative femoral nerve block is a safe procedure that may decrease the requirement for intraoperative morphine while providing effective post-operative pain control in patients undergoing hip arthroscopy. [236] (10.1177/2325967113s00058)
• [L3] Patients undergoing hip arthroscopy with minimal or no arthritis have significant short-term improvement whether the capsule is closed or left unrepaired. [237] (10.1016/j.arthro.2017.10.019)
• [L3] Preoperative MRI for patients with FAIS aged 40 or under undergoing primary hip arthroscopy provides little to no actionable clinical information with respect to the labrum or cartilage and may negatively impact outcomes by delaying access to care unnecessarily by at least two weeks. [239] (10.1177/2325967121s00609)
• [L3] [244] (10.1177/2325967118778785)
• [L3] The incidence of symptomatic postoperative VTE following hip arthroscopy is low. [245] (10.1016/j.arthro.2019.03.054)
• [L3] Once indicated for surgery based on history, physical examination, and radiographs, preoperative MRI did not alter the surgical plan for patients aged ≤40 years with FAIS undergoing primary hip arthroscopy. [246] (10.1016/j.arthro.2022.03.025)
• [L4] MRA may be more helpful in identifying capsular defects in patients presenting with hip instability symptoms who have had a previous hip arthroscopy. [249] (10.1016/j.asmr.2021.11.005)
• [L3] [250] (10.1002/arj.70611)
• [L4] Thromboembolic complications do occur after elective hip arthroscopy. [254] (10.1007/s00167-010-1392-x)
• [Paper] Radiography remains the primary screening tool for hip pain, while direct MR arthrography is critical for evaluating intra-articular pathology such as labral tears and cartilage defects due to its superior sensitivity and accuracy compared to nonarthrogram MR. [258] (10.1016/j.csm.2005.12.009)
• [L4] The low incidence of VTE events found in this review (2.0%) suggests that prophylaxis may not be necessary in low-risk patients undergoing hip arthroscopy; however, the true rate may be under-reported. [260] (10.1016/j.arthro.2017.07.006)
• [L5] [264] (10.1016/j.csm.2010.12.001)
• [L4] [272] (10.1016/j.arthro.2018.07.048)
• [L2] Although the majority of these participants remained asymptomatic, those with features of femoroacetabular impingement had radiographic findings consistent with early osteoarthritis. [275] (10.1177/0363546517719460)
• [L5] The authors state that MRI-positive acetabular cystic changes are predictive of advanced cartilage lesions in the hip and that hips with degenerative change do not perform as well following hip arthroscopy when compared with hips without degenerative change. [276] (10.1177/0363546516639252)
• [L4] [281] (10.5435/jaaos-d-17-00230)
• [L5] [284] (10.1016/j.eats.2024.103232)
• [L3] [285] (10.1177/03635465241234258)
• [L3] Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up. [286] (10.1177/03635465261421538)
• [L3] [289] (10.1177/03635465241255950)
• [L3] Master athletes demonstrated favorable outcomes after primary hip arthroscopy. [292] (10.1177/03635465221096843)
• [L4] [298] (10.1016/j.asmr.2022.04.016)
• [L5] [300] (10.1016/j.eats.2025.103524)
• [L5] The authors recommend consistently closing the capsule during hip arthroscopy for femoroacetabular impingement, as restoring capsular integrity improves patient-reported outcomes, decreases revision rates, and potentially reduces the need for total hip arthroplasty conversion. [301] (10.1016/j.eats.2024.103222)
• [L3] In a large series of hip arthroscopies performed under the NHS in England we have demonstrated that the survival of hip arthroscopy at eight years with joint replacement as the point of failure is 82%. [303] (10.1016/j.arthro.2013.09.017)
• [L3] In a large series of hip arthroscopies performed under the NHS in England we have demonstrated that the survival of hip arthroscopy at eight years with joint replacement as the point of failure is 82%. [304] (10.1016/j.arthro.2013.09.015)
• [L3] Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes. [307] (10.1016/j.arth.2018.01.012)
• [L5] Continued long-term follow-up and rigorous research are essential to refine surgical indications and techniques for hip preservation. [308] (10.1177/03635465241290992)
