Why Not Scope Only?

Many patients with hip pain are told they may benefit from hip arthroscopy to repair a labral tear or address femoroacetabular impingement (FAI). While arthroscopy can be highly effective in the right setting, it is often not sufficient on its own for patients with hip dysplasia or structural instability.

Understanding why arthroscopy alone may fail is critical to choosing the right treatment and avoiding persistent pain or repeat surgery.

What Does “Scope Only” Mean?

“Scope only” refers to performing hip arthroscopy without correcting the underlying bone structure of the hip. During arthroscopy, a surgeon may:

Repair or reconstruct the labrum
Trim bone to address FAI
Address cartilage damage
Tighten the joint capsule

For patients with normal hip socket coverage, this approach often works well.

Hip arthroscopy icon symbolizing minimally invasive surgery that does not correct structural hip instability

Why Hip Dysplasia Changes the Equation

Hip dysplasia is a structural problem, not just a soft-tissue problem.

In dysplasia, the hip socket does not adequately cover the femoral head. This leads to:

Joint instability
Increased stress on the labrum and cartilage
Early labral tears
Accelerated cartilage wear

When instability is not corrected, repairing the labrum alone is like fixing a door hinge without fixing the crooked door frame.

Why Arthroscopy Alone Often Fails in Dysplasia

1

The underlying instability remains

Arthroscopy does not reposition the hip socket. Even with a repaired labrum, the joint remains unstable.

2

The labrum is overloaded again

Without proper socket coverage, the repaired labrum continues to absorb excessive forces, increasing the risk of re-tear.

3

Pain relief may be temporary

Some patients feel initial improvement after arthroscopy, only to have symptoms return months later.

4

Repeat surgery becomes more likely

Studies show higher failure and revision rates when arthroscopy is performed alone in dysplastic hips.

A Periacetabular Osteotomy (PAO) corrects the root cause of dysplasia by:

Reorienting the hip socket
Improving femoral head coverage
Restoring joint stability
Protecting the labrum and cartilage

By addressing the structural problem, PAO creates a stable foundation for long-term hip function.

What Is PAO and Why Does It Matter?

Why Some Patients Need Both Arthroscopy and PAO

In many patients, the best approach is combined hip arthroscopy and PAO, either staged or performed together.

This allows surgeons to:

Repair labral and cartilage damage arthroscopically
Correct the socket position with PAO
Address both soft-tissue damage and instability

This team-based approach often leads to better durability and outcomes.

Are There Any Cases Where “Scope Only” Is Appropriate?

Yes — but only in carefully selected patients, such as those with:

Borderline dysplasia with adequate stability
Normal lateral center-edge angles
No signs of instability on exam or imaging
Symptoms driven primarily by FAI

Determining candidacy requires specialized imaging, clinical exam, and experience with hip preservation surgery.

The Risk of Delaying Structural Correction

Choosing arthroscopy alone when PAO is indicated may:

Delay definitive treatment
Allow further cartilage damage
Reduce long-term joint preservation options
Increase the likelihood of arthritis

This is why a comprehensive evaluation is essential before surgery.

Hip X-ray showing the pelvis and hip joint used to evaluate hip dysplasia, joint alignment, and socket coverage

How the Hip Preservation Team Decides

At the International Center for Hip Preservation, complex cases are reviewed by surgeons experienced in both arthroscopic and open hip preservation techniques. This collaborative approach helps ensure that treatment decisions are based on what the hip truly needs — not just what can be done arthroscopically.

Summary

Hip arthroscopy is a powerful tool, but it cannot correct structural instability.
For patients with hip dysplasia, treating the bone structure is often the key to lasting pain relief and joint preservation.

If you’ve been told you need a “scope only” procedure and have questions about dysplasia or instability, a second opinion with a hip preservation specialist may be helpful.