Purpose
To (1) report clinical outcomes, complication rates, and total hip arthroplasty (THA)
conversion rates for patients age 40 or older who underwent hip arthroscopy, and (2)
report any age-related predictors of outcome identified in the literature.
Methods
MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data
were abstracted from eligible studies. No meta-analysis was performed because of heterogeneity
amongst studies.
Results
Seventeen studies were included in this review comprising 16,327 patients, including
9,954 patients age 40 or older. All studies reported statistically significant improvements
in outcomes after hip arthroscopy for femoral osteochondroplasty, labral repair, or
unspecified indications. In patients 40 or older who underwent labral debridement,
these improvements were not clinically significant. Obesity and osteoarthritic changes
predicted poorer outcomes. Only 1 of 3 studies directly comparing the 2 groups found
that patients 40 or older had a significantly less improvement in a standardized hip
outcome score than patients under 40 after hip arthroscopy, but all found that patients
40 or older had significantly higher rates of THA conversion. The rate of conversion
to THA was 18.1% for patients 40 or older, 23.1% for patients over 50, and 25.2% for
patients over 60 with a mean of 25.0 months to THA.
Conclusions
Indications for hip arthroscopy including femoral osteochondroplasty and labral repair
resulted in clinically significant improvements in patients 40 or older in most research
studies examined in this review, whereas labral debridement did not produce clinically
significant improvements postoperatively in the same studies. In these studies, the
rate of conversion to THA is higher than in patients under 40 and increases with each
decade of life, with many individual studies showing a significant increase in the
rate of THA conversion. Hip arthroscopy may be suitable for some patients 40 or older,
but patient selection is key and patients should be informed of the higher risk of
conversion to THA.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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References
- Descriptive epidemiology of femoroacetabular impingement: A North American cohort of patients undergoing surgery.Am J Sports Med. 2013; 41: 1348-1356
- Trends in hip arthroscopy utilization in the United States.J Arthroplasty. 2013; 28: 140-143
- National trends of hip arthroscopy in Korea.J Korean Med Sci. 2014; 29: 277-280
- Hip arthroscopic surgery: Patient evaluation, current indications, and outcomes.Am J Sport Med. 2013; 41: 1174-1189
- Open surgical dislocation versus arthroscopic treatment of femoroacetabular impingement.Am J Orthop (Belle Mead NJ). 2014; 43: 209-214
- The prevalence of femoroacetabular impingement as an aetiologic factor for end-stage degenerative osteoarthritis of the hip joint: Analysis of 1,000 cases.Hip Int. 2016; 26: 164-168
- Treatment of femoroacetabular impingement: A systematic review.Curr Rev Musculoskelet Med. 2013; 6: 207-218
- Prevalence of cam-type morphology in elite ice hockey players.Am J Sports Med. 2016; 44: 1024-1030
- Good results after hip arthroscopy for femoroacetabular impingement in top-level athletes.Orthop J Sport Med. 2015; 3 (2325967115569691)
- On-ice functional assessment of an elite ice hockey goaltender after treatment for femoroacetabular impingement.Sports Health. 2015; 7: 542-547
- Use of hip arthroscopy and risk of conversion to total hip arthroplasty: A population-based analysis.Arthroscopy. 2016; 32: 587-593
- Hip arthroscopy and osteoarthritis: Where are the limits and indications?.SICOT J. 2015; 1: 27
- Arthroscopic treatment of femoroacetabular impingement in patients over 60 years old.Cartilage. 2010; 1: 188-193
- Methodological index for non-randomized studies (minors): Development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic).CMAJ. 2004; 171: 1369-1373
- Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.Arthroscopy. 2009; 25: 369-376
- Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.Arthroscopy. 2012; 28: 59-65
- Arthroscopic acetabular labral debridement in patients forty-five years of age or older has minimal benefit for pain and function.J Bone Jt Surg. 2014; 96: 113-118
