title: The evidence for hip arthroscopy: grading the current indications.
abstract: OBJECTIVE
  The purpose of this systematic review is to provide a comprehensive analysis of the Level of Evidence and the Grade of Recommendation for hip arthroscopy.
  
  
  METHODS
  A literature review was performed (in June 2010) using the PubMed and Cochrane databases. Studies that focused on the efficacy of hip arthroscopy for all therapeutic indications were reviewed to determine their Level of Evidence. The studies were grouped based on indication, and the literature supporting each indication was analyzed and assigned a Grade of Recommendation. A subscale proposed by us was used to further describe the evidence base for indications receiving a Grade of Recommendation indicating poor-quality evidence.
  
  
  RESULTS
  Fair evidence (grade B) exists to support the surgical technique of hip arthroscopy for the treatment of femoroacetabular impingement. Poor-quality evidence (grade C(f)) exists to support a recommendation for the use of hip arthroscopy in the treatment of acetabular labral tears, extra-articular lesions, septic arthritis, and loose bodies. There is poor-quality conflicting evidence (C(c)) regarding the use of hip arthroscopy for the treatment of mild to moderate osteoarthritis of the hip.
  
  
  CONCLUSIONS
  Although fair evidence (grade B) exists to support the use of hip arthroscopy for the treatment of femoroacetabular impingement, a majority of recognized indications for this surgical technique currently lack adequate evidence-based support in the literature (grade C or grade I). Higher-quality trials (Level I and Level II) are needed to provide support for the increasing application of this surgical technique. We also applied a new subscale to the grades of recommendation for summaries or reviews of orthopaedic surgical studies proposed by Wright et al. to provide a description of the direction in which outcomes are trending in Level IV studies.
  
  
  METHODS
  Level IV, systematic review.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery,Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stevens
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Legay
authors.forename: Mark A
authors.initials: MA
authors.lastname: Glazebrook
authors.forename: David
authors.initials: D
authors.lastname: Amirault
mesh_terms: D001182:Arthroscopy / Q000379:methods* / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome