Summary

Duration of Symptoms Negatively Affects Hip Arthroscopy Outcomes

Abstract

Introduction

There is a paucity of aggregate data reporting on the effects of duration of symptoms on outcomes after hip arthroscopy.

Purpose

To evaluate the effect of duration of hip pain symptoms on outcomes in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS).

Methods

A systematic review of the literature was conducted with the following keywords: “hip arthroscopy,” “outcomes,” “femoroacetabular impingement,” “duration,” “symptoms,” “time,” “delay,” “earlier,” and “timing” was performed in PubMed, and Cochrane in May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for this review. When available, article information including the author, study type, study period, and follow-up, demographics, radiographic measurements, intraoperative findings, surgical procedures, surgical outcome tools, and secondary surgeries were recorded.

Results

Six studies including 3,298 hips were included in this systematic review. Five studies had minimum 2-year follow-up and one study had minimum 5-year follow-up. Femoroacetabular impingement (including subtypes cam and pincer impingement) was a surgical indication in all six studies, and the most common indication for surgery. All six studies reported patient-reported outcome sores (PROs). The most common PRO reported was the modified Harris Hip Score which was reported in all 6 studies. The preoperative mHHS ranged from 55.0 – 71.1 and the postoperative mHHS at minimum 2-year follow-up ranged from 70 – 91.9. Four out of six studies reported clinical benefit. All four studies reported that their cohorts with duration of hip pain symptoms less than 24 months achieved at least one clinical benefit threshold at a rate of 70%. All studies conducted statistical analyses comparing the duration of symptoms’ effect on outcomes and found superior outcomes in patients with shorter duration of symptoms prior to hip arthroscopy. Three studies reported secondary surgeries. Conversion to total hip arthroplasty ranged from 0.60% - 8% while overall secondary surgery rates ranged from 0.3% - 13%.

Conclusion

Shorter duration of symptoms is associated with superior outcomes in patients undergoing hip arthroscopy for treatment of FAIS. However, significant improvements can still be expected regardless of time between onset of symptoms and surgery. Arthroscopic treatment of properly indicated patients with hip pain symptoms of less than 2 years may help optimize postoperative outcomes.