July 2024

Modern Hip Arthroscopy: Evidence Demonstrates Efficacy, Durability and Hip Joint Preservation

By Andrea, M. Spiker, M.D. Member, AANA Communications and Technology Committee


I recently overheard another physician, in a specialty which shall remain unnamed, who confidently told his team “There is no evidence to support hip arthroscopy” while preparing to care for a patient indicated for hip arthroscopy surgery. This event was the inspiration for this month’s enewsletter topic: Modern Hip Arthroscopy: Evidence Demonstrates Efficacy, Durability, and Hip Joint Preservation. I hope to highlight what has now grown to be abundant literature supporting hip arthroscopy as a successful intervention for multiple hip pathologies, most commonly femoroacetabular impingement and hip labral tears. As a surgeon who performs hip arthroscopy and hip preservation surgeries along with other sports medicine surgeries, it is shocking to me that there is still a stigma of the “unproven” surrounding hip arthroscopy. This outdated, historical stereotype has apparently percolated other medical specialties, embedding itself in the unabashed (and uninformed) opinions of even recently trained attendings in non-orthopaedic specialties.


When hip arthroscopy was first introduced in the 1970s-1990s, it was indeed met with skepticism by the orthopaedic community. Drs. Richard Gross, James Glick and Thomas Sampson described hip arthroscopy in the lateral position beginning in the 1970s, and in the 1990s, Dr. J.W. Thomas Byrd published his success with the supine position.1 Over the past 30+ years, hip arthroscopists and hip preservation surgeons have diligently worked to improve equipment, instrumentation and our understanding of the underlying hip pathologies and how best to treat these. Surgeons have carefully documented patient outcomes, technique modifications, anatomic analyses and long-term follow-ups, which has now resulted in a solid and ever-expanding body of literature demonstrating the effectiveness of hip arthroscopy, more finely tuned indications for the procedure and now evidence supporting hip arthroscopy’s role in preventing hip arthritis. 


Ample literature now supports that hip arthroscopy, in the appropriately indicated patient, is an effective surgical intervention which improves patient outcomes at short, mid and long-term follow-up.2–5 It is a minimally invasive surgery with a low risk of complication,6–9 and with a low risk of requiring additional surgery.10,11 Hip arthroscopy has been shown to be more cost effective than nonoperative management at treating femoroacetabular impingement syndrome and labral tears based on gains in quality-adjusted life-years (QALY).12


Recently, multiple studies have demonstrated a preventative effect of hip arthroscopy. While it always made sense that removing the mechanical source of soft tissue impingement in the hip (excess bone known as cam or pincer lesions) would relieve symptoms, it has taken much longer to demonstrate efficacy of this surgery in preventing articular cartilage wear (aka osteoarthritis). Husen et al. evaluated patients with 13-year follow-up and found that those who had been treated with hip arthroscopy had a lower progression to total hip arthroplasty (THA) than those with femoroacetabular impingement who had been treated nonoperatively.13 Ramkumar et al. recently published the results of 12-year follow-up, demonstrating a relative risk reduction of 42% in the progression of hip osteoarthritis in hips treated with hip arthroscopy.14 These studies represent some the first of hopefully many forthcoming publications supporting the hip preservation potential of hip arthroscopy.


The American College of Physicians Ethics Manual states “It is unethical for a physician to disparage the professional competence, knowledge, qualifications, or services of another physician to a patient or third party or to state or imply that a patient has been poorly managed or mistreated by a colleague, without substantial evidence…”15 (p.93). While the aforementioned physician’s comment that “there is no evidence to support hip arthroscopy” was not directly targeted at a physician or to a patient, his audience consisted of other physicians, nurses, technicians and trainees, and reflects a type of interprofessional criticism counter to the “culture of respect” that is necessary to ensure the best patient outcomes.16,17 He was obviously unaware of the evidence contrary to his uneducated statement – but recognizing the limits of one’s knowledge is critically important in providing the best care to our patients. With so much evidence to support the efficacy, durability and hip preservation potential of hip arthroscopy, I hope that we can dispel the unfounded, surprisingly still persistent, belief that hip arthroscopy is less than the successful surgery it has become.


