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Hip arthroscopy

209 citationsUpdated Sep 2026

Overview

Hip arthroscopy has evolved rapidly as a minimally invasive diagnostic and therapeutic tool, allowing surgeons to treat conditions that historically required large open surgeries with promising results [18]. While 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 is femoroacetabular impingement (FAI) [6], and the incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for FAI and osteoarthritis [46]. Successful outcomes are most dependent on patient selection, with patient expectations being a paramount criterion [186]. With proper surgical indication, both male and female patients achieve significant postoperative improvement and demonstrate comparable survival rates [40]. Furthermore, outcomes in older patients can equal those in younger patients when degenerative articular cartilage changes are absent [164]. 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 [168].

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 who underwent primary hip arthroscopy demonstrated favorable outcomes and high rates of clinical benefit at 5-year follow-up [65]. Specifically, hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery [50]. Bilateral hip arthroscopy for FAI has improved modified Harris Hip Score and North American Hip Score at 2 years of follow-up compared to baseline [48]. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection [47].

Although about 20% of patients treated between 2005 and 2013 underwent either a subsequent hip arthroscopy or total hip arthroplasty within 2 years, suggesting the need for further refinement of appropriate indications [37], revision procedures remain supported for a variety of indications [44]. The most common indications for revision hip arthroscopy include unaddressed femoroacetabular impingement and new labral tears [191, 63], with residual impingement remaining the most common indication in the treatment of FAI [199]. Following revision hip arthroscopy, minimum 2-year follow-up thresholds for achieving significant clinical benefit have been established for multiple outcome measures [57, 59].

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 [86]. The hemipelvis comprises three bones—the ilium, ischium, and pubis—which unite at the triradiate cartilage within the concave acetabulum [86]. The acetabulum consists of an articular crescent-moon–shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [86]. Inferiorly, the acetabulum is incomplete, forming a notch through which vital blood vessels and nerves pass to supply the joint [86]. 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 [86].

The neck-shaft angle of the femur averages 125° [86], while the mean femoral neck-shaft angle in the adult is 130° ± 7° [94]. Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [86], and the mean anteversion of the femoral neck is 10° ± 7° [94] [94]. The weakest area in the femoral neck is located in the Ward triangle [94]. 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 [94].

Ligaments and Soft Tissue

The acetabular labrum is a fibrocartilaginous ring attached to the rim of the acetabulum that extends the articulating surface area and increases femoral head coverage [86]. Triangular in cross section, the labrum contributes to creating a pressurized seal of the central compartment of the hip during loading [86]. 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 [86]. The labrum is highly innervated, with the presence of both mechanoreceptors and nociceptors [86]. It is absent in the area of the inferior acetabular notch, where the transverse acetabular ligament serves as the continuation of the labrum [86].

The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck [86]. The capsule enhances joint stability by preventing translation of the femoral head in the acetabulum [86]. The iliofemoral ligament is Y-shaped and is the thickest and strongest of the three main ligaments supporting the hip [86]. The medial portion of the iliofemoral ligament 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 [86]. The iliofemoral ligament functions to limit external rotation, while in isolation, the lateral arm limits extension of the joint [86]. The ischiofemoral ligament extends from the ischial margin of the acetabulum to the greater trochanter of the femur and restricts internal rotation motion [86]. The pubofemoral ligament extends from the obturator crest of the pubic bone to the femoral neck and acts to limit abduction of the joint [86]. Deep fibers from the iliofemoral, ischiofemoral, and pubofemoral ligaments merge to form the zona orbicularis, which circumvents the femoral neck [86].

The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [87]. It transmits an arterial branch of the posterior division of the obturator artery to the femoral head, which is less significant in adults [83]. The hip capsule attaches anteriorly and posteriorly along the periphery of the acetabulum outside the labrum, and inferiorly to the acetabular labrum [87]. On the posterior side, the hip capsule attaches only partially to the femur, such that the basicervical region of the femoral neck and the intertrochanteric region are not intracapsular [87]. The iliofemoral ligament becomes taut in full extension, preventing anterior dislocation and hyperextension of the hip [87]. The twisted orientation of the hip ligaments provides a screw mechanism for the hip in full extension [87].

Vascular Anatomy

From birth to approximately 4 years of age, the major blood supply to the femoral head comes from the medial and lateral femoral circumflex arteries, with major contributions from the artery of the ligamentum teres [98]. From the age of 4 years to adulthood, the posterosuperior and posteroinferior retinacular arteries from the medial circumflex artery are the major blood supply to the femoral head [98]. In adulthood, the major blood supply to the femoral head is from the medial femoral circumflex and lateral epiphyseal arteries [98].

The medial femoral circumflex artery is the main blood supply to the femoral head and terminates in the posterior aspect of the extracapsular arterial ring [94]. The lateral femoral circumflex artery gives rise to the anterior aspect of the extracapsular arterial ring [94]. The ascending cervical arteries originate from the extracapsular arterial ring and are divided into lateral, medial, posterior, and anterior groups based on their anatomic relationship to the femoral neck [94]. The lateral group of ascending branches is the main blood supply to the femoral head [94]. The lateral epiphyseal artery penetrates the femoral head and is believed to be the dominant blood supply to the femoral head from the ascending branch system [94]. Fractures that disrupt the ascending blood flow to the lateral epiphyseal vessel have an increased risk of osteonecrosis [94]. The artery of the ligamentum teres arises from either the obturator or medial femoral circumflex artery and does not provide sufficient blood supply to maintain the viability of the femoral head [94].

Pathophysiology

Femoroacetabular impingement (FAI) is recognized as a common cause of hip dysfunction and secondary osteoarthritis [21]. In FAI, distinct structural abnormalities produce repetitive impingement between the acetabulum and the femoral head-neck junction [21]. Three types of FAI are recognized: * Cam impingement: Involves femoral-based abnormalities such as an aspherical femoral head, reduced head-neck offset, or femoral retroversion, resulting in repetitive abutment of the acetabular rim and femoral head-neck junction [21]. * Pincer impingement: Involves acetabular-based disorders such as acetabular retroversion, global overcoverage, or acetabular protrusio, creating abnormal abutment of the acetabular rim and femoral head-neck junction [21]. * Combined cam/pincer: A mix of the aforementioned femoral and acetabular pathologies [21].

Impingement abnormalities can cause labral tears, degeneration, or ossification [21], acetabular cartilage delamination [21], and secondary osteoarthritis [21]. The acetabular labrum plays a role in shock absorption, joint lubrication, and pressure distribution [205]. Its most critical role is the creation of a negative pressure seal with the femoral head, which aids in joint stability [205]. Removal of the labrum leads to a shift in the femoral contact point toward the acetabular rim [205], a decrease in intra-articular fluid pressurization [205], and a loss of lateral restraint to femoral head motion [205]. Furthermore, removal of the labrum increases contact stresses between the articular cartilage of the femoral head and the acetabulum by 92% [205].

Hip microinstability refers to femoral head micromotion within the acetabulum, which is a prolonged phenomenon that leads to cartilage damage and eventually osteoarthritis of the hip [99]. FAI-related damage to the labrum and loss of the seal between the labrum and the femoral head might generate hip microinstability [179]. Current evidence supports that the hip capsule is the structure mainly implicated in hip microinstability [179]. Sports that require a great deal of hip torsion can lead to capsule attenuation and laxity secondary to repetitive microtrauma [205]. Attenuation of the capsule leads to microinstability of the joint, in which the femoral head subluxates anteriorly and rides on the anterior superior labrum [205]. Microinstability can occur in patients with collagen disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and Down syndrome [205]. Iliopsoas impingement on the anterior hip joint is a mechanism for labral tears where the tear occurs on the anterior acetabulum directly beneath where the iliopsoas tendon crosses the hip joint [205].

