348 patients with femoroacetabular impingement syndrome were randomized to either arthroscopic intervention or a personal hip therapy programme. Patients were assessed after 6 and 12 months (primary endpoint) using the International Hip Outcome Tool (iHOT-33; primary outcome), the EQ-5D-5L and VAS, and the SF-12 measures, and were monitored for any adverse events. A cost-utility analysis was performed using quality-adjusted life-years generated from results on the EQ-5D-5L. Results demonstrated significantly greater iHOT-33 scores at 12 months in the arthroscopy group compared to the personalized hip therapy group, and the difference exceeded the minimum clinically important difference (MCID) threshold. Secondary outcome measures did not significantly differ between groups. The cost-effectiveness of arthroscopy compared to personalized hip therapy, however, was not demonstrated in the cost-utility analysis.