• [L4] Open surgical hip dislocation can benefit patients with complex pathology who are not candidates for hip arthroscopy, demonstrating high survivorship and improvements in patient-reported outcomes. [310] (10.1097/corr.0000000000003118)
• [Paper] [312] (10.1016/j.eats.2014.05.005)
• [L5] Hip arthroscopy has a low risk of venous thromboembolism, but risk stratification based on individual factors is necessary to determine which patients require prophylaxis. [316] (10.1016/j.arthro.2019.05.016)
• [L5] [317] (10.1177/03635465030310060701)
• [L3] Master athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome achieve comparable patient-reported outcomes, achievement of clinically significant outcomes, and reoperation-free time-dependent survivorship to nonmaster athletes at long-term follow-up. [318] (10.1177/03635465251395219)
• [L3] Athletes undergoing staged bilateral hip arthroscopy showed favorable return to sports rates, continuation of sports and PROs at minimum 5-year follow-up. [319] (10.1002/arj.70385)
• [L4] [322] (10.1016/j.arthro.2006.07.012)
• [L4] [324] (10.1016/j.csm.2016.02.011)
• [L3] In the primary setting, professional athletes with borderline hip dysplasia who underwent hip arthroscopy for FAI demonstrated a 79% return-to-sport rate. [325] (10.1177/03635465261439048)
• [L4] [326] (10.1016/j.otsr.2010.09.010)
• [L3] [328] (10.1177/23259671221131059)
• [L5] Using more precise return-to-sport definitions that evaluate continued participation and integrate level of competition with sport- and sex-specific considerations are essential to better define long-term success following hip arthroscopy in athletes. [329] (10.1002/arj.70217)
• [L4] The rate of major complications was 0.58% after hip arthroscopy. [330] (10.1016/j.arthro.2012.11.003)
• [L5] [331] (10.1016/j.eats.2023.09.014)
• [L4] [333] (10.1097/corr.0000000000001599)
• [L3] Second-time revision hip arthroscopy results in clinically significant improvement in patient-reported outcomes; however, outcomes for repeat revision cases are similar to first-time revision cases but inferior to those obtained following primary surgeries. [334] (10.1016/j.arthro.2021.04.031)
• [L3] High-level athletes with borderline hip dysplasia undergoing primary hip arthroscopy may expect favorable midterm outcomes and high return to sport rates. [336] (10.1016/j.arthro.2022.08.023)
• [L3] Despite different clinical characteristics and surgical procedures, both female and male athletes undergoing primary hip arthroscopy with labral reconstruction had significant improvements in all PROs at the minimum 2-year follow-up, high RTS rates, and similar rates of achieving the minimal clinically important difference and patient acceptable symptom state. [337] (10.1177/23259671221100861)
• [L1] Obesity, smoking, and age >45 years are found to be significant risk factors for postoperative VTE after hip arthroscopy. [339] (10.1186/s13018-025-05536-2)
• [L3] In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the five-year secondary surgery rate was 4.9%. [340] (10.1016/j.jisako.2023.03.064)
• [L3] High-level athletes who undergo staged bilateral primary hip arthroscopy for femoroacetabular impingement syndrome may expect favorable PROs and RTS rates at minimum 2-year follow-up. [341] (10.1177/03635465211043491)
• [L3] Professional athletes who underwent hip arthroscopy with microfracture procedure were able to return to the same high level of competition after surgery at a high rate. [342] (10.1016/j.arthro.2012.08.028)
• [L3] Competitive athletes undergoing primary hip arthroscopy with symptoms for less than 1 year demonstrated superior 2-year patient-reported outcomes compared to a propensity-matched control group with symptoms for over 1 year, but the rates achieving MCID and return to sport were similar between groups. [343] (10.1016/j.arthro.2021.11.053)
• [L4] The nature of complications changed with experience, but no significant variation in the incidence was observed over the 9-year period of experience with hip arthroscopy. [344] (10.1016/j.arthro.2009.12.021)
