Beyond the Scope Open Treatment of Femoroacetabular Impingement.

Hip arthroscopy as we know it today developed over the last 15 to 20 years, yet its true beginning is far more dated. Initially developed as a means of removing loose bodies or as a means of lavage, hip arthroscopy was not utilized to treat femoroacetabular impingement (FAI) until much later. Its usefulness as a means of treating FAI did not arise until hip impingement was understood to be causal in the development of degenerative changes of the labrum and articular surfaces. As our understanding of FAI grew, the tools for treating it developed in tandem. Open treatment of FAI had been the first treatment of choice as this allowed for circumferential access to the femoral head, labrum, and acetabulum, which could be done without compromising femoral head perfusion. Yet, as arthroscopic techniques evolved, allowing for better access to the femoral head, labrum, and acetabulum, treatment of FAI with arthroscopy became the norm. However, several recent reports of revision hip arthroscopy for treatment of residual FAI have exposed potential shortcomings of arthroscopic treatment of FAI, specifically limitations with hip arthroscopy's ability to address large or complex cam and pincer deformities. While hip arthroscopy can certainly be useful for treatment of FAI in some patients, we have yet to identify which patients truly benefit from this minimally invasive approach and those who are better served by open surgical techniques. Honing our understanding of the pathology of FAI will help improve patient selection and therefore patient outcomes.