- Joint space predicts THA after hip arthroscopy in patients 50 years and older.Clin Orthop Relat Res. 2013; 471: 2492-2496
- Hip arthroscopy in the older patient.Arthroscopy. 2012; 28: e25-e26
- Age-related trends in hip arthroscopy: A large cross-sectional analysis.Arthroscopy. 2015; 31: 2307-2313.e2
- The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients.Sport Med Arthrosc Rehabil Ther Technol. 2010; 2: 18
- Two-year follow-up of hip arthroscopies: A matched control study comparing patients over 50 years to patients under 30 years.Arthroscopy. 2013; 29: e15-e16
- Arthroscopic hip surgery with a microfracture procedure of the hip: Clinical outcomes with two-year follow-up.Hip Int. 2014; 24: 448-456
- Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: The influence of age and arthritis.Arthroscopy. 2012; 28: 1359-1364
- Evaluation of sexual function before and after hip arthroscopic surgery for symptomatic femoroacetabular impingement.Am J Sports Med. 2015; 43: 1850-1856
- What factors influence long-term survivorship after hip arthroscopy?.Clin Orthop Relat Res. 2011; 469: 362-371
- Is hip arthroscopy for femoroacetabular impingement only for athletes?.Br J Sports Med. 2012; 46: 1016-1018
- Clinical and functional outcome after acetabular labral repair in patients aged older than 50 years.Arthroscopy. 2014; 30: 305-310
- Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.Arthroscopy. 2015; 31: 231238
- Outcome and patient satisfaction of middle-aged patients undergoing arthroscopic treatment of femoroacetabular impingement (FAI).Arthroscopy. 2013; 29: e193
- Arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement in patients over 60 years of age.J Bone Jt Surg Br. 2011; 93: 326-331
- Complications and survival analyses of hip arthroscopies performed in the national health service in England: A review of 6,395 cases.Arthroscopy. 2015; 31: 836-842
- Arthroscopic treatment of labral tears in patients aged 60 years or older.Arthroscopy. 2015; 31: 1921-1927
- Use of hip arthroscopy and risk of conversion to total hip arthroplasty: A population-based analysis.Arthroscopy. 2016; 32: 587-593
Appendix: References of Included Studies
- Clinical and functional outcome after acetabular labral repair in patients aged older than 50 years.Arthroscopy. 2014; 30: 305-310
- Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.Arthroscopy. 2015; 31: 231238
- Arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement in patients over 60 years of age.J Bone Jt Surg Br. 2011; 93: 326-331
- Evaluation of sexual function before and after hip arthroscopic surgery for symptomatic femoroacetabular impingement.Am J Sports Med. 2015; 43: 1850-1856
- Two-year follow-up of hip arthroscopies: A matched control study comparing patients over 50 years to patients under 30 years.Arthroscopy. 2013; 29: e15-e16
- Complications and survival analyses of hip arthroscopies performed in the national health service in England: A review of 6,395 cases.Arthroscopy. 2015; 31: 836-842
- Arthroscopic treatment of femoroacetabular impingement in patients over 60 years old.Cartilage. 2010; 1: 188-193
- What factors influence long-term survivorship after hip arthroscopy?.Clin Orthop Relat Res. 2011; 469: 362-371
- Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: The influence of age and arthritis.Arthroscopy. 2012; 28: 1359-1364
- Hip arthroscopy in the older patient.Arthroscopy. 2012; 28: e25-e26
- Joint space predicts THA after hip arthroscopy in patients 50 years and older.Clin Orthop Relat Res. 2013; 471: 2492-2496
- Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.Arthroscopy. 2012; 28: 59-65
- Arthroscopic treatment of labral tears in patients aged 60 years or older.Arthroscopy. 2015; 31: 1921-1927
- Outcome and patient satisfaction of middle-aged patients undergoing arthroscopic treatment of femoroacetabular impingement (FAI).Arthroscopy. 2013; 29: e193
- Use of hip arthroscopy and risk of conversion to total hip arthroplasty: A population-based analysis.Arthroscopy. 2016; 32: 587-593
- Age-related trends in hip arthroscopy: A large cross-sectional analysis.Arthroscopy. 2015; 31: 2307-2313.e2
- Arthroscopic acetabular labral debridement in patients forty-five years of age or older has minimal benefit for pain and function.J Bone Jt Surg. 2014; 96: 113-118
