Mid To Long-term Outcomes Of Hip Arthroscopy: A Systematic Review

Purpose: (1) to assess mid to long-term patient-reported outcomes (PROs) of hip arthroscopy as well as the rates of secondary surgery and (2) to identify indications for surgery and noted predictors of failure.

Methods: A systematic review of the current literature was performed with the terms “hip arthroscopy,” outcomes,” “patient-reported outcomes,” “mid-term,” “5-year,” “long-term,” and “10-year” in the PubMed, Cochrane, and Embase databases in April of 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data for study characteristics, patient demographics, follow-up time, indications for surgery, PROs, predictors of failure or unfavorable PROs, and rates of secondary hip preservation surgery and conversion to total hip arthroplasty (THA) were collected.

Results: Thirteen articles were included. Four studies were level III and nine were level IV. In total, 1571 hips were included, and the average follow-up time ranged from 60 to 240 months. The most common indications for hip arthroscopy were labral tears and femoroacetabular impingement syndrome (FAIS). Twelve studies reported on PROs and all reported improvement at latest follow-up. The most reported on scores were the modified Harris Hip Score, Harris Hip Score, and the Hip Outcome Score-Sport Specific Subscale. When grouped based on average follow-up time, the conversion rates at the five and ten-year timepoints ranged from 3.0% to 17.9% and 2.4% to 32.5%, respectively. One study with 20-year follow-up reported a conversion rate of 41.0%. Osteoarthritis (OA) and increased age were the most cited predictors for secondary surgery or decreased PROs.

Conclusion: At mid to long-term follow-up, patients who underwent primary hip arthroscopy demonstrated improvement in several PROs. There was great variability in rates for revision surgery and conversion to THA. The most common indications for hip arthroscopy were labral tears and FAIS. OA and increased age were the most cited predictors for unfavorable outcomes.