The unique anatomy of the hip is challenging, and has slowed the progress of hip arthroscopy. The aim of this review is to provide an updated synthesis of existing clinical evidence on hip arthroscopy. A systematic computerized literature search was conducted by two independent reviewers using an iterative manipulation process of the keywords used singularly or in combination. The following databases were accessed on 30th November, 2009: PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez/); Ovid (http://www.ovid.com); and Cochrane Reviews (http://www.cochrane.org/reviews/). Case reports, literature reviews, letters to editors and articles not including outcome measures were excluded. Twenty-three publications met the inclusion criteria and were included. Hip arthroscopy can provide an alternative to traditional arthrotomy with great therapeutic potential. However, the available data do not allow definitive conclusion on its routine use. It is still unclear whether arthroscopy is superior to open surgery in the management of femoroacetabular impingement and labral lesions. Rather than providing strong evidence for or against the use of hip arthroscopy, this study generates potential areas for additional prospective investigations to evaluate the role of hip arthroscopy in clinical practice. There is a need to perform appropriately planned and powered studies to clarify the role of arthroscopy in hip pathology.