Purpose
To assess mid- to long-term patient-reported outcomes (PROs) of hip arthroscopy as
well as the rates of secondary surgery and to identify indications for surgery and
noted predictors of failure.
Methods
A systematic review of the current literature was performed with the terms “hip arthroscopy,”
“outcomes,” “patient-reported outcomes,” “mid-term,” “5-year,” “long-term,” and “10-year”
in the PubMed, Cochrane, and Embase databases in April of 2020 according to the Preferred
Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data for study
characteristics, patient demographics, follow-up time, indications for surgery, PROs,
predictors of failure or unfavorable PROs, and rates of secondary hip preservation
surgery and conversion to total hip arthroplasty were collected.
Results
Thirteen articles were included. Four studies were level III and 9 were level IV.
In total, 1571 hips were included, and the average follow-up time ranged from 60 to
240 months. The most common indications for hip arthroscopy were labral tears and
femoroacetabular impingement syndrome. Twelve studies reported on PROs and all reported
improvement at latest follow-up. The most reported on scores were the modified Harris
Hip Score, Harris Hip Score, and the Hip Outcome Score-Sport Specific Subscale. When
grouped based on average follow-up time, the conversion rates at the 5- and 10-year
time points ranged from 3.0% to 17.9% and 2.4% to 32.5%, respectively. One study with
20-year follow-up reported a conversion rate of 41.0%. Osteoarthritis and increased
age were the most cited predictors for secondary surgery or decreased PROs.
Conclusions
At mid- to long-term follow-up, patients who underwent primary hip arthroscopy demonstrated
improvement in several PROs. There was great variability in rates for revision surgery
and conversion to total hip arthroplasty. The most common indications for hip arthroscopy
were labral tears and femoroacetabular impingement syndrome. Osteoarthritis and increased
age were the most cited predictors for unfavorable outcomes.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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Article info
Publication history
Published online: November 18, 2020
Accepted:
October 2,
2020
Received:
May 5,
2020
Footnotes
See commentary on page 1026
The authors report the following potential conflicts of interest or sources of funding: A.C.L. reports grants, personal fees, and nonfinancial support from Arthrex, nonfinancial support from Iroko, nonfinancial support from Medwest, nonfinancial support from Smith & Nephew, grants and nonfinancial support from Stryker, nonfinancial support from Vericel, nonfinancial support from Zimmer Biomet, and personal fees from Graymont Medical, outside the submitted work. A.C.L. is the Medical Director of Hip Preservation at St. Alexius Medical Center. B.G.D. reports grants and other from American Orthopedic Foundation, during the conduct of the study; personal fees from Adventist Hinsdale Hospital, personal fees and non-financial support from Amplitude, grants, personal fees and non-financial support from Arthrex , personal fees and non-financial support from DJO Global, grants from Kaufman Foundation, grants, personal fees and non-financial support from Medacta, grants, personal fees, non-financial support and other from Pacira Pharmaceuticals, grants, personal fees, non-financial support and other from Stryker , grants from Breg, personal fees from Orthomerica, grants, personal fees, non-financial support and other from Mako Surgical Corp, grants and non-financial support from Medwest Associates, grants from ATI Physical Therapy, grants, personal fees and non-financial support from St. Alexius Medical Center, grants from Ossur, outside the submitted work; has patents with royalties paid to Arthrex, and a patent with royalties paid to Orthomerica and DJO Global. Dr. Domb is the Medical Director of Hip Preservation at St. Alexius Medical Center, a board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, the Journal of Arthroscopy; has HAD ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. D.R.M. reports non-financial support from Arthrex, Stryker, Smith & Nephew, and Ossur, outside the submitted work; also, Dr. Maldonado is an editorial board member of the Journal of Arthroscopy. J.S. reports non-financial support from Arthrex, Stryker, Smith & Nephew, and Ossur, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was performed at the American Hip Institute Research Foundation.
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© 2020 by the Arthroscopy Association of North America
