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Studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) with associated labral tears. The purposes of this study were to report 10-year outcomes and hip survival following hip arthroscopy for FAI and to compare labral debridement with labral repair.Prospectively collected data on patients followed for a minimum of 10 years after hip arthroscopy for FAI with either labral debridement or labral repair performed by a single surgeon were retrospectively analyzed. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. Mann-Whitney U tests were used to compare outcomes between groups, and Wilcoxon signed-rank tests were used to compare preoperative with postoperative scores. Survival analysis was performed using a multivariate Cox proportional hazards model.Seventy-nine patients who underwent labral repair and 75 who underwent debridement were included in the study, and 94% (145) were followed for ≥10 years. Fifty patients (34%) underwent total hip arthroplasty (THA) within 10 years following the arthroscopy. Older patients, hips with ≤2 mm of joint space preoperatively, and patients requiring acetabular microfracture had significantly higher prevalences of THA. The multivariate Cox proportional hazards model showed that increased age (hazard ratio [HR] for 31 years to 51 years = 3.06, 95% confidence interval [CI] = 1.69 to 5.56, p < 0.001), a joint space of ≤2 mm (HR = 4.26, 95% CI = 1.98 to 9.21, p < 0.001), and acetabular microfracture (HR = 2.86, 95% CI = 1.07 to 7.62, p = 0.036) were independently associated with an increased hazard rate for THA. When the analysis was adjusted for these factors, there was no significant difference in the HR between treatment groups (HR = 1.10, 95% CI = 0.59 to 2.05, p = 0.762). There was also no significant difference in postoperative outcome scores between groups. The debridement group demonstrated a significant increase, between the preoperative and postoperative evaluations, in the HOS-ADL score (from 71 to 96; p < 0.001), HOS-Sport score (from 42 to 89; p < 0.001), modified Harris hip score (mHHS) (from 62 to 90; p < 0.001), and Short Form-12 physical component summary (SF-12 PCS) score (from 43 to 56; p < 0.001). The repair group also demonstrated a significant increase in the HOS-ADL score (from 71 to 96; p < 0.001), HOS-Sport score (from 47 to 87; p < 0.001), mHHS score (from 65 to 85; p < 0.001), and SF-12 PCS score (from 41 to 56; p < 0.001). The median patient satisfaction score was 10 (very satisfied) in both groups.Hip arthroscopy for FAI with labral debridement or repair resulted in significant improvements in the patient-reported outcomes and satisfaction of patients who did not eventually require THA. Higher rates of conversion to THA were seen in older patients, patients treated with acetabular microfracture, and hips with ≤2 mm of joint space preoperatively, regardless of labral treatment.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.