In developmental dysplasia of the hip (DDH), the posterosuperior rim of the acetabulum loses its sharp margin and becomes flattened and thickened in the area over which the femoral head slides [90]. A ridge of thickened articular cartilage called the neolimbus arises along the posterosuperior acetabular wall [90]. In dislocated hips with DDH, the fatty tissue known as the pulvinar thickens in the depths of the acetabulum and may impede reduction [90]. The ligamentum teres elongates and thickens, taking up valuable space within the acetabulum [90]. The inferior capsule of the hip assumes an hourglass shape, presenting an opening smaller in diameter than the femoral head [90]. The iliopsoas tendon contributes to the narrowing of the hourglass-shaped capsule in dislocated hips with DDH [90]. In DDH, the blocking structure encountered during reduction is not only the labrum but also a significant portion of the cartilaginous acetabulum itself [90].

Hip dysplasia predisposes patients to premature joint degeneration because joint loading forces are concentrated at the edge of the dysplastic acetabulum and labrum, leading to chondrolabral damage [217]. Extra-articular abnormalities including abnormal femoral torsion have been found to exacerbate or cause impingement or instability [217]. Chondrolabral damage occurs quickly in patients who acquire a deformity, as seen in those with slipped capital femoral epiphysis [217]. Even in the absence of symptoms, chondrolabral junction damage may occur in the presence of osseous deformity [217].

Classification

MAHORN: The Multicenter Arthroscopic Hip Outcome Research Network (MAHORN) group was developed to elucidate and classify uniformly 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 [260].

Beck Classification: The Beck classification of transition zone cartilage is used to grade chondrolabral junction damage, stratifying grades 0 to 2 as mild and grades 3 and 4 as severe [285]. In cohorts undergoing hip arthroscopy for symptomatic labral tears, this system grades labral damage and transition zone cartilage injury [281]. It is also applied during diagnostic arthroscopic surgery for femoroacetabular impingement to assess and grade femoral and acetabular articular cartilage as well as labral tears [241]. In patients with acetabular retroversion, grading of the 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 [200].

Outerbridge Classification: In a cohort of patients undergoing hip arthroscopy for symptomatic labral tears, the Outerbridge classification is used to grade femoral head and acetabular cartilage [281].

Modified 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 [193].

Tuberculosis Hip Classification: An arthroscopy-based classification of tuberculosis hip indicates that the disease process spreads from the periphery to the center [165].

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]. The International Society of Hip Arthroscopy is working toward an international registry that will allow the development of prospective studies using the same classification systems [260]. In a study of patients with acetabular dysplasia undergoing reorientation osteotomy, significant heterogeneity was found in the reporting of disease classification and intraoperative findings [268].

Clinical Presentation

History and Symptoms

Patients with symptomatic femoroacetabular impingement (FAI) frequently present with activity-related groin pain exacerbated by hip flexion, alongside difficulty with prolonged sitting, walking, running, or pivoting [21]. The onset of symptoms is often insidious or follows minor trauma, and mechanical symptoms secondary to labral and articular cartilage disease are common [21]. Patients being evaluated for arthroscopy may present with groin pain, clicking, pinching pain with sitting, or lateral thigh pain [56]. Anterior groin pain is most associated with intra-articular pathologies, including labral tears, degenerative changes, synovial pathologies, loose bodies, and osteonecrosis [266]. However, anterior groin pain can also result from extra-articular conditions such as hip flexor strains, iliopsoas snapping syndrome, or femoral stress fractures [266]. Pain along the lateral thigh is often associated with greater trochanteric bursitis, iliotibial band syndrome, or abductor tendon tears or tendinitis [266]. Pain in the posterior region of the hip and pelvis can result from muscle pathologies such as piriformis syndrome and hamstring muscle tears, or from referred pain from the sacroiliac joint or low back [266].

Patients with hip microinstability often describe hip or groin pain that has increased over time and report a feeling of instability or giving way in the hip during activity [270]. In adolescent hip dysplasia, lateral hip pain is often the initial symptom, occurring later in the day as fatigue develops due to altered biomechanics requiring greater force to maintain normal walking [273]. Deep anterior groin pain in this population generally indicates pain originating from the joint itself, such as joint overload, edge-loading of the acetabulum, labral irritation or injury, or labral chondral injury [273]. Patients with acetabular dysplasia presenting in adolescence may complain of aching pain in the groin or lateral hip that is worse with exertion and long periods of walking or standing [235]. These patients may limp when tired or uncomfortable, and symptoms usually increase steadily in frequency and severity over a relatively short time [235].

Physical Examination

A thorough history is essential to differentiating between common causes of hip pain, with clinical examination tests and imaging findings used to confirm a suspected clinical diagnosis [17]. Assessing the onset, duration, and location of symptoms, along with factors that exacerbate or alleviate pain, is important to determining the causes of hip pain [266]. Identifying changes to activity type or training regime can help differentiate between conditions when there is no known precipitating event for hip pain [266]. Documenting any family history of hip conditions is important, as certain genetic conditions such as Ehlers-Danlos syndrome can affect the hip [266].

Patients with FAI exhibit restricted hip internal rotation in 90° of flexion [21]. The impingement test (flexion, adduction, internal rotation) elicits pain in patients with FAI, but the test is not specific for FAI [21]. Groin pain, clicking, pinching pain with sitting, lateral thigh pain, the flexion abduction external rotation test, the flexion–internal rotation–adduction test, and trochanteric tenderness were not useful in identifying patients with greater than 50% pain relief from anesthetic intra-articular injection [56]. A history of mechanical symptoms such as clicking, catching, locking, or buckling, or a restricted range of motion when plain radiographs are within normal limits, gives reasonable suspicion for an intra-articular problem [146].

The physical examination for adolescent hip dysplasia should include observation of ambulation to assess for an antalgic gait or a subtle Trendelenburg gait [273]. The hip range of motion should be examined for restriction in motion and to determine relative femoral version in patients with adolescent hip dysplasia [273]. The impingement test should be performed to determine the likelihood of true symptomatic labral pathology in patients with adolescent hip dysplasia [273]. Some patients with acetabular dysplasia presenting in adolescence have a Trendelenburg limp or a delayed Trendelenburg sign [235]. Discomfort at the extremes of hip motion may be present in patients with acetabular dysplasia presenting in adolescence [235]. Surgeons should be alert to signs of snapping or popping in patients with acetabular dysplasia, which may be caused by a tear in the labrum [235].

Imaging

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]. MRI or magnetic resonance arthrography may be used to assess the anatomy of the proximal femur as well as the version of the acetabulum and femur [21]. The sensitivity of MRI or magnetic resonance arthrography to acetabular rim chondral lesions is limited [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 of hip pain [17].

Gadolinium-enhanced MRI arthrography may demonstrate labral pathology in patients with acetabular dysplasia presenting in adolescence [235]. The radiographic assessment for adolescent hip dysplasia should include a standing AP pelvic radiograph, an abduction-internal rotation view, and false-profile radiographs of the hip [235]. The false-profile radiograph is used to assess anterior acetabular coverage with the ventral center-edge angle, which should be more than 25 degrees [235]. The width of the posterior column of the acetabulum can be assessed on the false-profile radiograph in preparation for a periacetabular osteotomy [235]. On the AP pelvic radiograph, it is important to distinguish among dysplasia, subluxation, and degenerative disease [235]. Acetabular dysplasia is defined radiographically by a loss of concavity of the acetabular roof, an excessive lateral inclination of the roof, and a widening of the teardrop body [235]. Subluxation of the hip is best documented by comparing the distance from the medial acetabular wall to the femoral head on the involved and uninvolved sides [235]. A subluxated femoral head is displaced proximally as well as laterally, and the Shenton line is broken [235]. Degenerative disease is indicated by the presence of sclerosis and cyst formation on both sides of the joint and the narrowing of the cartilage joint space [235]. Osteophyte formation is a late manifestation of degenerative disease [235].

