Arthroscopic Procedure for Femoroacetabular Impingement Syndrome in Adolescents: A Systematic Review and Meta-analysis

Abstract

Femoroacetabular impingement (FAI) is caused by aberrant anatomy involving the proximal femur with or without the acetabulum resulting in mechanical impingement. FAI's effects can be devastating in the young. In recent studies, significant associations have been found between skeletal immaturity, FAI, and sports involvement. Hip arthroscopy for FAI has been demonstrated to produce good results. We opted to update the review and meta-analysis to further narrow the research gap in the literature by including recently published studies and a comprehensive review of the arthroscopic approach for FAI. Prior to January 1, 2024, PubMed, Embase, and Google Scholar databases were searched for the studies with data on surgical procedures and patient-related outcomes for arthroscopic FAI. RevMan 5.2 was utilized to calculate the pooled mean differences with a 95% confidence interval to compare reported postoperative and preoperative patients' outcomes. In total, 24 studies of adolescent subjects with a mean age of less than 20 years, including 1,619 patients and 1,767 hips, were included. Eleven studies included acetabuloplasty and femoroplasty as major treatments. When preoperative and postoperative outcomes were compared, statistically significant changes were seen in the mHHS (modified Harris hip score), HOS-ADL (Hip Outcome Score-Activities of Daily Living), HOS-SSS (Hip Outcome Score-Sports-Specific Subscale), i-HOT (International Hip Outcome Tool 12 questions), NAHS (Nonarthritic Hip Score), and the visual analog scale. Numbness, neuropraxia and infections were seen in only 12 patients. This meta-analysis demonstrated overall improvements in hip pain, quality of life, and hip function along with few complications.

Keywords: Adolescent; Femoroacetabular impingement; Hip arthroscopy; Meta-analysis.

Fig. 1

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow chart of the study selection process¹³⁾.

Fig. 2

(A) Mean differences between preoperative and postoperative modified Harris hip score (mHHS) scores. (B) Mean differences between preoperative and postoperative mHHS scores of the prospective and retrospective study subgroups.

Fig. 3

Publication bias for studies with reported modified Harris hip score outcomes.

Fig. 4

(A) Mean differences in Hip Outcome Score–Activities of Daily Living (HOS-ADL) preoperative and postoperative scores. (B) Mean differences in HOS-ADL preoperative and postoperative scores of the prospective and retrospective study subgroups.

Fig. 5

(A) Mean differences in preoperative and postoperative Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) scores. (B) Mean differences in preoperative and postoperative HOS-SSS scores of prospective and retrospective study subgroups.

Fig. 6

Publication bias for studies with reported HOS-SSS (Hip Outcome Score–Sports-Specific Subscale) outcomes.

Fig. 7

(A) Mean differences in preoperative and postoperative Nonarthritic Hip Score (NAHS) scores. (B) Mean differences in preoperative and postoperative NAHS scores of the prospective and retrospective study subgroups.

Fig. 8

(A) Mean differences in preoperative and postoperative visual analog scale (VAS) pain scores. (B) Mean differences in preoperative and postoperative VAS pain scores of the prospective and retrospective study subgroups.

Fig. 9

(A) Mean differences in preoperative and postoperative International Hip Outcome Tool (12 questions) (i-HOT) scores. (B) Mean differences in preoperative and postoperative i-HOT scores of the prospective and retrospective study subgroups.