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Access to the hip joint by arthroscopic means was once considered an impossible task due to the complexity of the joint and the inability to insert an instrument directly between the femoral head and acetabulum.1 Since Burman's1 initial report, advances in surgical techniques have not only proven arthroscopy to be a safe and effective tool in treating hip pathology, but have also allowed for the diagnosis of previously unrecognized, and thus untreated, hip conditions.2 It is important to recognize that such strides have created new options for patients and surgeons and have provided a greater understanding of the nature of the intra-articular hip pathology.
Indications for hip arthroscopy have expanded significantly and currently include symptomatic acetabular labral tears, hip capsule laxity and instability, chondral lesions, osteochondritis dissecans, ligamentum teres injuries, snapping hip syndrome, iliospsoas bursitis, loose bodies, and femoroacetabular impingement. Less commonly used indications include management of the early stages of osteonecrosis of the femoral head, synovial abnormalities, crystalline hip arthropathy, infection, and posttraumatic intra-articular debris.3 Under judicial discretion of the treating surgeon, hip arthroscopy has been useful in treating symptoms and delaying the need for total hip arthroplasty (THA) in some cases of mild to moderate osteoarthritis.4,5 This expanding list of indications and operative techniques has led to a subsequent increase in hip arthroscopy procedures performed annually. Consequently, this has also led to an increase in failed arthroscopy and revision procedures.
Presence of Osteoarthritis
Although hip arthroscopy has become a reliable option in treating many pathologic hip conditions, the treating physician must be diligent in assessing the overall condition of the joint, as well as in making an accurate preoperative diagnosis. Failed hip arthroscopy, defined as either persistent pain or eventual total hip replacement, has been attributed to incorrect preoperative diagnosis and poor patient selection.4,6
In determining whether hip arthroscopy is an option for the treatment of a particular condition, the treating physician should pay considerable attention to the presence and the degree of degenerative change within the hip joint. Current evidence demonstrates limited success and suboptimal outcomes after arthroscopic intervention indicated for symptomatic relief of early stages of osteoarthritis.4,5 Furthermore, the presence of arthritis in conjunction with any other indication for arthroscopic intervention has been...