To identify whether hip arthroscopy is a suitable option for treating hip pain in elderly patients and investigate the clinical outcomes of hip arthroscopic surgery for labrum tear and/or osteoarthritis in patients over 50Â years of age. Between August 2009 and May 2014, a series of 23 patients (6 men and 17 women) with a mean age of 59Â years underwent arthroscopy. We retrospectively examined the clinical records, radiographs, and outcome questionnaires from all patients. The mean follow-up period was 28Â months. The mean Japan Orthopedic Association hip score after surgery improved by a statistically significant amount. Eight patients (34.8%) were noted to have a progression of osteoarthritis (OA) diagnosed by radiograph, and one underwent THA after 13Â months following arthroscopic surgery. The patients in which OA progression was noted were identified as having radiographical OA preoperatively and acetabular cartilage damage in the arthroscopic findings. Arthroscopic surgery performed in selected patients over 50Â years of age might be beneficial if classified as TÃ¶nnis grade 0 preoperatively and/or classified as Outerbridge grade II in the arthroscopic findings.