Arthroscopic removal of symptomatic loose bodies from the hip joint has become an accepted treatment option, and the clearest indication for arthroscopic intervention in the hip. Although accepted, the procedure should be used judiciously within its narrowly defined indications, because it is technically difficult, has a steep learning curve, requires specialized equipment, and is not without complication. Removal of loose bodies from an articulation has been effective in relieving mechanical symptoms, but although it makes intuitive sense that loose body removal prevents future joint degeneration, this has been shown only in the posttraumatic situation.3 When hip disease or a pathological condition results in loose body formation, symptomatic improvement can be expected after arthroscopic removal, but the effect on the future of the joint remains dependent on the natural history of the underlying condition. Examples include osteoarthritis, synovial chondromatosis, and avascular necrosis; in each process the disease is affected, but not cured by arthroscopic intervention. Progression or recurrence of disease unfortunately cannot be predicted with our current knowledge, except in advanced cases that undoubtedly will progress to joint degeneration necessitating joint replacement. The minimally invasive nature and low morbidity associated with hip arthroscopy make the procedure ideal for establishing an early preventive strategy to treat symptomatic patients with loose bodies in the hip joint. Regardless of the underlying disease, intervention may slow disease progression that would have otherwise been managed using palliative measures. Before advocating preemptive and widespread hip arthroscopy, disease and stage-specific intervention needs to be delineated to determine when and if ar-throscopy is beneficial. The current literature essentially supports the applicability of hip arthroscopy in the removal of loose bodies, alluding to its efficacy in specific situations. Long-term outcome studies supported by large numbers of patients will be required to prove or disprove the effectiveness of these interventions.
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