(5a–5f) Male patient, 65 years with an advanced osteoarthritis of the hip with a significant ROM (5a). The patient and his wife (orthopedic surgeon) refused the proposed treatment with a total joint replacement insisting to perform a hip arthroscopy. The complemental imaging studies with CAT Scan demonstrate the extensive osteophytes (5b) with conservation of the joint space in the load-bearing area (5c). After a long discussion with the patient without creating false expectations, a hip arthroscopy was performed. The osteophytes in the peripheral compartment were resected and the acetabular labrum was debrided (5d, 5e). The acetabular rim was resected as well as the existing cam deformity (5f). (5g–5j) The same patient from Figures 5a–5f. The intraoperative radioscopy demonstrated the satisfactory resection of the osteophytes and the bone deformity (5g, 5h). The postoperative CAT scan (51) and the postoperative X-ray (5j) demonstrated also a satisfactory result. Five years after this surgery the patient has still an excellent clinical outcome (HHS 92) without progression of osteoarthritis. This case demonstrates that we still do not know where exactly are the limits for hip arthroscopy in cases with osteoarthritis. It demonstrated also that in advanced pincer cases with arthritis due to the resection of the deformity, good results can be achieved (5i, 5j). Independent of this satisfactory clinical result, in cases like these a total joint replacement (TJR) is the most effective and predictable option of treatment but it was refused by the patient.