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Our purpose is to describe the evolving indications, technical pearls and contraindications for hip arthroscopy. Although traditional clinical and radiographic measures may identify structural abnormalities or fracture or the hip, recently developed arthroscopic access to the joint has provided new ways of viewing lesions of the labrum, chondral surfaces, and synovium that previously were unrecognized. Development of hip-specific distraction equipment and instruments has allowed treatment of many conditions, especially loose bodies and labral and chondral injuries. In the senior author’s experience of more than 2000 hip arthroscopies, several key issues have been resolved. The procedure can be done safely and reproducibly. It can be done with minimal morbidity, and it can be accomplished in a cost-efficient manner as outpatient surgery. Symptom relief and functional improvement can be achieved. Further research is necessary to determine long-term outcomes.Level of Evidence: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.