Hip arthroscopic surgery: Patient evaluation, current indications, and outcomes

Arthroscopic surgery in the hip joint has historically lagged behind its counterparts in the shoulder and knee. However, the management of hip injuries in the athletic population has rapidly evolved over the past decade with our improved understanding of mechanical hip pathology as well as the marked improvement in imaging modalities and arthroscopic techniques. Current indications for hip arthroscopic surgery may include symptomatic labral tears, femoroacetabular impingement (FAI), hip capsular laxity/instability, chondral lesions, disorders of the peritrochanteric or deep gluteal space, septic joint, loose bodies, and ligamentum teres injuries. Furthermore, hip arthroscopic surgery is developing an increasingly important role as an adjunct diagnostic and therapeutic tool in conjunction with open femoral and/or periacetabular osteotomy for complex hip deformities. Arthroscopic techniques have evolved to allow for effective and comprehensive treatment of various hip deformities. Techniques for extensile arthroscopic capsulotomies have allowed for improved central and peripheral compartment exposure and access for labral takedown, refixation, treatment of chondral injury, and osteochondroplasty of the femoral head-neck junction and acetabular rim. While favorable short-term and midterm clinical outcomes have been reported after arthroscopic treatment of prearthritic hip lesions, greater long-term follow-up is necessary to assess the efficacy of hip arthroscopic surgery in altering the natural history and progressive degenerative changes associated with FAI.