• [L5] A patient-specific approach to VTE prevention after hip arthroscopy, rather than a one-size-fits-all approach, is essential, with risk factors including oral contraceptive use, prior malignancy, and obesity. [345] (10.1016/j.arthro.2022.11.036)
• [L4] Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. [346] (10.1016/j.arthro.2014.04.103)
• [L4] Rates of total hip arthroplasty were similar to prior studies, whereas the rates of revision hip arthroscopy were higher. [351] (10.1016/j.arthro.2017.01.021)
• [L4] The reoperation rate after revision hip arthroscopy is 5% within 2 years, including further arthroscopy or conversion to hip arthroplasty. [352] (10.1016/j.arthro.2014.12.027)
• [L3] This meta-analysis demonstrated that routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules. [353] (10.1177/23259671231197435)
• [L3] Routine thromboprophylaxis after HA may not be indicated in all patients but can be considered based on patient-specific risk factors. [354] (10.1016/j.arthro.2022.10.029)
• [L4] Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations of hip arthroscopy outcomes. [355] (10.1016/j.arthro.2018.01.018)
• [L3] The likelihood of requiring a subsequent hip arthroscopy was 4.83 times higher for the revision group compared with the primary group. [358] (10.1002/arj.70139)
• [L5] Surgeons must be more vigilant to look for unintended and perhaps even unfavorable results, as complications likely see us more commonly than we see them, particularly with procedures such as hip arthroscopy that are growing in volume. [359] (10.1016/j.arthro.2017.03.014)
• [L3] Complication rates and revision arthroscopy did not differ significantly, whereas conversion to total hip arthroplasty was lower in late cases (odds ratio [OR] 0.10). [360] (10.1002/ksa.70431)
• [L4] Hip arthroscopy for FAI results in increased patient-reported outcome measures at interval follow-up, with most patients reaching critical thresholds of minimal and satisfactory clinical improvement. [362] (10.1016/j.arthro.2019.06.020)
• [L3] The overall complication rate after hip arthroscopy was 6.9% and higher than previously reported in the literature. [363] (10.1016/j.arthro.2013.09.046)
• [L3] The overall complication rate after hip arthroscopy was 6.9% and higher than previously reported in the literature. [364] (10.1177/2325967113s00045)
• [L3] Overall failure rate was 9.6% with 3.7% requiring revision hip arthroscopy and 5.9% converting to THA. [365] (10.1016/j.arthro.2017.04.054)
• [L3] Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients. [369] (10.1016/j.arthro.2023.07.047)
• [L3] The rate of total hip arthroplasty after hip arthroscopy was 9.3% at 2 years. [374] (10.5435/jaaos-d-20-00748)
• [L3] The overall rate of surgical site infections is low following hip arthroscopy. [375] (10.5435/jaaos-d-24-00262)
• [L4] The overall major complication rate was low and thus hip arthroscopy can be rated as a safe procedure. [377] (10.1007/s00402-018-2960-7)
• [L1] Similar rates of markers of clinical benefit and THA conversion were achieved by both groups; however, lower rates of revision hip arthroscopy were demonstrated in the capsular repair cohort. [378] (10.1016/j.arthro.2023.04.016)
• [L3] Early improvements in PROMs following hip arthroscopy, assessed by 6-month MCID, predicted clinically meaningful outcomes at 5-year follow-up, underscoring the importance of progressive but cautious recovery during these six months. [379] (10.1016/j.jisako.2025.100467)
• [L4] The incidence of post-related complications is 5 times greater in prospective versus retrospective hip arthroscopy literature. [380] (10.1016/j.arthro.2021.11.045)
• [L3] Risk of infection after hip arthroscopy increased when preoperative intra-articular hip injections were given within 3 months of surgery. [382] (10.1016/j.arthro.2017.06.037)
• [L3] Resident involvement in hip arthroscopy procedures was not a risk factor for 30-day complications between 2006 and 2012. [386] (10.1016/j.asmr.2021.06.005)
• [L3] Postoperative infection following intraarticular hip injection ≤3 months prior to hip arthroscopy is rare (<0.5%) and no more common than in patients who did not undergo preoperative injection. [387] (10.1177/2325967121s00280)

