Editorial Commentary : Bilateral Staged Hip Arthroscopy for Femoroacetabular Impingement: Timing Is in the Eye of the Beholder

Abstract

The timing of surgery on the second symptomatic hip in bilateral femoroacetabular impingement syndrome remains uncertain. Simultaneous bilateral surgery is demanding for patients, with many surgeons preferring staged procedures. Unfortunately for the evidence‐based hip arthroscopist, prior studies have identified conflicting thresholds for the interval between procedures beyond which patient outcomes may decline. The literature supporting this decision is often underpowered to detect differences in failure rates and seldom accounts for the progression of osteoarthritis. Without definitive evidence, the interval between hip procedures should remain a shared decision. Shorter staging intervals may suit patients with bilateral symptoms and sport‐ or work‐related time constraints, although they risk overtreating a contralateral hip that may improve without surgery. Longer staging allows the first hip to recover, but risks prolonged pain and progression of intra‐articular pathology. Adequately powered prospective studies that stratify patients by bilateral symptom status at presentation are needed before we consider adjusting our clinical practice.