Appendix: References of Studies Eliminated at Full Text Screen
- Osteochondroplasty as a treatment of femoroacetabular impingement.Ortop Traumatol Rehabil. 2010; 12: 504-510
- Capsular closure does not affect development of heterotopic ossification after hip arthroscopy.Arthroscopy. 2015; 31: 225-230
- Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 801-805
- Results of the learning curve for interventional hip arthroscopy: A prospective study.Acta Orthop Belg. 2014; 80: 39-44
- Why do hip arthroscopy procedures fail?.Clin Orthop Relat Res. 2013; 471: 2523-2529
- Open surgical dislocation versus arthroscopic treatment of femoroacetabular impingement.Am J Orthop (Belle Mead NJ). 2014; 43: 209-214
- Femoroacetabular impingement: A resurfacing solution.J Bone Joint Surg Br. 2012; 94: 32-35
- Preoperative delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) for patients undergoing hip arthroscopy: Indices are predictive of magnitude of improvement in two-year patient-reported outcomes.J Bone Jt Surg Am. 2015; 97: 1305-1315
- Femoroacetabular impingement syndrome—efficacy of surgical treatment with regards to age and basic diagnosis.Int Orthop. 2015; 39: 417-422
- Hip arthroscopy for femoroacetabular impingement: The changing nature and severity of associated complications over time.Arthroscopy. 2014; 30: 957-963
- Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy.Arthroscopy. 2015; 31: 57-62
- Outcomes of hip arthroscopy. A prospective analysis and comparison between patients under 25 and over 25 years of age.Br J Sports Med. 2013; 47: 234-238
- The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement.Bone Joint J. 2013; 95-B: 893-899
- Preoperative femoral nerve block in hip arthroscopic surgery: A retrospective review of 108 consecutive cases.Am J Sports Med. 2014; 42: 144-149
- Arthroscopic hip surgery with a microfracture procedure of the hip: Clinical outcomes with two-year follow-up.Hip Int. 2014; 24: 448-456
- Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: A matched-pair controlled study with minimum 2-year follow-up.Am J Sports Med. 2014; 42: 122-130
- A matched-pair controlled study of microfracture of the hip with average 2-year follow-up: Do full-thickness chondral defects portend an inferior prognosis in hip arthroscopy?.Arthroscopy. 2015; 31: 628-634
- Arthroscopic grafting of chondral defects and subchondral cysts of the acetabulum.Hip Int. 2011; 21: 479-486
- Treatment of cam-type femoroacetabular impingement.Joints. 2015; 3: 67-71
- Sustained five-year benefit of autologous matrix-induced chondrogenesis for femoral acetabular impingement-induced chondral lesions compared with microfracture treatment.Bone Joint J. 2015; 97-B: 628-635
- Pre-operative predictors of early failure following hip arthroscopy.Arthroscopy. 2011; 27: e109
- Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: A prospective study after a mean follow-up of 4.6 (4.2-5.5) years.Orthop Traumatol Surg Res. 2014; 100: 651-656
- Effect of anterior acetabular rim recession on radiographic parameters: An in vivo study.Arthroscopy. 2013; 29: 1292-1296
- Does obesity affect outcomes in hip arthroscopy? A matched-pair controlled study with minimum 2-year follow-up.Am J Sport Med. 2015; 43: 965-971
- The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients.Sport Med Arthrosc Rehabil Ther Technol. 2010; 2: 18
- Acceptable symptom state after surgery for femoroacetabular impingement compared with total hip arthroplasty.Hip Int. 2013; 23: S54-S60
- Arthroscopic labral base repair in the hip: Clinical results of a described technique.Arthroscopy. 2014; 30: 208-213
- Are crutches required after hip arthroscopy? A case-control study.Hip Int. 2013; 23: 269-273
- Microfracture for acetabular chondral defects in patients with femoroacetabular impingement: Results at second-look arthroscopic surgery.Am J Sports Med. 2012; 40: 2725-2730
- Ligamentum teres injury is associated with the articular damage pattern in patients with femoroacetabular impingement.Arthroscopy. 2014; 30: 1582-1587
- A new method to analyze dGEMRIC measurements in femoroacetabular impingement: Preliminary validation against arthroscopic findings.Osteoarthritis Cartilage. 2012; 20: 1127-1133
- Is hip arthroscopy for femoroacetabular impingement only for athletes?.Br J Sports Med. 2012; 46: 1016-1018
- Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement.Int Orthop. 2014; 38: 2057-2064
- Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement.Osteoarthritis Cartilage. 2013; 21: 44-50
- Treatment of failed arthroscopic acetabular labral debridement by femoral chondro-osteoplasty: A case series of five patients.J Bone Joint Surg Br. 2007; 89: 595-598
- What factors influence long-term survivorship after hip arthroscopy?.Clin Orthop Relat Res. 2011; 469: 362-371
- Evidence of capsular defect following hip arthroscopy.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 902-905
- Hip arthroscopy for femoroacetabular impingement: A health economic analysis.Hip Int. 2014; 24: 457-464
- The hip sports activity scale (HSAS) for patients with femoroacetabular impingement.Hip Int. 2013; 23: 204-211
- Femoroacetabular impingement: Prevalent and often asymptomatic in older men: The osteoporotic fractures in men study.Clin Orthop Relat Res. 2015; 473: 2578-2586
- Joint space predicts THA after hip arthroscopy in patients 50 years and older.Clin Orthop Relat Res. 2013; 471: 2492-2496
- Psychological distress in hip arthroscopy patients affects postoperative pain control.Arthroscopy. 2014; 30: 195-201
- Psychologic distress reduces preoperative self-assessment scores in femoroacetabular impingement patients.Clin Orthop Relat Res. 2014; 472: 1886-1892
- Arthroscopic acetabuloplasty and labral refixation without labral detachment.Am J Sport Med. 2015; 43: 105-112
- Labral injury: Radiographic predictors at the time of hip arthroscopy.Arthroscopy. 2015; 31: 51-56
- Hip osteoplasty by an anterior minimally invasive approach for active patients with femoroacetabular impingement.Hip Int. 2007; 17: 91-98
- Causes and risk factors for revision hip preservation surgery.Am J Sports Med. 2014; 42: 2627-2633
- The international Hip Outcome Tool-33 (iHOT-33): Multicenter validation and translation to Spanish.Health Qual Life Outcomes. 2015; 13: 62
- Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome.J Orthop Res. 2013; 31: 1461-1468
- Outcomes after hip arthroscopy in patients with workers' compensation claims.Orthopedics. 2015; 38: e94-e98
- The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy. A retrospective review.Hip Int. 2013; 23: 93-98
- Hip arthroscopy for labral tears in workers' compensation: A matched-pair controlled study.Am J Sports Med. 2013; 41: 2302-2307
- Hip arthroscopy for femoroacetabular impingement: Results of 118 consecutive cases in a district general hospital.Hip Int. 2013; 23: 400-405
- Clinical diagnosis and arthroscopic treatment of acetabular labral tears.Orthop Surg. 2011; 3: 28-34
- Intra-articular adhesions following hip arthroscopy: A risk factor analysis.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 822-825
- Lumbar plexus blockade reduces pain after hip arthroscopy: A prospective randomized controlled trial.Anesth Analg. 2012; 115: 968-972
- Femoral neck fractures after arthroscopic femoral neck osteochondroplasty for femoroacetabular impingement.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 926-931
- Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: Clinical and morphological short-term results.Arch Orthop Trauma Surg. 2013; 133: 69-79
Article info
Publication history
Published online: September 10, 2016
Accepted:
June 22,
2016
Received:
May 25,
2016
Footnotes
See commentary on page 476
The authors report the following potential conflicts of interests or sources of funding: N.S. is an employee of McMaster University. M.R.S. receives support from ISAKOS, ISHA, Medacta, ConMed Linvatec, Biomimedica, Cool Systems, Smith & Nephew, Ossur, Breg, Medacta, Stryker, DJ Ortho, and has submitted patent personally for hip brace and hip arthroscopy distraction with Stanford. M.J.P. receives support from Steadman Philippon Research Institute, ISHA, Smith & Nephew, MIS, Ossur, Siemens, Vail Valley Medical Center, Arthrosurface, DonJoy, Slack, Elsevier, Linvatec, Arthrosurface, and HIPCO. O.R.A. is an employee of McMaster University, speakers bureau member for Conmed and Smith & Nephew, and editorial board member for Knee Surgery, Sports Traumatology, Arthroscopy, and American Journal of Sports Medicine.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
