Abstract
Purpose
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).
Methods
A systematic review of the literature was conducted with the following keywords: “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 (PRISMA) guidelines. Level I to Level IV were 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 non-conversion to THA. P < 0.05 was defined
as statistical significance.
Results
Twelve studies met the inclusion criteria. In total, 4 studies were level III, and
8 studies were level IV. A total of 1344 hips were included, and follow-up ranged
from 10 to 20 years. FAIS was the most common indication for hip arthroscopy. Ten
out of the 12 studies reported on PROs and 8 studies reported significant improvement
after hip arthroscopy at long-term follow-up. The remaining two 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 (MCID) and 75% patient acceptable symptomatic state
(PASS) for at least one PRO. Rates of secondary arthroscopy ranged from 4.5% to 24%,
and rates of conversion to THA varied from 0%-44.1%. Older age and chondral damage
were the most commonly cited predictors for conversion to THA.
Conclusion
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 Tonnis Grade < 1 and labral repair experienced
over 90% survivorship. . Chondral damage and older age were the most cited predictors
for conversion to THA.
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Article Info
Publication History
Accepted:
October 26,
2022
Received in revised form:
October 24,
2022
Received:
June 27,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.
This study was performed at the Department of Orthopaedics and Rehabilitation, Yale School of Medicine.
Author Contributions:
Michael S. Lee, BA - Data collection/analysis and writing of the manuscript
David Nam-Woo Kim, BS - Data collection and writing of the manuscript
Jay Moran, BS - Data collection and revision of manuscript
Steven M. Gillinov - Data collection and revision of manuscript
Ronak J. Mahatme, BS - Data collection and writing of the manuscript
Peter F. Monahan, BS – Data analysis and revision of the manuscript
Wasif Islam, BS – Data analysis and revision of the manuscript
William M. Mclaughlin, MD - Data analysis and revision of the manuscript
Nathan L. Grimm, MD - Data interpretation and revision of manuscript
Andrew E. Jimenez, MD. - Data interpretation, revision of manuscript and writing of the
manuscript
Patients Undergoing Primary Hip Arthroscopy Report Favorable Outcomes at Minimum 10 Year Follow-up: A Systematic Review.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