See Also

• Femoroacetabular impingement
• Greater trochanteric pain syndrome
• Acetabular labral tear
• Hip resurfacing
• Hip osteoarthritis
• Periacetabular osteotomy

References

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[51] Editorial Commentary: Hip Arthroscopy in the Professional Athlete…Back in the Game. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.01.001

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[56] Podium Presentation Title: Defining the Clinical Benefit & Identifying Predictors for Achievement for Revision Hip Arthroscopy. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.11.015

[58] Podium Presentation Title: Pain & Quality of Life Scores After Hip Arthroscopy for FAI are More Related to Mental Health Than Hip Pathology. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.11.014

[59] Return to Sports in a General Hip Arthroscopy Cohort: Minimum Two-Year Follow-Up. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00083

[60] Long-Term Outcomes of Hip Arthroscopy in Workers' Compensation Patients Compared to Non-Workers' Compensation Patients: A Propensity-Matched Study at Minimum 10-Year Follow-up. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261449801

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[62] Indications and Outcomes of Secondary Hip Procedures After Failed Hip Arthroscopy: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.02.028

[63] Can Patient-Reported Outcomes Predict the Need for Secondary Surgeries After Hip Arthroscopy?. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520974374

[64] Athletes Report Favorable Outcomes at 5‐Year Minimum Follow‐Up After Primary Hip Arthroscopy: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.11.008

[65] Revision Hip Arthroscopy Yields Inferior Patient Reported Outcome Measures and Patient Acceptable Symptomatic State Along with Higher Total Hip Arthroplasty Conversion Compared to the Primary Setting at a Minimum 2-Year Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.014

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[71] Correlation of Obesity With Patient‐Reported Outcomes and Complications After Hip Arthroscopy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.07.013

[73] Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520956292

[74] Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221075642

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[94] The current situation in hip arthroscopy. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.150041

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[116] Patients Generally May Return to Driving 4 Weeks After Hip Arthroscopy and 6 Weeks After Knee Arthroscopy: A Systematic Review and Meta‐analysis. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.08.015

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[118] Editorial Commentary : Comprehensive Treatment of Hip Acetabular Dysplasia Plus Labral and/or Cam Pathology With Combined Periacetabular Osteotomy and Hip Arthroscopy. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.08.007

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[132] Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241232154

[133] Paper 46: Modern Hip Arthroscopy for FAIS Delays the Natural History of Osteoarthritis in a Fourth of Patients: A 12-Year Follow-Up Analysis. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00058

[136] Arthroscopic Hip Surgery: Who can? Who should?. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.069

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[147] Editorial Commentary: Hip Arthroscopy and Periacetabular Osteotomy in Patients 45 Years and Older Have Similar Outcomes to a Younger Cohort: Articular Cartilage Status Is the Primary Determinant of Outcome. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.11.074

[149] Revision Hip Arthroscopy: Identifying Indications and Outcomes With a Mean 5-Year Follow-up. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251381775

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[153] Paper #222: Return to Driving After Hip Arthroscopy. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.185

[154] A Smartphone App Shows Patients Return to Preoperative Gait Metrics 6 Weeks After Hip Arthroscopy, and Gait Metrics Have Low to Moderate Correlations With a Hip‐Specific Patient‐Reported Outcome Measure. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100779

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[159] A comprehensive five‐phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2664-z

[162] Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520943580

[163] Rehabilitation After Hip Arthroscopy. Clinics in Sports Medicine. 2016. DOI: 10.1016/j.csm.2016.02.012

[165] Examining the Role of Perioperative Nerve Blocks in Hip Arthroscopy: A Systematic Review. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.12.022

[166] Paper 66: Short-Term Outcomes in Hip Arthroscopy Patients Participating in Formal Physical Therapy vs a Home Exercise Program: A Prospectively Enrolled Cohort Analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00091

[167] Editorial Commentary: Hip Arthroscopy Outcomes in Older Patients Can Equal Outcomes in Younger Patients With Proper Surgical Indications. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.03.006

[168] Hip Arthroscopy in Children with Tuberculosis‐ Experience from the Developing World. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.042

[169] Simultaneous Bilateral Hip Arthroscopy. Arthroscopy Techniques. 2017. DOI: 10.1016/j.eats.2017.03.002

