What do we mean when we say an operation works?

At a conference the other day, while hotly debating the role of hip arthroscopic surgery in the management of osteoarthritis, a friend and colleague announced to the assembled throng, 'We know that hip arthroscopy doesn't work'. You would not have expected the Editor-in-Chief of this journal to remain silent at that moment and I certainly was not. However, what the statement did highlight, of course, is what do any of us mean when we say an operation works? The first thing to remember is that hip arthroscopy is not an operation, it is a technique. One major issue, to my mind, is the apparent obsession that the success, or otherwise , of hip arthroscopy is intimately linked to femoroace-tabular impingement (FAI). That close association has brought with it many problems. I hear of regions, indeed countries that are considering rejecting hip arthroscopic surgery based solely on the assessment that it may not work for FAI. Believe me when I say, if FAI disappeared tomorrow there would still be plenty enough for a hip arthro-scopic surgeon to do. There are some surgeons around who were arthroscoping hips well before FAI was ever re-invented. How about stabilization, labral repair, labral grafting , chondral repair, loose body removal, synovectomy, sepsis, debridement, extra-articular techniques and plenty more besides? For the future of hip arthroscopy, certainly when seen from the viewpoint of this ageing orthopaedic surgeon, the sooner we can unlink hip arthroscopy from FAI in the managerial mind, so much the better. By all means lay out an algorithm for the management of FAI but do that for FAI not for hip arthroscopy. But to say an operation works depends on who you are. One surgeon may feel that the definition of success is if a patient makes it to the Recovery Area after the procedure while another is seeking 2 years of pain relief to justify recommending surgery. Meanwhile the hospital manager might prefer a short stay, no chance of readmission, and as little expenditure as may seem reasonable. The patient, who is after all the major player in all of this, might have an entirely different view. Only the other day a 40-year-old patient came to my clinic with cam FAI. I offered him hip arthroscopic surgery based on an 80% chance of success. To me that seemed reasonable and reflected my own performance figures, not those borrowed from elsewhere. However, I …