The assessment of the degree of early osteoarthritis in adolescent hip dysplasia should be determined using the Tönnis grading system [273]. The abduction-internal rotation view, known as the Von Rosen view, is used to determine whether the hip reduces concentrically, which is a prerequisite for a rotational acetabular osteotomy [273]. The false-profile radiograph is used to determine the anterior coverage of the femoral head by the acetabulum and provides an understanding of the width of the posterior column for planning osteotomies [273]. A 45° or 90° Dunn lateral view is used to determine whether there is concurrent cam morphology, an asphericity of the femoral head-neck junction [273]. The alpha angle is measured by placing a best-fit circle over the femoral head and determining the angle subtended by a line from the center of the head along the femoral neck axis and a line from the center of the femoral head and the point where the anterosuperior head-neck junction exits from the best-fit circle [273]. An alpha angle greater than 42° suggests some femoral head-neck offset deformity [273]. CT scans are used to determine femoral and acetabular version, evaluate for possible cam morphology, and assess overall acetabular morphology, but are not a routine study for most cases of adolescent hip dysplasia [273]. The indication for a magnetic resonance arthrogram in the adolescent patient population to assess labral and labral-chondral abnormalities is controversial but is generally indicated for severe groin pain with a positive impingement sign even at mild arcs of flexion/internal rotation/adduction [273]. The incidence of labral pathology in patients with hip dysplasia is reported to occur in two-thirds of patients [273]. The incidence of labral pathology in asymptomatic young adults is approximately 40% [273]. Acetabular cartilage lesions are found in 69% of adult patients with hip dysplasia, and combined labral/cartilage lesions are found in 59%, most commonly on the anterior and superolateral acetabulum [273].

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]. Clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [17]. An accurate diagnosis before 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 [26]. A diagnosis before arthroscopy is critical to improved outcome in the investigation and treatment of painful hip resurfacing arthroplasty [35].

In a study of 105 subjects with hip pain, an anesthetic intra-articular injection was performed in 49 potential candidates for arthroscopic surgery [56]. In patients with definite or possible labral tears on MRI arthrogram, 39% and 45% respectively did not achieve greater than 50% reduction of pain after anesthetic intra-articular injection [56]. 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 intra-articular injection [56].

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [34]. Plain radiographs are the first imaging studies obtained for patients presenting with hip pain and can determine the presence of fractures, degenerative changes, and abnormal joint morphology [103]. Radiography remains the primary screening tool for hip pain [254]. Radiographs are essential in the workup of patients with hip pain and may be used to assess for osteoarthritis, femoroacetabular impingement (FAI), and developmental dysplasia of the hip (DDH) [142].

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 [34]. Standard AP radiographs of the hip and pelvis are obtained to examine bony architecture, check for evidence of joint space narrowing or changes to bone quality, and quantify femoral head coverage [103]. The AP pelvis radiograph should be performed with the lower extremities in approximately 15° of internal rotation and centered over the pelvis [34]. For neutral pelvic tilt, the sacrococcygeal joint should be between 3 and 5 cm above the superior border of the symphysis pubis [34].

Osteoarthritis of the hip can be categorized using the Kellgren-Lawrence or Tönnis classifications [34]. The Kellgren-Lawrence classification is a 4-point grading system classified into doubtful, mild, moderate, and severe [34]. The Tönnis classification is a 3-point grading system categorized into mild, moderate, and severe [34]. Radiographic and clinical severity do not necessarily correlate, particularly if the radiographs are non-weight-bearing or if false-profile views are not included [34].

Acetabular morphology is assessed on AP pelvis radiographs to evaluate acetabular overcoverage and undercoverage [34]. Coxa profunda is diagnosed when the fossa line touches or is medial to the ilioischial line on AP pelvis radiographs [34]. 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 [34]. Femoral head extrusion index values greater than 25% are considered abnormal [34]. Tönnis angles between 0° and 10° are considered normal [34]. Center-edge angles of 20°–40° are considered normal, while angles from 20° to 25° are considered borderline [34].

Specific views of the hip are used to detect abnormalities of the femoral head-neck junction seen with femoroacetabular impingement (FAI) [34]. The femoral head-neck junction morphology is often assessed using the alpha angle [34]. The Dunn view and frog leg view are appropriate to measure the alpha angle to determine the presence of impingement [103]. A normal alpha angle is less than 50°–55° [34]. An abnormal alpha angle of 70° was demonstrated in a patient with femoroacetabular impingement on a Dunn 90° view radiograph [34]. 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 [34].

The “crossover” sign on AP pelvis radiographs indicates acetabular retroversion related to lateralization of the anterior acetabular wall relative to the posterior acetabular wall [34]. Pelvic tilt or rotation may lead to false-positive and false-negative “crossover” signs on AP pelvis radiographs [34]. Radiographs remain integral to the assessment of fractures and can be supplemented with CT to further investigate suspected occult fractures [34]. Radiographs can serially assess hardware positioning and evaluate symptomatic hardware related to open reduction and internal fixation and total hip arthroplasty [34].

MRI: MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology, given its superior sensitivity and specificity [103]. MRI can give important diagnostic information with regard to various intra-articular and extra-articular hip pathologies [142]. Conventional MRI is effective at identifying osteochondral injuries, musculotendinous pathologies, and inflammation [103]. Noncontrast MRI at 3T is generally adequate for diagnosing intra-articular pathology [142]. If 3T imaging is unavailable, MRA can be considered at 1.5T for increased diagnostic accuracy [142].

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 [103]. 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 [254]. Gadolinium-enhanced MRI arthrogram is useful when labral pathology is suspected, especially when associated with FAI [154]. The utility of MR arthrography was shown to assist in the diagnosis and treatment of patients with ongoing or recurrent symptoms who have had prior hip arthroscopy [192]. MRA may be more helpful in identifying capsular defects in patients presenting with hip instability symptoms who have had a previous hip arthroscopy [246]. More than one half of patients undergoing revision hip arthroscopy had MRI and intraoperative evidence of capsular incompetency [252].

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 [103]. 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 [103]. 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 [103]. MRI-positive acetabular cystic changes are predictive of advanced cartilage lesions in the hip [272].

MRI is helpful in identifying femoral neck stress fracture in athletes and predicting patients that may require surgical intervention [142]. MRI is helpful in assessing complications of conventional and resurfacing hip arthroplasties, particularly those with metal-on-metal bearing systems [142]. Major findings that help predict histologic ALVAL scores include synovial thickening, synovitis, synovial volume, abductor disruption, and soft-tissue edema [142]. MRI is used when osteonecrosis is suspected [154]. MRI may identify gluteus medius and gluteus minimus tears in patients with lateral hip pain and abductor weakness [154].

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]. Sensitivity to acetabular rim chondral lesions is limited when using MRI or magnetic resonance arthrography [21]. A prospective study comparing noncontrast 3T MRI to 1.5T MRA found similar accuracies between the two techniques [120]. A retrospective study evaluating the accuracy of noncontrast 3T MRI versus hip arthroscopy found accuracy for labral tears and acetabular cartilage lesions was 98% and 90%, respectively [120].

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 femoroacetabular impingement syndrome (FAIS) [172]. 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 [236]. Preoperative MRI for patients with FAIS aged 40 or under may negatively impact outcomes by delaying access to care unnecessarily by at least two weeks [236]. 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 [243]. 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 [201]. Gadolinium intra-articular contrast magnetic resonance imaging is not required for every patient undergoing hip arthroscopy [202]. Contrast magnetic resonance imaging plus computed tomography with 3-dimensional reconstruction are essential for patients requiring revision hip arthroscopy [202].

