Hip arthroscopy is an up and coming field of Orthopaedics. Putting a camera (arthroscope) in the hip joint is technically more demanding than knees or shoulders and has been done only by few surgeons until recently. The recognition of conditions that can be treated with this “key-hole” operation and fellowship training has contributed to more and more surgeons starting up doing hip arthroscopies.

I feel that identifying patients who could benefit from this operation is still less than ideal. Conditions such as labral tears and femoro-acetabular impingement (FAI) is still massively under-diagnosed both in the primary and the secondary setting. The fact that most of these patients are young, active, haven’t got significant osteoarthritis and therefore not considered candidates for joint replacements and that radiographs are often reported to be normal, contributes to this.

General practitioners and physiotherapists should look out for and refer those patients who complains of:

- hip (groin or trochanteric) or sometimes knee pain with pivoting activities;

1. -pain after prolonged sitting or squatting;
   

2. -often walking or running is well tolerated;
   

3. -stairs and slopes produce more problems than level ground;
   

4. -positive impingement test: flexion-adduction-internal-rotation (FADIR) and flexion-abduction-external rotation (FABER)
   

5. -patients with unexplained, activity related hip pain should be referred for specialist assessment.
   

Radiographs are often reported normal:

1. -radiographs are normal with regards to soft tissue pathology (e.g. labral tears);
   

2. -bumps on the femoral head-neck junction (cam lesions) can be best seen on the lateral view, large bumps cause a “pistol-grip” appearance on the AP view;
   

3. -specific signs (alpha angle, crossover sign) are often overlooked and not reported by General Radiologists;
   

4. -the investigation of choice for soft tissue abnormality is MRI, to assess a cam lesion CT scan (with 3D reconstruction) is particularly useful.
   

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