[171] Hip Arthroscopy Results in Similar Short‐Term Function Compared to Total Hip Arthroplasty in Patients of Similar Demographic Profiles. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.06.013

[172] Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221078620

[175] Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671221144776

[176] Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517734518

[177] Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post‐Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.08.032

[178] One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00015

[179] Lumbar Plexus Block versus Peri-capsular Injection for Hip Arthroscopy: A Single-Blinded Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00350

[180] NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00032

[183] Survey results from an international hip course: comparison between experts and non-experts on hip arthroscopy clinical practice and post-operative rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5289-4

[184] Hip arthroscopy for femoroacetabular impingement. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170041

[186] Preoperative Quadratus Lumborum Block Reduces Opioid Requirements in the Immediate Postoperative Period Following Hip Arthroscopy: A Randomized, Blinded Clinical Trial. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.07.029

[187] Return to Work After Primary Hip Arthroscopy: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465211064271

[189] Editorial Commentary: Great Expectations or “We'll See,” Said the Zen Master—Hip Arthroscopy Patient Selection. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.02.011

[191] Pre-operative Predictors of Return to High Functional Status after Hip Arthroscopy for Femoroacetabular Impingement at 2-year Minimum Follow-up. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00070

[193] Time taken to resume driving following hip arthroscopy. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03662-y

[194] Residual Structural Disease and New Labral Tears Are the Most Common Indications for Revision Hip Arthroscopy: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.024

[195] Correlation of Magnetic Resonance Arthrography with Revision Hip Arthroscopy. Clinical Orthopaedics & Related Research. 2013. DOI: 10.1007/s11999-013-3202-5

[196] Validation of the Ligamentous-Fossa-Foveolar Complex (LFFC) Grading System With Clinical Correlation for Patients Undergoing Hip Arthroscopy. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251340986

[198] Peripheral Nerve Block for Hip Arthroscopy Does Not Have any Clinical Advantage Compared With Local Anesthetic Regarding Pain Management: A Meta‐analysis of Randomized Controlled Trials. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.12.011

[201] Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.06.045

[202] Capsular Complications and Subsequent Instability on the Rise as Indications for Revision Hip Arthroscopy (140). Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00279

[203] Female Sex Is a Risk Factor for Failure of Hip Arthroscopy Performed for Acetabular Retroversion. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117737479

[204] Editorial Commentary: Routine Preoperative Magnetic Resonance Imaging for Hip Arthroscopy Is Wasting Health Care Dollars and Delaying Surgical Intervention: Decision Making Should Be at the Discretion of the Health Care Provider Not Mandated by Health Care Insurers. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.04.009

[205] Editorial Commentary : Gadolinium Intra‐Articular Contrast Magnetic Resonance Imaging Is Not Required for Every Patient Undergoing Hip Arthroscopy, but Contrast Magnetic Resonance Imaging Plus Computed Tomography With 3‐Dimensional Reconstruction Are Essential for Patients Requiring Revision. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.12.008

[207] Return to Sport and Clinical Outcomes After Hip Arthroscopic Labral Repair in Young Amateur Athletes: Minimum 2‐Year Follow‐Up. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.03.011

[208] Orthopaedic Knowledge Update Sports Medicine 6. Athletic Hip Injuries > Acetabular Labral Tears.

[209] Comparison of Outcomes Between Nonsmokers and Patients Who Discontinued Smoking 1 Month Before Primary Hip Arthroscopy: A Propensity-Matched Study With Minimum 2-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221097372

[210] Return to Sport in Elite‐Level Athletes Undergoing Hip Arthroscopy Varies Based on Return‐to‐Sport Definition: A Systematic Review. Arthroscopy. 2026. DOI: 10.1002/arj.70165

[214] Hip Manipulation Under Anesthesia for Post‐Hip Arthroscopy Pericapsular Scarring: Indications and Techniques. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.02.036

[215] Editorial Commentary: Returning to High‐Impact Sports After Hip Arthroscopy: Are We Shooting Ourselves in the Hip?. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.01.007

[218] Editorial Commentary : Two Hips, One Patient: Insights From Staged Bilateral Hip Arthroscopy. Arthroscopy. 2026. DOI: 10.1002/arj.70099