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 [103]. Measurements of femoral head coverage and acetabular and femoral impingement can also be performed reliably using CT images [103]. The multiplanar and 3D capabilities of CT make it an invaluable tool for assessing bone morphology, but at higher cost and radiation dose [142]. 3D volume renderings are useful to aid in preoperative planning in FAI and subspine impingement [142]. Three-dimensional CT with pelvic remodeling may be indicated for preoperative planning for reconstruction associated with dysplasia surgery, FAI, posttraumatic arthritis, or other complex primary total hip arthroplasty [154].

CT overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology and, to some degree, assessment of soft-tissue abnormalities [89]. Combined with arthrography, CT can evaluate chondrolabral abnormalities, specifically in patients with contraindications to MRI [89]. CT is helpful in fracture evaluation, particularly in the setting of negative radiographs or for further defining fracture morphology in patients requiring surgical reduction [89]. In cases where there is a suspected fracture but normal or equivocal plain radiographs, CT scanning is a more accurate investigation than technetium bone scan but exposes the patient to further radiation [153]. Multidetector CT scanning reported 100% specificity and sensitivity in diagnosis of hip fracture in a series of 209 patients with negative plain radiographs [153]. CT scanning missed no occult hip fracture in a series of 179 patients presenting with pelvic pain after trauma [153]. CT scanning yielded sensitivity of 86% and specificity of 98% in a series of 78 scans for occult hip fractures [153]. Studies comparing CT and MRI for occult hip fractures have come out in favor of MRI scanning [153].

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 [89]. Ultrasonography is particularly useful in providing real-time guidance during diagnostic and therapeutic procedures [89]. Ultrasonography can be used at the time of clinical evaluation and provides real-time guidance during therapeutic and diagnostic procedures, which can be performed in the office setting [142]. Ultrasonography allows bedside evaluation of the hip and can be used to guide interventions in the office setting [142].

Although ultrasonography is a valuable tool to examine pediatric hip conditions, its utility in evaluating the adult hip is limited [103]. Ultrasonography can be an effective modality to identify musculotendinous disruptions, effusions associated with intra-articular pathology, or inflammatory conditions, such as bursitis [103]. Ultrasonography is increasingly used for targeted injections into muscles, tendons, or intra-articularly around the hip for use with corticosteroids or biologic treatments [103].

Other Considerations: In a study of 70 patients, 39 cases of chondral degeneration were diagnosed on arthroscopy compared to 26 on plain X-ray [55]. In a study of 70 patients, 26 cases of labral tears were diagnosed on arthroscopy compared to 0 on plain X-ray [55]. In a study of 70 patients, 3 cases of loose bodies were diagnosed on both plain X-ray and arthroscopy [55]. In a study of 70 patients, 2 cases of undiagnosed hip pain were identified on clinical evaluation but not on arthroscopy or plain X-ray [55]. The finding of a femoral head lesion at arthroscopy does not, in and of itself, portend a worse outcome in hip arthroscopy patients [283]. Hips with degenerative change do not perform as well following hip arthroscopy when compared with hips without degenerative change [272].

A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years [33]. Studies of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome demonstrated increased radiographic progression of hip osteoarthritis over time [52]. Patient-reported outcome measures and diagnostic imaging are the most frequently reported outcomes in surgical outcome reporting for FAI syndrome [78]. Measures of hip strength and range of motion are underreported in surgical outcome reporting for FAI syndrome [78]. Current surgical outcomes for FAI syndrome are limited to mid-term follow-up time frames with inconsistent reporting [78]. Clinicians should consider patient history (e.g., imaging, comorbidities, etc.) and values when electing for hip arthroscopy in the older population [39]. Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain [41]. Prior ipsilateral hip arthroscopy does not appear to compromise subsequent total hip arthroplasty in most patients [81]. Hip arthroscopy in obese patients yielded significant long-term improvements [286]. Predictors of clinical outcomes after hip arthroscopy may prove useful to clinicians in refining indications and guiding patients on expected outcomes [30].

Treatment

Non-Operative

The provided evidence base does not detail specific conservative management protocols such as weight loss, physical therapy regimens, or injection strategies as standalone treatments. However, it notes that an individual physiotherapy treatment and rehabilitation program may augment improvements in patient-reported outcomes following arthroscopy for FAI syndrome [15]. Additionally, 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].

Operative

Indications: Hip arthroscopy is a standard element of the armamentarium for the diagnosis and treatment of hip pathology [1]. It has evolved from a diagnostic tool to a therapeutic procedure with expanding indications for intra-articular and extra-articular hip disorders [11]. 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]. Hip arthroscopy is a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis for FAI syndrome [128, 129]. Age over 45 is not a contraindication for periacetabular osteotomy (PAO) or hip arthroscopy if articular cartilage status is normal [143]. Hip arthroscopy for the treatment of FAI syndrome in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups [49]. Hip arthroscopy after hip arthroplasty is supported by a systematic review for a variety of indications [44].

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 [263]. The vast majority of intra- and extra-articular procedures are performed using two or three common portals [263]. Fluoroscopy facilitates joint access for guidance and for proper osseous resection during acetabuloplasty or femoroplasty [263]. 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]. The PIPA technique for hip arthroscopy eliminates the need for continuous excessive distraction and mitigates risks of labral penetrations, resections, and cartilage damage in patients with challenging hip morphology [280]. The air-lift technique increases the space available for portal creation and reduces the risk of chondrolabral injury when entering the hip joint [328]. 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 [296]. This approach facilitates the restoration of capsular integrity and hip biomechanics at the conclusion of the case [43]. When bony deformity is excessive, difficult to access, or multiple procedures are to be performed, the surgical hip dislocation becomes the procedure of choice [263]. 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 [308]. Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes [175]. 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 [114].

Pain Management: Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls [173]. 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 [174, 177]. Epidural anesthesia provides superior early postoperative analgesia and reduces intraoperative opioid use in hip arthroscopic surgery for femoroacetabular impingement syndrome [227]. Quadratus lumborum blocks are an effective component of multimodal analgesia options for patients undergoing elective hip arthroscopy [183]. 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 [232]. 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 [195]. NSAID use was prominent in the patient population, demonstrating that opioids and NSAIDs together can be effective pain management strategy tools for hip arthroscopy patients in the postoperative period [234]. 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 [225].

Adjuncts: 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 protocols among institutions because of a lack of standardization [15]. Most rehabilitation protocols are not evidence based and rely on expert opinion [15]. When diagnosed, hip manipulation under anesthesia can be a viable treatment option for post-hip arthroscopy pericapsular scarring [211].

Other Considerations: 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 lateral femoral cutaneous nerve (LFCN) is most commonly involved in neurapraxia following hip arthroscopy [20]. Permanent nerve injury following hip arthroscopy is less than 5% [20]. Inadequate resection in FAI surgery, more commonly on the femoral side, is the most common reason for revision hip preservation surgery [20]. The leading cause of failure after hip arthroscopy is inadequate bony resection of cam (majority) or pincer deformities [263]. Excessive resection has recently been proposed as a potential reason for failure as well [263]. 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 [37]. The surgeon requires a high level of technical skill and experience if serious complications are to be avoided [113]. 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 [132]. 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 [293]. Recent data show unintended cartilage injuries occurring in approximately 73% of videos taken during arthroscopic treatment of femoroacetabular impingement [295]. Optimal outcomes for hip arthroscopy require 519 cases, with competency achieved after 388 cases [295]. In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues [60]. 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 [61]. Hip arthroscopy in the obese patient population leads to improved short- to mid-term patient-reported outcomes similar to those seen in nonobese patients [72]. 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 [228]. 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 [75]. 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 [188]. The survival of hip arthroscopy at eight years with joint replacement as the point of failure is 82% [299, 300]. Patients undergoing hip arthroscopy with minimal or no arthritis have significant short-term improvement whether the capsule is closed or left unrepaired [233]. Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up [282]. Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes [305]. 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 [229]. Lack of relief after preoperative intra-articular corticosteroid injection does not rule out the potential for successful long-term outcomes after hip arthroscopy [230]. More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively [224]. Hip arthroscopy patients used on average less than 50% of their postoperative opioid prescription at the reporting institution [231]. The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement [145].

