The understanding, diagnosis, and treatment of arthritic hip disease in young patients are rapidly evolving. A variety of new and refined surgical techniques are now being utilized worldwide, and continued progress in this realm of orthopaedics is inevitable. Nevertheless, there are major challenges to optimize the introduction and utilization of these procedures on a more widespread basis. In this American Orthopaedic Association (AOA) symposium, the attendees were asked whether ‘‘the overall quality of diagnostic evaluation and surgical treatment of prearthritic and early arthritic hip disease in the United States is optimal, acceptable or deficient’’1 . Fifty-seven percent of the respondents answered that diagnostic and surgical care is deficient, indicating a need for improved medical management of these patients. Progress in this subspecialty area is dependent on the development of improved methods of patient evaluation and selection for surgery, effective dissemination of new knowledge, and the clinical investigation of refined and new surgical interventions. Young adult patients pose a unique challenge in that they present to the orthopaedic surgeon with hip symptoms that originate from a wide range of disease processes, and the patient age range spans from adolescence through middle age. Perhaps most notable is that these patients present to a variety of orthopaedic surgeons with different treatment perspectives. These include general orthopaedists as well as pediatric, sports medicine, adult reconstruction, and trauma subspecialists. The purposes of this report are to describe the spectrum of hip disease encountered in young adult patients and to review the contemporary concepts of the etiology and surgical treatment of such disorders. Importantly, there is a relative lack of high-level clinical evidence for alternative hip procedures. The majority of reports regarding these interventions are Level IV, and many of the technical aspects of treatment continue to evolve without the support of strong clinical outcomes research. This fact underscores the need for surgeons to carefully consider the utilization of new procedures in these patients and to perform higher-level clinical studies to assess the true value of these interventions.