Hip Arthroscopy Evolution and Causes of Failure.

Abstract Hip arthroscopy utilization has grown due to expanding indications; improved imaging including higher resolution MRI with stronger magnetic fields and the advent of 3D CT revealing the nuances of hip joint morphology; increased specialized training; improvements in instruments and implants; a record of successful outcomes; and increased understanding of microinstability, focal acetabular undercoverage or occult dysplasia, segmental or circumferential labral reconstruction, capsular plication, and most of all, femoroacetabular impingement syndrome (FAIS), the leading diagnosis for which hip arthroscopy is performed, in the orthopaedic community, and the general medical and athletic communities. We now know that labral repair results in better outcomes than labral debridement, and evidence suggests that capsule closure leads to better long-term success. Osteoarthritis and it's correlate, advanced age, result in inferior survivorship after hip arthroscopy which is unsurprising; hip preservation surgery is not designed to treat irreparable cartilage damage. Association of female sex with hip arthroscopy failure requires additional investigation. More females undergo hip arthroscopy than males, and females initially present with greater disability. Females tend to have smaller alpha angles, greater femoral and acetabular anteversion, and lower center edge angles than males, consistent with increased risk of hip dysplasia. Thus, surgeons indicating females for hip arthroscopy should be aware of atypical locations of cam lesions, borderline dysplasia, or ligamentous laxity, all of which must be appropriately respected at the time of surgery. With all of the improvements we have made in techniques, patient diagnosis and surgical indications, and our overall understanding of complex anatomy and a technically challenging surgery, we can speculate that our long-term survivorship will only improve. I await with interest the long-term outcomes we will see 10 years from today, with the addition of insight from PROMs to answer these questions with greater certainty.