Objective:

To investigate the clinical, radiographic, and arthroscopic presentation of patients with subchondral insufficiency fracture of the femoral head (SIFFH) and the outcomes following arthroscopic treatment, emphasizing the clinical significance of these findings.

Key Findings:

• SIFFH is an uncommon cause of acute hip pain, often misdiagnosed as osteonecrosis, which can lead to delayed treatment.
• MRI is effective in diagnosing SIFFH, showing characteristic bone marrow edema and low-intensity bands, which are crucial for accurate diagnosis.
• Surgical treatment options include trochanteric rotational osteotomy for younger patients and total hip arthroplasty for older patients, emphasizing the need for tailored approaches based on patient age.
• Hip arthroscopy allows for minimally invasive treatment of SIFFH and associated intra-articular pathologies, potentially improving recovery times.

Interpretation:

Hip arthroscopy is a valuable tool for diagnosing and treating precollapse SIFFH, potentially improving outcomes through minimally invasive techniques.

Limitations:

• The retrospective nature of the study may introduce bias, affecting the reliability of the outcomes.
• The small sample size with only nine patients meeting inclusion criteria may limit the generalizability of the findings.

Conclusion:

Hip arthroscopy can effectively assess and treat precollapse SIFFH, offering a promising minimally invasive option for patients, which could significantly impact clinical practice.