[221] Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211038959

[222] Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211041763

[224] No Difference in Pain Levels and Functional Outcomes After Primary Hip Arthroscopy With Labral Repair Versus Labral Augmentation at Minimum 1‐Year Follow‐Up. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101175

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[227] Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.03.016

[228] Immersive Virtual Reality as Postoperative Therapy for Patients Undergoing Hip Arthroscopy. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100472

[229] Athletes experience a high rate of return to sport following hip arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-4929-z

[230] Short‐Term Clinical and Patient‐Reported Outcomes Are Similar for Neuraxial Compared With General Anesthesia for Hip Arthroscopy. Arthroscopy. 2026. DOI: 10.1002/arj.70603

[231] Comparative Effectiveness and Safety of Epidural Anesthesia, Intra-articular Injection, and Local Infiltration Analgesia in Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Journal of ISAKOS. 2026. DOI: 10.1016/j.jisako.2026.101207

[232] Does Obesity Affect Outcomes After Hip Arthroscopy?. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.00625

[233] Does Relief from Intra-articular Anesthetic Injection Predict Outcome after Hip Arthroscopy?. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00091

[234] No Difference in Responders and Nonresponders to Preoperative Intra-articular Corticosteroid Injection Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome at 10 Years: A Matched Analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.013

[235] Postoperative Opioid Use in Hip Arthroscopy for Femoroacetabular Impingement Syndrome Is Associated With Tobacco Use and Lower Preoperative Patient‐Reported Outcome Measures. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.04.040

[236] Pre-operative Femoral Nerve Block in Hip Arthroscopy—A Retrospective Review of 108 Consecutive Cases. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00058

[237] Patient‐Reported Outcomes of Capsular Repair Versus Capsulotomy in Patients Undergoing Hip Arthroscopy: Minimum 5‐Year Follow‐up—A Matched Comparison Study. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.10.019

[239] Paper 45: Preoperative MRI Offers Minimal Clinical Utility, Delays Access to Hip Arthroscopy, and Lacks Cost-Effectiveness in Patients Aged 40 or Under with Classic Femoroacetabular Impingement Syndrome: A Retrospective 5-Year Analysis. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00609

[244] Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118778785

[245] Incidence and Risk Factors for Venous Thromboembolism Following Hip Arthroscopy: A Population‐Based Study. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.03.054

[246] Preoperative Magnetic Resonance Imaging Offers Questionable Clinical Utility, Delays Time to Hip Arthroscopy, and Lacks Cost‐Effectiveness in Patients Aged ≤40 Years With Femoroacetabular Impingement Syndrome: A Retrospective 5‐Year Analysis. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.03.025

[249] Magnetic Resonance Arthrogram Improves Visualization of Hip Capsular Defects in Patients Undergoing Previous Hip Arthroscopy. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.11.005

[250] Healed Acetabular Labrum on Postoperative Magnetic Resonance Imaging Is Associated With Superior Achievement of Clinically Significant Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Minimum 2‐Year Follow‐Up. Arthroscopy. 2026. DOI: 10.1002/arj.70611

[254] Pulmonary embolism after hip arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-010-1392-x

[258] Radiographic and MR Imaging of the Athletic Hip. Clinics in Sports Medicine. 2006. DOI: 10.1016/j.csm.2005.12.009

[260] Venous Thromboembolism Events After Hip Arthroscopy: A Systematic Review. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.07.006

[264] History of Hip Arthroscopy: Challenges and Opportunities. Clinics in Sports Medicine. 2011. DOI: 10.1016/j.csm.2010.12.001

[267] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Early Degenerative Changes of the Hip > Hip Dysplasia > Treatments.

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[272] The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.07.048

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[275] Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517719460

[276] Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With FAI? Letter to the Editor. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516639252

[277] Orthopaedic Knowledge Update. Developmental Dysplasia of the Hip* > Adolescent HIP Dysplasia.

