The young adult with hip impingement: deciding on the optimal intervention.

Femoroacetabular impingement is a recognized cause of hip pain and osteoarthritis in young adults. The clinical presentation of this pathology is quite varied in terms of the underlying deformity, patient age, and the degree of cartilage damage. Open hip surgery with surgical dislocation is the gold standard for treating femoral deformities and the damaged acetabular labral complex; however, less invasive techniques such as hip arthroscopy and arthroscopy combined with limited anterior hip arthrotomy may provide comparable outcomes with less surgical morbidity. Unresolved issues include the indications for acetabular rim trimming with labral refixation in the presence of acetabular retroversion and/or delaminated acetabular cartilage. Other issues involve the use of arthroplasty in older patients and/or in those with significant cartilage damage.