  1. Kandil, A., Safran, M.R. Hip Arthroscopy: A Brief History. Clinical Journal of Sport Medicine. 2016;35(3):321-329. doi:10.1016/J.CSM.2016.02.001
  2. Khan, M., Habib, A., de Sa,D., et al. Arthroscopy Up to Date: Hip Femoroacetabular Impingement. Arthroscopy. 2016;32(1):177-189. doi:10.1016/J.ARTHRO.2015.10.010
  3. Hevesi, M., Krych, A.J., Johnson, N.R., et al. Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up. American Journal of Sports Medicine. 2018;46(2):280-287. doi:10.1177/0363546517734180
  4. Griffin, D.W., Kinnard, M.J., Formby, P.M., McCabe, M.P., Anderson, T.D. Outcomes of Hip Arthroscopy in the Older Adult: A Systematic Review of the Literature. American Journal of Sports Medicine. 2017;45(8):1928-1936. doi:10.1177/0363546516667915
  5. Domb, B.G., Martin, T.J., Gui, C., Chandrasekaran, S., Suarez-Ahedo, C., Lodhia, P. Predictors of Clinical Outcomes After Hip Arthroscopy: A Prospective Analysis of 1038 Patients With 2-Year Follow-up. American Journal of Sports Medicine. 2018;46(6):1324-1330. doi:10.1177/0363546518763362
  6. Weber, A.E., Harris, J.D., Nho, S.J. Complications in Hip Arthroscopy: A Systematic Review and Strategies for Prevention. Sports Medicine and Arthroscopy Review. 2015;23(4):187-193. doi:10.1097/JSA.0000000000000084
  7. Nakano, N., Lisenda, L., Khanduja, V., Jones, T.L., Loveday, D.T. Complications Following Arthroscopic Surgery of the Hip: A Systematic Review of 36,761 Cases. Journal of Bone and Joint Surgery, British. 2017;99-B(12):1577-1583. doi:10.1302/0301-620X.99B12.BJJ-2017-0043.R2
  8. Degen, R.M., McClure, J.A., Le, B., Welk, B., Lanting, B., Marsh, J.D. Hip Arthroscopy Utilization and Reoperation Rates in Ontario: A Population-Based Analysis Comparing Different Age Cohorts. Canadian Journal of Surgery. 2022;65(2):E228-E235. doi:10.1503/cjs.025020
  9. Cvetanovich, G.L., Chalmers, P.N., Levy, D.M., et al. Hip Arthroscopy Surgical Volume Trends and 30-Day Postoperative Complications. Arthroscopy. 2016;32(7):1286-1292. doi:10.1016/J.ARTHRO.2016.01.042
  10. Kester, B.S., Capogna, B., Mahure, S.A., Ryan, M.K., Mollon, B., Youm, T. Independent Risk Factors for Revision Surgery or Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Review of a Large Statewide Database From 2011 to 2012. Arthroscopy. 2018;34(2):464-470. doi:10.1016/J.ARTHRO.2017.08.297
  11. Cvetanovich, G.L., Harris, J.D., Erickson, B.J., Bach, B.R., Bush-Joseph, C.A., Nho, S.J. Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes. Arthroscopy. 2015;31(7):1382-1390. doi:10.1016/J.ARTHRO.2014.12.027
  12. Go, C.C., Kyin, C., Chen, J.W., Domb, B.G., Maldonado, D.R. Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2021;9(3). doi:10.1177/2325967120987538
  13. Husen, M., Leland, D.P., Melugin, H.P., et al. Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients. American Journal of Sports Medicine. 2023;51(11):2986-2995. doi:10.1177/03635465231188114
  14. Ramkumar, P.N., Olsen, R.J., Shaikh, H.J.F., Nawabi, D.H., Kelly, B.T. Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. American Journal of Sports Medicine. 2024;52(5):1137-1143. doi:10.1177/03635465241232154
  15. Snyder, L. American College of Physicians Ethics Manual: sixth edition. Annals of Internal Medicine. 2012;156(1 Pt 2):73. doi:10.7326/0003-4819-156-1-201201031-00001
  16. Leape, L.L., Shore, M.F., Dienstag, J.L., et al. Perspective: A Culture of Respect, Part 2: Creating a Culture of Respect. Academic Medicine. 2012;87(7):853-858. doi:10.1097/ACM.0B013E3182583536
  17. McDaniel, S.H., Morse, D.S., Reis, S., et al. Physicians Criticizing Physicians to Patients. Journal of General Internal Medicine. 2013;28(11):1405-1409. doi:10.1007/S11606-013-2499-9
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