Patients Undergoing Primary Hip Arthroscopy Report Favorable Outcomes at Minimum 10 Year Follow-Up: A Systematic Review

Published:November 02, 2022DOI:


      (1) To evaluate minimum 10-year PROs (patient-reported outcomes) and survivorship after primary hip arthroscopy and (2) to identify predictors of failure for secondary arthroscopy and conversion to total hip arthroplasty (THA).


      A systematic review of the literature was conducted with the following key words: “hip arthroscopy,” “long-term,” “outcomes,” “ten-year,” “survivorship,” “10-year,” “15-year,” “fifteen-year,” 20-year,” “twenty-year,” and “femoroacetabular impingement” in PubMed and Embase in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Level I to Level IV evidence was included and reported on minimum 10-year outcomes or greater after primary hip arthroscopy. Long-term studies were defined as minimum 10-year follow-up in accordance with established standards in the literature. Case reports, review articles, technique articles, and opinion articles were excluded. Articles not in English were excluded. Title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, PROs, predictors of failure for THA, and rates of secondary surgeries were recorded. Survivorship was defined as a nonconversion to THA. P < .05 was defined as statistical significance.


      Twelve studies met the inclusion criteria. In total, 4 studies were Level III, and 8 studies were Level IV. A total of 1,344 hips were included, and follow-up ranged from 10 to 20 years. Femoroacetabular impingement syndrome was the most common indication for hip arthroscopy. Ten of the 12 studies reported on PROs, and 8 studies reported significant improvement after hip arthroscopy at long-term follow-up. The remaining 2 studies reported favorable outcomes that satisfied clinical benefit thresholds at minimum 10-year follow-up. Five studies reported clinical benefit where each patient cohort achieved 80% minimal clinically important difference and 75% patient acceptable symptomatic state for at least one PRO. Rates of secondary arthroscopy ranged from 4.5% to 24%, and rates of conversion to THA varied from 0% to 44.1%. Older age and chondral damage were the most commonly cited predictors for conversion to THA. Conclusions: At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. Patients undergoing hip arthroscopy within the last 20 years with Tönnis grade <1 and labral repair experienced greater than 90% survivorship. Chondral damage and older age were the most cited predictors for conversion to THA.