[281] Incidence of Nerve Injury After Hip Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00230

[284] Percutaneous Intraarticular Peripheral Access Technique for Hip Arthroscopy. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103232

[285] Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241234258

[286] Midterm Outcomes After Labral Reconstruction in Revision Versus Primary Hip Arthroscopy: A Propensity-Matched Study. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261421538

[289] Association Between Severity of Chondrolabral Junction Breakdown and Functional Outcomes After Hip Arthroscopy for Acetabular Labral Tears. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241255950

[292] Outcomes After Primary Hip Arthroscopy in Athletes Older Than 40 Years Compared With Nonathletes. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221096843

[298] Hip Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.04.016

[300] Step‐by‐Step Guide for Safe Joint Access During Hip Arthroscopy. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103524

[301] Basic Hip Arthroscopy Part 3: Peripheral‐Compartment Arthroscopy (T‐Capsulotomy, Femoroplasty, and Capsular Closure). Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103222

[303] The Incidence of Ankle Symptoms Following Hip Arthroscopy. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.017

[304] Which is the Most Reliable Spanish Translated Score for Hip Arthroscopy?. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.015

[307] The Effect of Prior Hip Arthroscopy on Patient-Reported Outcomes After Total Hip Arthroplasty: An Institutional Registry–Based, Matched Cohort Study. The Journal of Arthroplasty. 2018. DOI: 10.1016/j.arth.2018.01.012

[308] Hip Arthroscopy: How Far We Have Come, and Where We Need to Go. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241290992

[310] CORR Insights®: Surgical Hip Dislocation in the Era of Hip Arthroscopy Demonstrates High Survivorship and Improvements in Patient-reported Outcomes for Complex Femoroacetabular Impingement. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003118

[312] The Modified Mid‐Anterior Portal for Hip Arthroscopy. Arthroscopy Techniques. 2014. DOI: 10.1016/j.eats.2014.05.005

[316] Editorial Commentary: Don't Worry About It—Hip Arthroscopy Is Safe From Venous Thromboembolism…Mostly Yes!. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.016

[317] Hip Arthroscopy: Current Indications, Treatment Options, and Management Issues. The American Journal of Sports Medicine. 2003. DOI: 10.1177/03635465030310060701

[318] Long-term Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Master Athletes: A Propensity-Matched Study With Mean 10-Year Follow-up. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251395219

[319] Athletes Undergoing Staged Bilateral Hip Arthroscopy Show Favorable Midterm Outcomes and Return to Sport: A Propensity‐Matched Study. Arthroscopy. 2026. DOI: 10.1002/arj.70385

[322] Hip Arthroscopy Without a Perineal Post: A Safer Technique for Hip Distraction. Arthroscopy. 2006. DOI: 10.1016/j.arthro.2006.07.012

[324] Avoiding Failure in Hip Arthroscopy. Clinics in Sports Medicine. 2016. DOI: 10.1016/j.csm.2016.02.011

[325] Return to Sport in Professional Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261439048

[326] Hip arthroscopy technique and complications. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.09.010

[328] Local and Systemic Complications of Knee and Hip Arthroscopy: A Matched-Cohort Study. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221131059

[329] Editorial Commentary : Return to Sport Is Not the Finish Line: Raising the Bar for Long‐Term Outcomes After Hip Arthroscopy in Athletes. Arthroscopy. 2026. DOI: 10.1002/arj.70217

[330] Complications and Reoperations During and After Hip Arthroscopy: A Systematic Review of 92 Studies and More Than 6,000 Patients. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.11.003

[331] The Air‐Lift Technique for Improving Ease and Safety When Establishing the Modified Midanterior Portal in Hip Arthroscopy. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.09.014

[333] What Mid-term Patient-reported Outcome Measure Scores, Reoperations, and Complications Are Associated with Concurrent Hip Arthroscopy and Periacetabular Osteotomy to Treat Dysplasia with Associated Intraarticular Abnormalities?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001599

[334] Repeat Revision Hip Arthroscopy Outcomes Match That of Initial Revision But Not That of Primary Surgery for Femoroacetabular Impingement Syndrome. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.04.031

[336] High‐Level Athletes With Borderline Hip Dysplasia Achieve Favorable Outcomes and Return to Sport Rates Following Primary Hip Arthroscopy: Minimum 5‐Year Outcomes Comparison to a Propensity‐Matched Control Group. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.023