Complications

Overall Complication Rates: The major complication rate for primary hip arthroscopy is 0.41%, with a minor complication rate of 4.1% [344]. Other data report an overall major complication rate of 0.58% [327] and an overall complication rate of 6.9%, which is higher than previously reported in the literature [360, 361]. In a study of primary hip arthroscopy, 90-day adverse events were low at 1.28% [92, 338]. The overall failure rate after hip arthroscopy is 9.6%, with 3.7% requiring revision hip arthroscopy and 5.9% converting to total hip arthroplasty [362]. The overall major complication rate is low, rating hip arthroscopy as a safe procedure [374]. Complication rates for hip arthroscopy are underestimated in population-based studies, with higher rates of revision hip arthroscopy observed compared to prior studies [349]. Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations [353]. The incidence of post-related complications is 5 times greater in prospective versus retrospective hip arthroscopy literature [378].

Nerve Injury and Neurapraxia: The lateral femoral cutaneous nerve (LFCN) is the most commonly involved nerve in neurapraxia following hip arthroscopy [20]. Permanent nerve injury following hip arthroscopy occurs in less than 5% of cases [20]. The incidence of neurapraxia during hip arthroscopy may be markedly higher than previously reported in the literature [277]. No association was found between increased traction time and risk of nerve injury in a study of neurapraxia incidence [277]. Patients undergoing hip arthroscopy had a significantly greater rate of nerve injuries at 6, 12, and 24 months postoperatively compared with a knee arthroscopy cohort [325]. Nerve injury rates in the hip arthroscopy cohort were 0.21% at 6 months, 0.35% at 12 months, and 0.54% at 24 months [325]. Pudendal neurapraxia can occur even with short traction times, especially in stiff, prearthritic hips [20]. The anterior portal puts the lateral femoral cutaneous nerve at risk [70, 71]. The anterolateral portal is associated with injury to the superior gluteal nerve [70, 71]. The posterolateral portal places the sciatic nerve at risk, particularly when the hip is externally rotated [70, 71]. The sciatic and pudendal nerves are most frequently injured by traction when using a perineal post [70, 71]. Maximum traction weight, not the duration of traction, has been associated with sciatic nerve injury [70, 71]. Nerve paresthesia occurred in 3.8% of hips following hip arthroscopy [331]. Pudendal neuropraxia occurred in 2.6% of hips following hip arthroscopy [331]. Lateral femoral cutaneous nerve neuropraxia occurred in 1.9% of hips following hip arthroscopy [331].

Traction and Positioning Complications: Traction injuries related to the post include skin and soft-tissue necrosis [20]. Limiting traction time to 1 hour, with an absolute maximum of no greater than 2 hours, will likely reduce the incidence of neurapraxias and skin breakdown [321]. Traction time, force, and postoperative nerve block significantly influence the development and duration of neuropathy following hip arthroscopy [318].

Iatrogenic and Intraoperative Injuries: Iatrogenic chondrolabral injury can occur while the surgeon is gaining access to the central compartment [20]. Iatrogenic chondrolabral injury was the most reported complication in one systematic review [20]. Careful insertion of arthroscopic instruments helps to avoid traumatic injuries to intraarticular structures and chondral surfaces [321]. Acute iatrogenic dislocation can occur following hip impingement arthroscopic surgery [16]. Hip subluxation can occur as a complication of arthroscopic debridement [16]. Anterior dislocation of the hip can occur after arthroscopy in a patient with capsular laxity [16]. Femoral neck fracture can occur after arthroscopic management of femoroacetabular impingement [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 [242]. Thromboembolic complications do occur after elective hip arthroscopy [250]. The low incidence of VTE events (2.0%) suggests that prophylaxis may not be necessary in low-risk patients undergoing hip arthroscopy [256]. Hip arthroscopy has a low risk of venous thromboembolism, but risk stratification based on individual factors is necessary to determine which patients require prophylaxis [313]. Obesity, smoking, and age >45 years are significant risk factors for postoperative VTE after hip arthroscopy [337]. Routine thromboprophylaxis after hip arthroscopy may not be indicated in all patients but can be considered based on patient-specific risk factors [352]. A patient-specific approach to VTE prevention after hip arthroscopy is essential, with risk factors including oral contraceptive use, prior malignancy, and obesity [343]. The incidence of VTE after hip arthroscopy is low with or without prophylaxis, but risk factors include oral contraceptive use, obesity, and malignancy [352].

Infection: The overall rate of surgical site infections is low following hip arthroscopy [372]. Risk of infection after hip arthroscopy increased when preoperative intra-articular hip injections were given within 3 months of surgery [380]. 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 [385].

Heterotopic Ossification and Other Local Complications: Heterotopic ossification has been reported to occur following hip arthroscopy [70, 71]. NSAIDs have been shown to reduce the incidence of heterotopic ossification following hip arthroscopy [70, 71]. A greater proportion of heterotopic ossification was found in the hip arthroscopy cohort compared with a knee arthroscopy cohort [325]. Heterotopic ossification rates in the hip arthroscopy cohort were 0.07% at 6 months, 0.15% at 12 months, and 0.21% at 24 months [325]. Stiffness was significantly greater in the hip arthroscopy cohort compared with a knee arthroscopy cohort at 6, 12, and 24 months postoperatively [325]. Abdominal compartment syndrome can occur after hip arthroscopy [16]. Osteonecrosis is a reported complication associated with hip arthroscopy [20]. The hip arthroscopy cohort exhibited a significantly greater incidence of osteoarthritis compared with a knee arthroscopy cohort at 6, 12, and 24 months postoperatively [325]. Incidences of avascular necrosis were greater in the hip arthroscopy cohort compared with a knee arthroscopy cohort at 6, 12, and 24 months postoperatively [325].

Revision Surgery and Conversion to Arthroplasty: The 5-year secondary surgery rate after primary hip arthroscopy is 4.9% [92, 338]. Persistent structural disease is the most common cause of repeat hip preservation surgery [16]. The rate of total hip arthroplasty after hip arthroscopy was 9.3% at 2 years [371]. The unweighted proportion of revision surgery after hip arthroscopy was 5.2% [331]. The unweighted proportion of conversion to total hip arthroplasty after hip arthroscopy was 2.1% [331]. The mean time from primary hip arthroscopy to conversion to total hip arthroplasty was 45.7 months [331]. The mean time from primary hip arthroscopy to revision arthroscopy was 31.1 months [331]. The reoperation rate after revision hip arthroscopy is 5% within 2 years, including further arthroscopy or conversion to hip arthroplasty [350]. Patients undergoing revision hip arthroscopy achieve inferior functional outcomes compared to the primary setting [66]. Second-time revision hip arthroscopy results in clinically significant improvement in patient-reported outcomes, but outcomes are inferior to those obtained following primary surgeries [332]. The likelihood of requiring a subsequent hip arthroscopy was 4.83 times higher for the revision group compared with the primary group in adolescents [355]. Capsular repair is associated with lower rates of revision hip arthroscopy yet similar clinical outcomes and arthroplasty conversion 5 years after hip arthroscopy [375]. Routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules [351]. Patients with unhealed or partially healed anterior capsules after hip arthroscopy for borderline developmental dysplasia of the hips have inferior patient-reported outcome measures [42].

