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 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.
Results
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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Article info
Publication history
Published online: November 02, 2022
Accepted:
October 26,
2022
Received:
June 27,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.E.J. received education support from Arthrex, Gotham, and Medwest; and a grant from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was performed at the Department of Orthopaedics and Rehabilitation, Yale School of Medicine.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
