Hip arthroscopy - separating the evidence from the hype and why we need it
Hip arthroscopy has evolved from a marginal, technically demanding procedure performed by a handful of pioneers into a consolidated component of contemporary hip preservation surgery. This editorial, written ahead of the forthcoming ESSKA Congress in Prague, offers a personal and historical perspective on that journey, drawing on more than two decades of clinical experience and active involvement within ESSKA’s Hip Arthroscopy Committee, now expanded into the European Hip Preservation Associates (EHPA) section.
The author retraces the difficult early years of hip arthroscopy at the turn of the millennium, when published evidence was scarce, casuistry limited, indications poorly understood, and procedures essentially confined to loose body removal and labral debridement, the latter associated with disappointing mid-term outcomes. The article highlights the conceptual turning point represented by Reinhold Ganz’s definition of femoroacetabular impingement syndrome (FAIS), which transformed hip conservative surgery from the mid-2000s onwards, and the seminal contributions of Sampson, Kelly and Philippon to arthroscopic cam osteoplasty, labral suture and treatment of FAIS in athletes.
The initial scepticism of senior hip surgeons, who occasionally dismissed cam osteoplasty as mere “osteophyte surgery”, is also addressed. The current state of the art is then reviewed, emphasising the broad therapeutic armamentarium now available through the arthroscope: postless hip distraction, femoral and acetabular osteoplasty (including correction of coxa profunda), labral and capsular repair or reconstruction, removal of loose bodies and benign bone tumours, management of aggressive synovitis of the acetabular fossa, gluteal tendon repair, psoas tenotomy, and ligamentum teres reconstruction.
The author argues that, although hip arthroscopy remains demanding, time-consuming and reserved for adequately trained surgeons with a long learning curve, it now delivers reproducible benefits with an acceptable complication profile. The piece is intended for orthopaedic surgeons, trainees and researchers seeking historical context, a clear understanding of why hip arthroscopy is needed, and an appreciation of why its full potential has not yet been reached.