Surgeon Experience and Learning Curve: The nature of complications changed with experience, but no significant variation in the incidence was observed over a 9-year period of experience with hip arthroscopy [342]. Complication rates and revision arthroscopy did not differ significantly with surgeon experience, whereas conversion to total hip arthroplasty was lower in late cases [357]. There is a substantial learning curve for hip arthroscopy, and receiving specialized training likely helps to reduce the duration of this curve [321]. Resident involvement in hip arthroscopy procedures was not a risk factor for 30-day complications between 2006 and 2012 [384].

Risk Factors and Patient Characteristics: Understanding patient-related risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile [54]. There are no significant differences in reoperation rates and patient-reported outcomes between patients aged 50 years or older versus matched controls aged 20 to 35 years after primary hip arthroscopy for femoroacetabular impingement [368]. Patients with a preoperative fibromyalgia diagnosis undergoing hip arthroscopy demonstrated similar rates of complications and adverse medical events compared to matched controls [320]. Patients with a prior diagnosis of opioid-related disorder demonstrated similar rates of adverse events and revision surgery when compared to a propensity-matched group without opioid-related disorder undergoing primary hip arthroscopy [369]. The risk for secondary procedures may be evaluated with the modified Harris Hip Score (mHHS) at 1 year after primary hip arthroscopy [64]. Labral repair prevents the need for a revision procedure in patients with femoroacetabular impingement [119].

Recovery

Light activity (weeks): Patients may return to driving as early as 2 weeks after a right-sided hip arthroscopy procedure [149], with driving performance returning to preoperative levels by 2 to 4 weeks for right-sided cases and 2 weeks for left-sided procedures [82]. A general recommendation for safe return to driving is 4 weeks postoperatively [112]. Braking parameters normalize to the preoperative state at 1 week after simple arthroscopy and 2 weeks after femoroacetabular impingement surgery for right hip cases [190].

Full activity (months): Return to work occurs at a high rate, averaging 115 days after surgery [184]. Patients with workers' compensation claims demonstrate significant improvement and high rates of returning to work at a minimum 5-year follow-up [169]. Athletes return to sport at a high rate (92%; 46/50) and perform activities at near preinjury levels [204]. Reported return-to-sport rates for elite athletes are high [207], and the overall rate of reported return to play is high after hip arthroscopy for femoroacetabular impingement [218]. Hip arthroscopy yields a high rate of return to sport alongside marked improvement in pain and function in the majority of patients [226].

Complete recovery / outcome plateau (months): The provided evidence does not specify a distinct timeline for complete recovery or outcome plateau separate from the follow-up intervals cited in long-term studies.

Rehabilitation protocol: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome return to baseline levels in step count, step length, and walking speed after phase 1 (6 weeks) of rehabilitation [151]. A comprehensive five-phase rehabilitation protocol results in satisfactory clinical and functional outcomes [156]. Rehabilitation should be tailored to specific functional demands, with exercise progressions monitored closely to prevent complications such as persistent soft tissue irritation [160]. Formal physical therapy and home exercise programs are similarly efficacious in terms of patient-reported outcomes of hip function, with both options resulting in significant patient improvement at short-term follow-up from preoperative baseline [163]. Considerable variability exists in postoperative physical therapy protocols available online, including postoperative restrictions, rehabilitation activities, and time points for activities [198]. The current literature lacks high-quality evidence to support a specific protocol [222], prompting the presentation of a targeted clinical rehabilitation approach to address the lack of high-quality studies and detailed reporting on postoperative rehabilitation programs [178].

Functional milestones: 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 [359]. Early improvements in patient-reported outcome measures, assessed by 6-month minimal clinically important difference, predicted clinically meaningful outcomes at 5-year follow-up [377]. The risk for secondary procedures after primary hip arthroscopy may be evaluated with the modified Harris Hip Score at 1 year [64].

Other Considerations: Primary hip arthroscopy results in favorable midterm outcomes in high-level athletes [219]. Master athletes demonstrated favorable outcomes after primary hip arthroscopy [288], and those 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 [315]. Professional athletes with borderline hip dysplasia who underwent hip arthroscopy for femoroacetabular impingement demonstrated a 79% return-to-sport rate [322], and high-level athletes with borderline hip dysplasia undergoing primary hip arthroscopy may expect favorable midterm outcomes and high return to sport rates [334]. 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 [335]. 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 [339]. 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 [316]. 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 [340]. 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 [341]. 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 [212]. 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 [326]. 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 [66]. 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 [366]. 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 [223]. 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 [166]. 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 [215]. Former smokers who underwent primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up [206].

