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

Published:November 02, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.040

      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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