Clinical Equipoise Regarding Arthroscopic Management of Femoroacetabular Impingement with Tönnis Grade 2 Osteoarthritis May Mean We Don't Know or Don't Agree: It Does Not Mean We Don't Care.

Management of patients with FAI and moderate (Tönnis grade 2) osteoarthritis remains a debated topic. Outcomes demonstrate that such patients can benefit from hip arthroscopy, yet the improvement may not be as favorable as desired. While certain factors, such as Tönnis grade 3 hip OA, older age, higher BMI, bipolar cartilage defects, and joint space less than 2mm may influence surgeons to avoid arthroscopic treatments, the threshold for grade 2 OA is not as clear. Moreover, while radiographs may appear similar in Tönnis 2, there may be a wide range of chondral damage seen arthroscopically. Thus, until higher level studies are performed, it is the responsibility of the surgeon to delineate appropriate treatment strategies for individual patients in this category, and most of all, it is crucial for surgeons to set reasonable expectations for patients when considering hip arthroscopy. This highlights the importance of careful preoperative evaluation and patient education. .