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 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. [26] (10.1016/j.arthro.2022.03.034)
• [L3] These may prove useful to clinicians in refining indications and guiding patients on expected outcomes of hip arthroscopy. [30] (10.1177/03635465241254076)
• [L3] A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years. [33] (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. [35] (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. [37] (10.1016/j.arth.2016.09.004)
• [L4] Clinicians should consider patient history (e.g., imaging, comorbidities, etc.) and values when electing for hip arthroscopy in the older population. [39] (10.1016/j.arthro.2022.08.019)
• [L4] With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. [40] (10.1016/j.arthro.2024.12.031)
• [L4] Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. [41] (10.1177/03635465211015431)
• [L3] [42] (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. [43] (10.1016/j.eats.2023.102893)
• [L4] Hip arthroscopy after hip arthroplasty is supported by this systematic review for a variety of indications. [44] (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. [46] (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. [47] (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)
• [L4] Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. [54] (10.1302/0301-620x.102b7.bjj-2020-0031.r1)
• [L3] [55] (10.1007/s00264-004-0585-7)
• [L3] [56] (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. [57] (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. [59] (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. [60] (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. [61] (10.1177/03635465261449801)
• [L1] The most common indications for revision hip arthroscopy were labral tears and femoroacetabular impingement. [63] (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. [64] (10.1177/0363546520974374)
• [L4] Athletes who underwent primary hip arthroscopy demonstrated favorable outcomes and high rates of clinical benefit at 5-year follow-up. [65] (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. [66] (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. [72] (10.1016/j.arthro.2014.07.013)
• [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. [75] (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. [78] (10.1016/j.arthro.2017.11.037)
• [L3] Prior ipsilateral hip arthroscopy does not appear to compromise subsequent THA in most patients. [81] (10.1186/s12891-026-10094-7)
• [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. [82] (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%. [92] (10.1016/j.arthro.2023.01.100)
• [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. [112] (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. [113] (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. [114] (10.1016/j.arthro.2024.08.007)
• [L3] [119] (10.1177/0363546520968562)
• [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. [128] (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. [129] (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. [132] (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. [143] (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. [145] (10.1177/03635465251381775)
• [L5] [146] (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. [149] (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. [151] (10.1016/j.asmr.2023.100779)
• [L4] Patients following this rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes, validating its implementation. [156] (10.1007/s00167-013-2664-z)
• [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. [160] (10.1016/j.csm.2016.02.012)
• [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. [163] (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. [164] (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. [165] (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. [166] (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. [168] (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. [169] (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. [172] (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. [173] (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. [174] (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. [175] (10.1177/2325967117s00015)
• [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. [177] (10.1177/2325967121s00032)
• [L5] The aim of this clinical commentary was to present a targeted clinical rehabilitation approach for individuals undergoing hip arthroscopy, addressing the lack of high-quality studies and detailed reporting on postoperative rehabilitation programs. [178] (10.2519/jospt.2018.8002)
• [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. [183] (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. [184] (10.1177/03635465211064271)
• [L5] Successful hip arthroscopy is most dependent on patient selection, with patient expectations being a paramount criterion. [186] (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. [188] (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. [190] (10.1186/s12891-020-03662-y)
• [L1] The most common indications for revision hip arthroscopy include unaddressed femoroacetabular impingement and new labral tears. [191] (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. [192] (10.1007/s11999-013-3202-5)
• [L3] The modified LFFC grading system demonstrated satisfactory intraobserver and interobserver reliability for patients undergoing hip arthroscopy. [193] (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. [195] (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. [198] (10.1016/j.arthro.2017.06.045)
• [L4] The most common indication for revision hip arthroscopy in the treatment of FAI remains residual impingement. [199] (10.1177/2325967121s00279)
• [L3] [200] (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. [201] (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. [202] (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. [204] (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. [206] (10.1177/23259671221097372)
• [L4] Reported return-to-sport rates for elite athletes undergoing hip arthroscopy were high. [207] (10.1002/arj.70165)
• [L4] When diagnosed, hip manipulation under anesthesia can be a viable treatment option. [211] (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. [212] (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. [215] (10.1002/arj.70099)
• [L4] The overall rate of reported return to play was high after hip arthroscopy for FAI. [218] (10.1177/03635465211038959)
• [L3] Primary hip arthroscopy results in favorable midterm outcomes in high-level athletes. [219] (10.1177/03635465211041763)
• [L2] The current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a specific protocol. [222] (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. [223] (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. [224] (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. [225] (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. [226] (10.1007/s00167-018-4929-z)
• [L3] Epidural anesthesia provides superior early postoperative analgesia and reduces intraoperative opioid use in hip arthroscopic surgery for femoroacetabular impingement syndrome. [227] (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. [228] (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. [229] (10.1177/2325967114s00091)
• [L2] Lack of relief after injection does not rule out the potential for successful long-term outcomes after hip arthroscopy. [230] (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. [231] (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. [232] (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. [233] (10.1016/j.arthro.2017.10.019)
• [L2] NSAID use was also prominent in the patient population, demonstrating that opioids and NSAIDs together can be effective pain management strategy tools for hip arthroscopy patients in the postoperative period. [234] (10.1177/23259671251397511)
• [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. [236] (10.1177/2325967121s00609)
• [L3] [241] (10.1177/2325967118778785)
• [L3] The incidence of symptomatic postoperative VTE following hip arthroscopy is low. [242] (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. [243] (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. [246] (10.1016/j.asmr.2021.11.005)
• [L4] Thromboembolic complications do occur after elective hip arthroscopy. [250] (10.1007/s00167-010-1392-x)
• [L3] More than one half of patients undergoing revision hip arthroscopy had MRI and intraoperative evidence of capsular incompetency. [252] (10.1016/j.arthro.2019.07.026)
• [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. [254] (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. [256] (10.1016/j.arthro.2017.07.006)
• [L5] [260] (10.1016/j.csm.2010.12.001)
• [L4] [268] (10.1016/j.arthro.2018.07.048)
• [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. [272] (10.1177/0363546516639252)
• [L4] [277] (10.5435/jaaos-d-17-00230)
• [L5] [280] (10.1016/j.eats.2024.103232)
• [L3] [281] (10.1177/03635465241234258)
• [L3] Labral reconstruction during primary and revision hip arthroscopy showed significant, durable clinical improvements over a minimum 5-year follow-up. [282] (10.1177/03635465261421538)
• [L3] The finding of a femoral head lesions at arthroscopy does not, in and of itself, portend a worse outcome. [283] (10.1177/2325967117s00411)
• [L3] [285] (10.1177/03635465241255950)
• [L3] Hip arthroscopy in obese patients yielded significant long-term improvements. [286] (10.1016/j.jisako.2025.100479)
• [L3] Master athletes demonstrated favorable outcomes after primary hip arthroscopy. [288] (10.1177/03635465221096843)
• [L4] [293] (10.1016/j.asmr.2022.04.016)
• [L5] [295] (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. [296] (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%. [299] (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%. [300] (10.1016/j.arthro.2013.09.015)
• [L3] Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes. [305] (10.1016/j.arth.2018.01.012)
• [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. [308] (10.1097/corr.0000000000003118)
• [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. [313] (10.1016/j.arthro.2019.05.016)
• [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. [315] (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. [316] (10.1002/arj.70385)
• [L3] [318] (10.1177/23259671261440203)
• [L3] [320] (10.1002/arj.70003)
• [L4] [321] (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. [322] (10.1177/03635465261439048)
• [L3] [325] (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. [326] (10.1002/arj.70217)
• [L4] The rate of major complications was 0.58% after hip arthroscopy. [327] (10.1016/j.arthro.2012.11.003)
• [L5] [328] (10.1016/j.eats.2023.09.014)
• [L4] [331] (10.1002/ars2.70036)
• [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. [332] (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. [334] (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. [335] (10.1177/23259671221100861)
• [L1] Obesity, smoking, and age >45 years are found to be significant risk factors for postoperative VTE after hip arthroscopy. [337] (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%. [338] (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. [339] (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. [340] (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. [341] (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. [342] (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. [343] (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. [344] (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. [349] (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. [350] (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. [351] (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. [352] (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. [353] (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. [355] (10.1002/arj.70139)
• [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). [357] (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. [359] (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. [360] (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. [361] (10.1177/2325967113s00045)
• [L3] Overall failure rate was 9.6% with 3.7% requiring revision hip arthroscopy and 5.9% converting to THA. [362] (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. [366] (10.1016/j.arthro.2023.07.047)
• [L3] There are no significant differences in reoperation rates and patient-reported outcomes between patients aged 50 years or older versus matched controls aged 20 to 35 years after primary hip arthroscopy for femoroacetabular impingement. [368] (10.1016/j.arthro.2023.01.105)
• [L3] ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity-matched group of NORD patients undergoing primary hip arthroscopy. [369] (10.1016/j.arthro.2023.12.008)
• [L3] The rate of total hip arthroplasty after hip arthroscopy was 9.3% at 2 years. [371] (10.5435/jaaos-d-20-00748)
• [L3] The overall rate of surgical site infections is low following hip arthroscopy. [372] (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. [374] (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. [375] (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. [377] (10.1016/j.jisako.2025.100467)
• [L4] The incidence of post-related complications is 5 times greater in prospective versus retrospective hip arthroscopy literature. [378] (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. [380] (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. [384] (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. [385] (10.1177/2325967121s00280)

See Also

• Femoroacetabular impingement
• Periacetabular osteotomy
• Hip resurfacing
• Hip osteoarthritis

References

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[13] Patients Undergoing Primary Hip Arthroscopy Report Favorable Outcomes at Minimum 10 Year Follow‐Up: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.10.040

[14] The Definition of Failure in Hip Arthroscopy May Include Factors Outside of Reoperation: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100962

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[16] Orthopaedic Knowledge Update Sports Medicine 6. Athletic Hip Injuries > Annotated References.

[17] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Summary.

[18] Advances in Hip Arthroscopy. Clinics in Sports Medicine. 2016. DOI: 10.1016/j.csm.2016.04.001

[19] The Role of Hip Arthroscopy in Investigating and Managing the Painful Hip Resurfacing Arthroplasty. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.08.029

[20] Orthopaedic Knowledge Update Sports Medicine 6. Athletic Hip Injuries > Introduction.

[21] Aaos Comprehensive Orthopaedic Review 3. Nonarthroplasty Surgical Treatment of the Hip > I. Femoroacetabular Impingement.

[26] Editorial Commentary : Successful Revision Hip Arthroscopy Requires Accurate Diagnosis of the Cause of Failure: “One‐Size‐Fits‐All Surgery Is Not Appropriate”. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.03.034

[30] Predictors of Clinical Outcomes After Hip Arthroscopy: 10-Year Follow-up Analysis of 1038 Patients. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241254076

[33] The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2646-5

[34] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Radiography.

