Introduction The hip is the second most common area for injury in collegiate athletes and may account for 2–5% of all sports injuries. Hip and groin pain in the athlete has long been associated with structural abnormalities of the femoral neck, acetabulum and labral pathology.

Review The relationship between osteoarthritis and femoroacetabular impingement (FAI) is well established now with clinical studies, radiographic studies and computer simulations.

Treatment The successful treatment of the athlete with FAI and subsequent labral and chondral damage has been well documented. New techniques, such as labral reconstruction, are being developed to address the more complex injuries seen in athletes, while helping to protect the joint surfaces and decrease the risk of early onsite osteoarthritis.

Conclusion The athlete's painful hip, which is becoming an increasingly more common complaint, is being identified and treated with greater chances of returning to play without compromising long-term hip function and the progression of hip osteoarthritis.