Purpose
To investigate whether hip arthroscopy (HA) is effective in patients with femoroacetabular
impingement and concomitant hip osteoarthritis (OA) of Tönnis grade 2 or greater.
Methods
This review was registered in the International Prospective Register for Systematic
Reviews and Meta-analysis (PROSPERO, CRD42020210936). It followed the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-analyses) guidelines and included
multiple databases: MEDLINE, Embase, Web of Science Core Collection, and Cochrane
Library. All studies in English or German from database inception to December 1, 2020,
that investigated outcomes of HA in patients with OA of Tönnis grade 2 or greater
were considered eligible. The risk of bias was assessed using the MINORS (Methodological
Index for Non-randomized Studies) tool. Data heterogeneity was explored using the
I2 test in a random-effects model.
Results
Eleven studies met the eligibility criteria. The MINORS (Methodological Index for
Non-randomized Studies) score averaged 68% (range, 46%-81%). A total of 616 hips,
consisting of 247 hips of interest (Tönnis grade 2 or greater) and 369 controls, were
included. The weighted estimated follow-up averaged 29.1 months (range, 12-84 months).
Data on patient-reported outcome measures (PROMs) could be extracted for 6 of 11 studies,
and date on conversion to total hip arthroplasty were available for 8 of 11. Four
studies reported an overall improvement in PROMs after HA, and 2 highlighted a failure
of improvement in PROMs. Failure of HA with conversion to total hip arthroplasty was
observed at a rate of 0% to 9% in 4 studies, as opposed to proportions as high as
35% to 70% in the other 4 studies. There was a high level of heterogeneity, with a
calculated I2 value of 89%.
Conclusions
There is currently contradictory and insufficient evidence regarding the efficacy
of HA for hips with femoroacetabular impingement and concomitant OA of Tönnis grade
2 or greater. This is in the context of data with low levels of evidence, mainly consisting
of retrospective case series (Level IV) with a high risk of bias and high heterogeneity
(I2 of approximately 90%).
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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Article info
Publication history
Published online: January 27, 2022
Accepted:
January 16,
2022
Received:
August 15,
2021
Footnotes
See commentary on page 2242
The authors report the following potential conflicts of interest or sources of funding: V.K. is a consultant for Smith and Nephew and Arthrex Limited. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
