Patients Maintain Clinically Significant Outcomes at 5-Year Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review

Abstract

Purpose: To assess 5-year outcomes and survival rate of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) and to determine achievement rates of clinically significant outcomes.

Methods: Three databases were searched around the following terms: hip arthroscopy, FAIS, and 5-year follow-up. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after primary HA using either patient-reported outcomes (PROs) or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using MINORS assessment, and relative agreement was calculated using Cohen's kappa.

Results: Fifteen articles were included. MINORS assessment ranged from 11 to 22, with excellent (k = 0.842) inter-rater reliability between reviewers. 2,080 patients were included at a follow-up range of 60.0-84 months. Labral repair was the most commonly performed procedure (range: 8.0%-100%). All studies included PROs, and all reported statistically significant improvement (P < .05) at the 5-year timepoint. The most frequent PRO was modified Harris Hip Score (mHHS) (n = 8). Nine studies reported on clinically significant outcome achievement, with mHHS being the most common (n = 8). The rate of achieving minimal clinically important difference (MCID) ranged from 64 to 100%, patient-acceptable symptomatic state (PASS) ranged from 45 to 87.4%, and substantial clinical benefit (SCB) ranged from 35.3 to 66%. Conversion to THA and revision surgery varied across studies, with ranges of 0.0%-17.9% (duration: 28.8-87.1 months) and 1.3%-26.7% (duration: 14.8-83.7 months), respectively. The most common definition of failure was conversion to THA or revision (n = 7). Increased age (n = 5) and greater joint degeneration (n = 4) were the most common predictors of clinical failure.

Conclusions: Patients undergoing primary hip arthroscopy for FAIS demonstrated significant improvement at 5-year follow-up, with maintained rates of achievement of MCID, PASS, and SCB. Survival rate of HA at 5 years is overall high, with ranges of 0.0-17.9% and 1.3-26.7% conversion to THA or revision surgery, respectively. Across studies, increased age and greater joint degeneration were the most commonly cited predictors of clinical failure.

Level of evidence: Level IV, systematic review of Level III and IV studies.