      Level of Evidence

      Level IV, systematic review of Level III and Level IV studies
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        • Montgomery S.R.
        • Ngo S.S.
        • Hobson T.
        • et al.
        Trends and demographics in hip arthroscopy in the United States.
        Arthroscopy. 2013; 29: 661-665
        • Zusmanovich M.
        • Haselman W.
        • Serrano B.
        • Banffy M.
        The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States.
        Arthroscopy. 2022; 38: 82-87
        • Carton P.
        • Filan D.
        • Mullins K.
        Survivorship rate and clinical outcomes 10 years after arthroscopic correction of symptomatic femoroacetabular impingement.
        Am J Sports Med. 2021; 50: 19-29
        • Kyin C.
        • Maldonado D.R.
        • Go C.C.
        • Shapira J.
        • Lall A.C.
        • Domb B.G.
        Mid- to long-term outcomes of hip arthroscopy: A systematic review.
        Arthroscopy. 2021; 37: 1011-1025
        • Owens J.S.
        • Jimenez A.E.
        • Shapira J.
        • et al.
        Capsular repair may improve outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement: A systematic review of comparative outcome studies.
        Arthroscopy. 2021; 37: 2975-2990
        • Nho S.J.
        • Beck E.C.
        • Nwachukwu B.U.
        • et al.
        Survivorship and outcome of hip arthroscopy for femoroacetabular impingement syndrome performed with modern surgical techniques.
        Am J Sports Med. 2019; 47: 1662-1669
        • Hoit G.
        • Whelan D.B.
        • Ly P.
        • Saskin R.
        • Atrey A.
        • Khoshbin A.
        Conversion to total hip arthroplasty after hip arthroscopy: A cohort-based survivorship study with a minimum of 2-year follow-up.
        J Am Acad Orthop Surg. 2021; 29: 885-893
        • Maldonado D.R.
        • Ouyang V.W.
        • Owens J.S.
        • et al.
        Labral tear management in patients aged 40 years and older undergoing primary hip arthroscopy: A propensity-matched case-control study with minimum 2-year follow-up.
        Am J Sports Med. 2021; 49: 3925-3936
        • Yao J.J.
        • Cook S.B.
        • Gee A.O.
        • Kweon C.Y.
        • Hagen M.S.
        What is the survivorship after hip arthroscopy for femoroacetabular impingement? A large-database study.
        Clin Orthop Relat Res. 2020; 478: 2266-2273
        • Öhlin A.
        • Ahldén M.
        • Lindman I.
        • et al.
        Good 5-year outcomes after arthroscopic treatment for femoroacetabular impingement syndrome.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1311-1316
        • Soares R.W.
        • Ruzbarsky J.J.
        • Arner J.W.
        • Comfort S.M.
        • Briggs K.K.
        • Philippon M.J.
        Midterm outcomes after hip labral augmentation in revision hip arthroscopy.
        Am J Sports Med. 2022; 50: 1299-1305
        • Menge T.J.
        • Briggs K.K.
        • Dornan G.J.
        • McNamara S.C.
        • Philippon M.J.
        Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair.
        J Bone Joint Surg Am. 2017; 99: 997-1004
        • Phillipon M.
        • Arner J.
        • Crawford M.
        • Bolia I.
        • Briggs K.
        Acetabular labral reconstruction with iliotibial band autograft: outcome and survivorship at a minimum 10-year follow-up.
        J Bone Joint Surg Am. 2020; 102: 1581-1587
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • McCarthy J.C.
        • Jarrett B.T.
        • Ojeifo O.
        • Lee J.A.
        • Bragdon C.R.
        What factors influence long-term survivorship after hip arthroscopy?.
        Clin Orthop Relat Res. 2011; 469: 362-371
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Dhawan A.
        • Pearls Research
        The significance of statistics and perils of pooling. Part 3: Pearls and pitfalls of meta-analyses and systematic reviews.
        Arthroscopy. 2017; 33: 1594-1602
        • Lee J.K.
        • Hwang D.S.
        • Kim S.B.
        • et al.
        The role and clinical relevance of the ligamentum teres: Long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement.
        J Hip Preserv Surg. 2021; 8: 360-366
        • Zimmerer A.
        • Janz V.
        • Sobau C.
        • Wassilew G.I.
        • Miehlke W.
        Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 10-year follow-up: The timing of surgery is crucial.
        Orthop J Sports Med. 2021; 92325967120985140
        • Zimmerer A.
        • Ramoser A.
        • Streit M.
        • et al.
        Osteoarthrosis, advanced age, and female sex are risk factors for inferior outcomes after hip arthroscopy and labral debridement for femoroacetabular impingement syndrome: Case series with minimum 10-year follow-up.
        Arthroscopy. 2021; 37: 1822-1828
        • Beals T.R.
        • Soares R.W.
        • Briggs K.K.
        • Day H.K.
        • Philippon M.J.
        Ten-year outcomes after hip arthroscopy in patients with femoroacetabular impingement and borderline dysplasia.
        Am J Sports Med. 2022; 50: 739-745
        • Buchler L.
        • Grob V.
        • Anwander H.
        • Lerch T.
        • Haefeli P.
        Good outcome scores and low conversion rate to THA 10 years after hip arthroscopy for the treatment of femoroacetabular impingement.
        Clin Orthop Relat Res. 2021; 479: 2256-2264
        • Byrd J.W.T.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 10-year followup.
        Clin Orthop Relat Res. 2010; 468: 741-746
        • Dwyer M.K.
        • Tumpowsky C.
        • Boone A.
        • Lee J.
        • McCarthy J.C.
        What is the association between articular cartilage damage and subsequent THA 20 years after hip arthroscopy for labral tears?.
        Clin Orthop Relat Res. 2019; 477: 1211-1220
        • Menge T.J.
        • Briggs K.K.
        • Rahl M.D.
        • Philippon M.J.
        Hip arthroscopy for femoroacetabular impingement in adolescents: 10-year patient-reported outcomes.
        Am J Sports Med. 2021; 49: 76-81
        • Rosinsky P.J.
        • Kyin C.
        • Maldonado D.R.
        • et al.
        Determining clinically meaningful thresholds for the nonarthritic hip score in patients undergoing arthroscopy for femoroacetabular impingement syndrome.
        Arthroscopy. 2021; 37: 3113-3121
        • Chahal J.
        • Thiel G.S.V.
        • Mather R.C.
        • Lee S.
        • Salata M.J.
        • Nho S.J.
        The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Orthop J Sports Med. 2014; 22325967114S00105
        • Lodhia P.
        • Chandrasekaran S.
        • Gui C.
        • Darwish N.
        • Suarez-Ahedo C.
        • Domb B.G.
        Open and arthroscopic treatment of adult hip dysplasia: A systematic review.
        Arthroscopy. 2016; 32: 374-383
        • Bolia I.K.
        • Fagotti L.
        • Briggs K.K.
        • Philippon M.J.
        Midterm outcomes following repair of capsulotomy versus nonrepair in patients undergoing hip arthroscopy for femoroacetabular impingement with labral repair.
        Arthroscopy. 2019; 35: 1828-1834
        • Perets I.
        • Chaharbakhshi E.O.
        • Hartigan D.E.
        • Ortiz-Declet V.
        • Mu B.
        • Domb B.G.
        The correlation between arthroscopically defined acetabular cartilage defects and a proposed preoperative delayed gadolinium-enhanced magnetic resonance imaging of cartilage index in hips of patients with femoroacetabular impingement syndrome.
        Arthroscopy. 2018; 3: 1202-1212
        • Ho C.P.
        • Ommen N.D.
        • Bhatia S.
        • et al.
        Predictive value of 3-T magnetic resonance imaging in diagnosing grade 3 and 4 chondral lesions in the hip.
        Arthroscopy. 2016; 32: 1808-1813
        • Kucharik M.P.
        • Abraham P.F.
        • Nazal M.R.
        • et al.
        Arthroscopic acetabular labral repair versus labral debridement: Long-term survivorship and functional outcomes.
        Orthop J Sports Med. 2022; 1023259671221109012
        • Woyski D.
        • “Chad.” Mather R.
        Surgical treatment of labral tears: Debridement, repair, reconstruction.
        Curr Rev Musculoskelet Med. 2019; 12: 291-299