Background
There is a paucity of aggregate literature reporting on long-term outcomes and survivorship after primary hip arthroscopy.
Purpose
The purpose of this study is 1) to evaluate minimum 10-year outcomes and survivorship after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) 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, Cochrane, and Scopus in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 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 and conversion to THA were recorded.
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
Patients at long-term follow-up who underwent primary hip arthroscopy demonstrated favorable outcomes and high rates of clinical benefit. There was large variability in the rates of secondary hip preservation procedures and conversion to THA. The most common indications for hip arthroscopy were labral tears and FAIS. Chondral damage and older age were the most cited predictors for conversion to THA.