Editorial Commentary: Proceed With Caution-Why Hip Arthroplasty After Failed Hip Arthroscopy Demands a Higher Diagnostic Bar.

Abstract

With the rapid expansion of hip arthroscopy, total hip arthroplasty (THA) following prior arthroscopic intervention is becoming an increasingly common clinical scenario. Yet the literature remains divided on whether the prior arthroscopy meaningfully degrades arthroplasty outcomes. Most patient-reported outcome data trend toward equivalence, while the largest and most recent matched and database studies consistently showed higher rates of dislocation, reoperation, and revision in the prior-arthroscopy cohort. Two patient subgroups warrant particular caution: those converting to THA within 1 year of arthroscopy and those proceeding to THA with minimal radiographic arthritis (Tönnis 0-1). In both groups, THA is more likely to disappoint because the pain generator may not be the joint at all. I argue that THA after failed hip arthroscopy should be a deliberate, evidence-supported decision, not a default endpoint, and that the diagnostic burden before arthroplasty should be raised, not lowered, in patients without clear radiographic disease.