Well, thank you, Chris and Vikas, for a fantastic case. This is really a perfect tweener. And thank you for choosing a very formidable adversary for me. So I'll argue for scope. My disclosures are with the Academy. This is a hard argument, because the hip replacement was called the operation of the century by the Lancet and is perhaps the holy grail of orthopedics, probably the best operation ever invented. So I have to argue that scope is better. Neil Gershenfeld said, give ordinary people the right tools, and they'll design and build the most extraordinary things. So let's do that in this case. So I guess the first question is, is this actually tonus 2? And again, perfectly chosen case, really a tweener. If it is tonus 2, there are limited indications and benefit of arthroscopy in tonus 2 hips. So it looks like the debate is probably over at this point. But let's come back to that. Is it tonus 2? There it has intact joint space, minimal sclerosis, maybe the beginnings of a subchondral cyst. On the MRI, you can see it a little bit better. But it's peripheral, where it was caused by FAI, not central in the weight-bearing zone. And maybe an osteophyte versus a primary CAM. So overall, this might actually fit closer in the tonus 1 category, if you take it all together. And in tonus 1 hips, our registry data has shown we can predict excellent outcomes. But it's not so easy. This is clearly a hard case to tackle arthroscopically. And to achieve a pain-free hip, we need precision FAI correction. We need labral restoration to restore the seal. We need to handle the cartilage damage in one way or another. And we need good capsular management. So not an easy case at all. We know labral repair is superior to debridement at short- and long-term follow-up. I think Chris gave us the first-ever data on that. We also know that we can achieve very good outcomes with the irreparable labrum using labral reconstruction. So labral reconstruction has given us a durable option for those patients with 87% survival at five-year follow-up. And we're currently in process of publishing the tenured data. And these results have been comparable to hips that had repairable labrum. So the fact that a labrum might be irreparable need not stop us at this point. Curing the FAI is paramount importance in this case. The CAM deformities cause higher-grade cartilage damage. Inaccurate femoroplasties are associated with lower survivorship and outcome scores. And optimal femoroplasties may actually change the natural history of a pre-arthritic hip. This is one of the papers we did on the technique for spherical femoroplasty. Again, something that Chris Larson's done a lot on. And getting a perfectly spherical femoroplasty with floral guidance in our hands has made a difference. Microfractures for chondral damage. We've shown nearly 80% survivorship at ten-year follow-up with microfractures. And furthermore, in the handful of second looks we've had, have seen excellent fill of those defects. We've also seen that those results can be maintained even with larger chondral defects on the acetabulum, and even with focal femoral head damage, which I don't suspect in this case. Capsule management matters. Higher survivorship with capsular repair or plication. Those results sustained at five-year follow-up. And then lastly in this patient, age is on our side. He's a young patient. Young patients have had much higher survivorship in every study ever done, including ours where in the younger group we showed 98% survivorship. So in summary, a lot to be done here in this hip if we're going to achieve a great outcome. But it's a young patient, arguably with tonus one changes. Likely requires precision femoroplasty, labral reconstruction, micro-drilling of the acetabulum, and capsular closure. And if we successfully do all those things, our data would prognosticate a very good prognosis. And hence, in this young patient, let's preserve the hip. And thank you very much. Stay in touch. Thank you.

hip case

femoroplasty

labral reconstruction

acetabulum micro-drilling

capsular closure