title: Interventions for hip pain in the maturing athlete: the role of hip arthroscopy?
abstract: BACKGROUND
  Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes.
  
  
  METHODS
  Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities.
  
  
  CONCLUSIONS
  Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good long-term results. Improvements in hip arthroscopy have led to outcomes equivalent to open surgery while utilizing significantly less invasive techniques. However, outcomes may ultimately depend on the degree of underlying OA. When counseling the mature athlete with hip pain, an understanding of the underlying anatomy, degree of arthritis, and expectations will help guide the treating surgeon in offering appropriate treatment options.
authors.affiliation: MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: M Mustafa
authors.initials: MM
authors.lastname: Gomberawalla
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.affiliation: MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan ; Center for Hip Preservation, Hospital for Special Surgery, New York, New York.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
keywords: femoroacetabular impingement; hip arthroscopy; hip pain; joint preservation