Six randomized controlled trials (839 patients) comparing arthroscopic hip surgery versus conservative management for femoroacetabular impingement syndrome were included in this systematic review and meta-analysis. A subgroup analysis of physiotherapy and lavage was also conducted. The primary outcome of interest was the International Hip Outcome Tool (iHOT-33) and Hip Outcome Score (HOS) Activities of Daily Living (ADL). Secondary outcomes of interest included the incidence of infection, numbness, nerve injury, osteoarthritis, and additional surgery. iHOT-33 and HOS scores at 6 and 12 months both favored the conservative management group. Additionally, the incidence of additional surgery and numbness also favored the conservative management group. All other outcomes were similar between the two groups.