It is only within the last few years that the details of ischiofemoral impingement have been understood. For severe cases that fail conservative treatment, surgical techniques have now been developed. Rarely is this necessary and is especially dependent on the accuracy of the diagnosis, which can be elusive. The surgery consists of opening up the ischiofemoral space by shaving down either the lesser trochanter or a prominence of the ischium. This can be performed via an endoscopic technique and does not require an open operation. For the surgeon, it does require advanced arthroscopic skills and familiarity with hip disorders. Results of surgical intervention are favorable, but all of these methods are fairly new and require close monitoring. Nonetheless, for severe cases, there are surgical options if all else fails.