Hip preservation surgery for the treatment of nonarthritic or prearthritic conditions has increased in popularity and utility over the last decade. The goal of hip preservation surgery is to decrease pain, improve function, and ideally delay or prevent the onset of early osteoarthritis. As we continue to expand the use of hip preservation surgery, it behooves us to continue to investigate the appropriate indications for hip preservation surgery and identify potentially modifiable factors that can influence the outcomes of these procedures.

The question that is raised by Fabricant et al. is whether femoral version is a modifiable variable that affects outcomes of hip preservation surgery. It is a continuation of previous investigations from this research group that has been investigating the role of femoral version on outcomes after hip arthroscopy．

A basis for this concern regarding the role of femoral version on outcomes after hip arthroscopy can be traced to work by Tönnis and Heinecke that found an association between relative decreases in femoral version and increases in the prevalence of hip osteoarthritis. Those authors demonstrated that patients with elevated femoral anteversion had increased hip internal rotation, whereas patients with relative femoral retroversion had increased hip external rotation. That manuscript also indicated a relationship between the presence of hip pain and the degree of femoral version, with pain being greatest at the extremes of both anteversion and retroversion. The authors’ expert opinion was that operative treatment of excessive femoral version could be used to decrease pain and prevent early osteoarthritis.