[337] Sex-Based Differences in Athletes Undergoing Primary Hip Arthroscopy With Labral Reconstruction: A Propensity-Matched Analysis With Minimum 2-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221100861

[339] Risk factors for venous thromboembolism after hip arthroscopy: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05536-2

[340] Low Rates of Five-Year Secondary Surgery and Postoperative Complications after Primary Hip Arthroscopy in over 30,000 Patients. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.064

[341] Return to Sports and Minimum 2-Year Outcomes of Bilateral Hip Arthroscopy in High-Level Athletes With a Propensity-Matched Benchmarking Against a Unilateral Control Group. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211043491

[342] Return to Play After Hip Arthroscopy With Microfracture in Elite Athletes. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.08.028

[343] Earlier Treatment Yields Superior Outcomes in Competitive Athletes Undergoing Primary Hip Arthroscopy. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.11.053

[344] Do Complications in Hip Arthroscopy Change With Experience?. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.12.021

[345] Editorial Commentary: A Patient‐Specific Approach to Preventing Venous Thromboembolism After Hip Arthroscopy Is Essential. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.11.036

[346] Safety Measures in Hip Arthroscopy and Their Efficacy in Minimizing Complications: A Systematic Review of the Evidence. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.103

[351] Complication Rates for Hip Arthroscopy Are Underestimated: A Population‐Based Study. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.01.021

[352] Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2014.12.027

[353] Systematic Review and Meta-analysis of Studies Comparing Complete Capsular Closure Against Unrepaired Hip Capsules During Hip Arthroscopy. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231197435

[354] Incidence of Venous Thromboembolism After Hip Arthroscopy Is Low With or Without Prophylaxis but Risk Factors Include Oral Contraceptive Use, Obesity, and Malignancy. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.10.029

[355] There Is a Significant Discrepancy Between “Big Data” Database and Original Research Publications on Hip Arthroscopy Outcomes: A Systematic Review. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.01.018

[358] Adolescents Who Underwent Revision Hip Arthroscopy Showed Comparable Magnitude of Improvement but Had Lower Clinical Benefit Rates and Higher Risk of Subsequent Surgeries Compared to a Propensity‐Matched Primary Group at 2‐Year Follow‐Up. Arthroscopy. 2026. DOI: 10.1002/arj.70139

[359] Editorial Commentary: With New Technology Comes New Responsibility: Do the Complications of Hip Arthroscopy See Us More Often Than We See Them?. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.03.014

[360] Surgeon experience in hip arthroscopy improves operative efficiency and reduces conversion to total hip arthroplasty: A meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70431

[362] Outcome Trends After Hip Arthroscopy for Femoroacetabular Impingement: When Do Patients Improve?. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.020

[363] Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using a Validated Grading Classification. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.046

[364] Complications after Hip Arthroscopy. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00045

[365] Independent Risk Factors for Revision Surgery or Conversion to THA after Hip Arthroscopy: An Analysis of 3,957 Patients. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.054

[369] Patients Undergoing Revision Hip Arthroscopy Demonstrate Comparable Survivability and Improvement but Worse Postoperative Outcomes Compared to Patients Undergoing Primary Hip Arthroscopy: A Propensity Matched Study at Five‐Year Follow‐Up. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.07.047

[374] Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00748

[375] Assessing the Risk Factors for Surgical Site and Deep Wound Infections Following Hip Arthroscopy: A Nationwide Study of 75,577 Patients. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00262

[377] The effect of surgeon’s learning curve: complications and outcome after hip arthroscopy. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-2960-7

[378] Capsular Repair Is Associated With Lower Revision Rates Yet Similar Clinical Outcomes and Arthroplasty Conversion 5 Years After Hip Arthroscopy: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.016

[379] Six Month Functional Scores Predict 5 Year Outcomes after Hip Arthroscopy. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100467

[380] Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2021.11.045

[382] The Timing of Hip Arthroscopy After Intra‐articular Hip Injection Affects Postoperative Infection Risk. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.06.037

[386] Resident Involvement in Hip Arthroscopy Procedures Does Not Affect Short‐Term Surgical Outcomes. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.06.005

[387] Image-guided Intraarticular Hip Injections and Risk of Infection After Hip Arthroscopy (141). Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00280