Surgical management of hip disease in adolescents and young to middle-aged adults is rapidly evolving, and a variety of operative techniques are needed to provide comprehensive care. The purpose of this study was to determine the utilization of surgical procedures and recent changes in procedure utilization in a comprehensive hip surgery program. We performed a retrospective review of 983 hip procedures in 854 patients performed over a seven year time period. The average patient age was 37.4 years (range 10-55). Five hundred fifty-six procedures were performed in female patients and 427 in male patients. Total hip arthroplasty (32.9%), hip arthroscopy (25.1%), and periacetabular osteotomy (13.1%) were the most common surgical procedures. Techniques utilized less often included osteochondroplasty of the femoral head-neck junction (7.9%), hip implant revisions (7.9%), and proximal femoral osteotomy (4.1%). Uncommon procedures included core decompression (2.2%), soft tissue releases (1.2%), femoral head resurfacing (0.6%), arthrodesis (0.3%), and Chiari pelvic osteotomy (0.2%). The most dramatic changes in utilization over the seven year time period included a marked increase in hip arthroscopies and osteochondroplasties of the femoral head-neck junction. These data underscore the variety of surgical techniques needed to treat this patient population, and emphasize an expanding role for nonarthroplasty surgical interventions.