Trends in Hip Arthroscopy Require Rapid Dissemination From Higher Volume and Academic Surgeons to the Greater Orthopaedic Community.

Trends in hip arthroscopy show that labral repair and preservation, capsular repair and preservation, and treatment of FAI during hip arthroscopy are associated with superior short-term and mid- to longer-term outcomes. Hip arthroscopy, and in particular arthroscopic femoroacetabular impingement (FAI) correction, is in its infancy compared to many other orthopaedic procedures. As we assimilate knowledge, data, and evidence-based research, it is critical to evaluate surgical trends and how they affect our management of these patients and pathologies. However, it is important to recognize that there is great variability with regards to surgical volume and awareness of impending evidence-based research for relatively newer procedures such as hip arthroscopy. This can lead to delays for incorporating newer evidence-based techniques. The gap is closing, but the time required to close this disparity in management trends between higher volume/academic surgeons and the orthopaedic community as a whole could be shorter. Whether this delay for adapting evidence-based trends is consistent across the spectrum of orthopaedic surgery or specific to smaller subspecialty areas such as hip arthroscopy is unclear. Regardless, it is essential that those who are doing the larger volume of cases and research must raise our voices, turn up our loudspeakers, and publish, present, and use social media platforms to spread the word of the latest evidence-based trends quickly! It is equally critical for the greater orthopaedic community to listen to the benefit of patients. If all parties collaborate, we can get up to speed in a more timely manner and achieve the best possible outcomes together. In comparison to other orthopedic disorders and procedures, non-arthritic hip disorders and hip arthroscopy are still in a period of relative infancy. The last 20 years has produced an increasing body of evidence-based work from open and arthroscopic hip preservation surgeons. We initially focused on simply accessing the joint arthroscopically with much excitement if the femoral head, acetabulum, or labrum were visualized. Although our focus early moved to management of labral tears and capsular management, an improved understanding and dissemination of the concept of hip FAI in addition to hip dysplasia markedly changed the landscape for hip arthroscopy. Sports medicine surgeons began to consume knowledge regarding hip pathoanatomy and developed innovative techniques to more comprehensively manage these disorders with an arthroscopic approach. As a result of these innovations, open hip preservation / reconstruction surgeons also realized the potential to manage FAI arthroscopically without the need for open corrective procedures for a large proportion of these patients. The amount of research regarding hip arthroscopy began to escalate at a rapid pace showing great promise with regards to arthroscopic management of these hip disorders in the late 2000's and beyond. Studies have evaluated the results of labral repair, capsular repair, management of FAI and very mild dysplasia, and we have further refined our indications and optimal management of these hip disorders based on this evidence (1,2,3,4,5,6,7,8,9,10). As a resident, I saw 2 hip arthroscopies and had no expertise or training to help implement this into my practice. However, as younger surgeons are currently exposed to larger numbers of hip arthroscopy in residency and fellowship, there has been a significant growth in the number of surgeons incorporating this into their practice. In contrast to over 20 years ago when I came out of fellowship and embarked on hip arthroscopy flying by the seat of my pants without any roadmap to success, surgeons today must be familiar with the increasing evidence regarding patient selection and surgical techniques. These evidence-based changes in hip arthroscopy management should be reflected in the procedural trends seen over the last 10-20 years.