[35] Editorial Commentary: Hip Arthroscopy Plays a Role in Painful Hip Resurfacing Arthroplasty but a Prearthroscopy Diagnosis Is Critical to Outcome. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.12.039

[37] Trends in Utilization and Outcomes of Hip Arthroscopy in the United States Between 2005 and 2013. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2016.09.004

[39] Hip Arthroscopy Improves Outcomes With Moderate Conversion to Total Hip Arthroplasty Rates in Patients Aged 50 Years or Older: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.019

[40] With Proper Surgical Indications, Sex‐Based Differences in Pathology Do Not Impact Hip Arthroscopy Outcomes or Complications: A Systematic Review. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.12.031

[41] Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211015431

[42] Patients With Unhealed or Partially Healed Anterior Capsules After Hip Arthroscopy for Borderline Developmental Dysplasia of the Hips Have Inferior Patient‐Reported Outcome Measures. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.024

[43] Capsular Management in Hip Arthroscopy: Interportal and T‐Capsulotomy, Suspension, and Closure. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.102893

[44] Hip arthroscopy in the setting of hip arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3379-5

[46] Trends in Hip Arthroscopy Utilization in the United States. The Journal of Arthroplasty. 2013. DOI: 10.1016/j.arth.2013.02.039

[47] Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967120987538

[48] Staged Bilateral Hip Arthroscopy Compared With a Matched Unilateral Hip Arthroscopy Group: Minimum 2-Year Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.02.025

[49] Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519885359

[50] When Do Patients Improve After Hip Arthroscopy for Femoroacetabular Impingement? A Prospective Cohort Analysis. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518795696

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

[52] The Impact of Hip Arthroscopy on the Progression of Hip Osteoarthritis in Patients With Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251326116

[54] Patient-related risk factors associated with less favourable outcomes following hip arthroscopy. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b7.bjj-2020-0031.r1

[55] Chondral degeneration and therapeutic hip arthroscopy. International Orthopaedics. 2004. DOI: 10.1007/s00264-004-0585-7

[56] The Diagnostic Accuracy of a Clinical Examination in Determining Intra‐articular Hip Pain for Potential Hip Arthroscopy Candidates. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.04.075

[57] 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

[59] 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

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

[61] 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

[63] 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

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

[65] 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

[66] 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

[70] Miller S Review Of Orthopaedics. HIP ARTHROSCOPY.

[71] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > HIP ARTHROSCOPY.

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

[75] 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

[78] Prevalence and Consistency in Surgical Outcome Reporting for Femoroacetabular Impingement Syndrome: A Scoping Review. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.11.037

[81] The effect of prior hip arthroscopy on outcomes of total hip arthroplasty: a systematic review of comparative studies. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10094-7

[82] Return to Driving After Hip Arthroscopy: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221128281

[83] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > 2. Arthrology > Hip (Fig. 2.49).

[86] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Osseous and Ligamentous Anatomy.

[87] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > IV. Hip Capsule and Ligaments.

[89] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Introduction.

[90] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Hip Development With Developmental Dysplasia of the Hip.

[92] Low Rates of 5‐Year Secondary Surgery and Postoperative Complications After Primary Hip Arthroscopy in More Than 30,000 Patients. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.100

[94] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Hip > I. General Considerations.

[98] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > VI. Neurovascular Structures Surrounding the Hip.

[99] Orthopaedic Knowledge Update Sports Medicine 6. Hip Microinstability > Introduction.

[103] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Imaging.

[112] 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

[113] A Catastrophic Complication of Hip Arthroscopy. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.02.012

[114] 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

[119] Hip Arthroscopy for Femoroacetabular Impingement: 1-Year Outcomes Predict 5-Year Outcomes. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520968562

[120] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Annotated References.

[128] 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

[129] 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

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

[142] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Summary.

[143] 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

[145] 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

[146] Hip Arthroscopy. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000195057.27653.93

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

[151] 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

[153] Rockwood And Green S Fractures In Adults. 51: Hip Dislocations and Femoral Head Fractures > Imaging and Other Diagnostic Studies for Femoral Neck Fractures.

[154] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > SECTION 1 EVALUATION OF THE ADULT PATIENT WITH HIP PAIN.

[156] 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

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

[163] 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

[164] 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

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

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

[168] 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

[169] 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

[172] 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

[173] 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

[174] 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

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

[177] 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

[178] Impairment-Based Rehabilitation Following Hip Arthroscopy: Postoperative Protocol for the HIP ARThroscopy International Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. 2018. DOI: 10.2519/jospt.2018.8002

[179] Orthopaedic Knowledge Update Sports Medicine 6. Hip Microinstability > Summary.

[183] 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

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

[186] 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

[188] 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

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

[191] 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

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

[193] 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

[195] 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

[198] 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

[199] 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

[200] 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

[201] 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

[202] 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

[204] 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

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

[206] 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

[207] 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

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

[212] 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

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

[217] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Early Degenerative Changes of the Hip > Introduction.

[218] 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

[219] 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

[222] Rehabilitation Following Hip Arthroscopy – A Systematic Review. Frontiers in Surgery. 2015. DOI: 10.3389/fsurg.2015.00021

[223] Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.03.039

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

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

[226] 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

[227] 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

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

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

[230] 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

[231] 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

[232] 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

[233] 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

[234] Opioid Usage, Disposal Methods, and NSAID Usage After Hip Arthroscopy. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251397511

[235] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Box 13.5 Age-Based Guidelines for the Treatment of Developmental Dysplasia of the Hip > Acetabular Dysplasia Presenting Late.

[236] 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

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

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

[243] 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

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

[252] Two-Year Patient-Reported Outcomes for Patients Undergoing Revision Hip Arthroscopy with Capsular Incompetency. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2019.07.026

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

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

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

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

[266] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Physical Examination.

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

[270] Orthopaedic Knowledge Update Sports Medicine 6. Hip Microinstability > Diagnosis.

[272] 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

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

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

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

[281] 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

[282] 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

[283] Do Femoral Head Osteochondral Lesions Predict a Poor Outcome in Hip Arthroscopy Patients? A Matched Control Study with Minimum 5 Year Follow-Up. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00411

[285] 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

[286] 10 Year Outcomes of Hip Arthroscopy for Femoroacetabular Impingement in Obese Patients. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100479

[288] 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

[293] 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

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

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

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

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

[305] 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] 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

[313] 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

[315] 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

[316] 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

[318] Effect of Postless Hip Arthroscopy on Functional Outcomes, Perineal Complications, and Lumbosacral Complications. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261440203

[320] Patients With Preoperative Fibromyalgia Undergoing Hip Arthroscopy Demonstrated Increased Odds of Postoperative Opioid Prescriptions Within 90 Days and 1 Year but Similar 2‐Year Reoperation Rates Compared to Matched Controls. Arthroscopy. 2026. DOI: 10.1002/arj.70003

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[326] 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

[327] 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

[328] 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

[331] Improvements in Patient‐Reported Outcomes and Few Reported Major Complications Following Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2026. DOI: 10.1002/ars2.70036

[332] 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

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[337] 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

[338] 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

[339] 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

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

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[343] 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

[344] 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

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

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[351] 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

[352] 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

[353] 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

[355] 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

[357] 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

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[362] 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

[366] 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

[368] Patient‐Reported Outcomes and Survivorship Are Not Different for Primary Hip Arthroscopy Patients of Age 50 Years and Older Compared With a 20‐ to 35‐Year‐Old Matched Cohort at Minimum 5‐Year Follow‐Up. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.105

[369] Prior Diagnosis of Opioid‐Related Disorder Is Associated With Higher Medical Resource Utilization Following Primary Hip Arthroscopy: A National Database Study. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.12.008

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[372] 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

[374] 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

[375] 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

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

[378] 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

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

[384] 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

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