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Outcomes of Arthroscopic Joint Preservation Techniques for Chondral Lesions in the Hip: An Updated Systematic Review
Muzammil Akhtar1, Jimmy Wen1, Daniel Razick1
1College of Medicine, California Northstate University, Elk Grove, California, U.S.A.
Insights
Joint preservation for hip chondral lesions shows varied success. Microfracture alone has declining survival rates, while newer techniques combined with or replacing microfracture offer better outcomes and patient-reported improvements.
Area of Science:
- Orthopedic Surgery
- Regenerative Medicine
- Sports Medicine
Background:
- Hip chondral lesions present a significant challenge in joint preservation.
- Understanding the efficacy of various arthroscopic procedures is crucial for optimizing patient outcomes.
- Systematic review of joint preservation techniques for hip chondral lesions.
Approach:
- Systematic literature search (2018-2023) in PubMed, Embase, and Google Scholar.
- Included studies reporting outcomes of hip arthroscopy for chondral lesions with quantifiable measures.
- Quality assessment using Methodological Index for Non-Randomized Studies criteria.
Key Points:
- Microfracture (MFx) is common but shows declining survival rates compared to earlier data.
- Novel techniques, including those combined with MFx or avoiding it, demonstrate higher survival rates.
- Autologous chondrocyte transplantation (ACT), AMIC, and MFx with CarGel show promising survival rates (92.9%-100%).
Conclusions:
- Isolated MFx shows decreased survival and increased conversion to total hip arthroscopy (THA) rates.
- Emerging techniques offer superior survival, though less frequently reported.
- Significant improvements in patient-reported outcomes (PROs) are observed across most procedures.
Purpose:
To systematically review outcomes of joint preservation procedures for chondral lesions of the hip through analysis of survival rates and patient-reported outcomes (PROs).
Methods:
A literature search from 2018 to May 2023 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in 3 databases: PubMed, Embase, and Google Scholar. Studies were included if they reported on outcomes of patients undergoing hip arthroscopy for the treatment of chondral lesions of the hip joint and if there were quantifiable postoperative outcome measures. Quality assessment was completed using the Methodological Index for Non-Randomized Studies criteria.
Results:
Twenty-seven studies were included, with 20 noncomparative and 7 comparative studies. Microfracture (MFx) was the most common procedure, reported in 17 studies. Other procedures include autologous chondrocyte transplantation (ACT) (5 studies), autologous matrix-induced chondrogenesis (AMIC) (3 studies), and MFx in conjunction with CarGel (3 studies). Seven other novel procedures were reported in individual separate studies. Survival rates, defined by no revision surgery or conversion to total hip arthroscopy (THA) at latest follow-up, for MFx (14 studies), AMIC (3 studies), and MFx in conjunction with CarGel (3 studies) ranged from 59.1% to 100%, 92.9% to 100%, and 94.4% to 95.7%, respectively. Survival rates of ACT, biological reconstruction, debridement and abrasion, microfragmented autologous adipose tissue transplantation, and ChondroFiller gel were all reported once in separate studies with rates of 100%, 100%, 85.4%, 100%, and 92.3%, respectively. All studies included PROs, most reporting statistically significant improvements (P < .05) at the latest follow-up.
Conclusions:
Isolated MFx remained the most commonly performed technique, but with lower survival and higher conversion to THA rates than in studies before 2018. Novel techniques that were performed in conjunction with MFx or that avoided MFx altogether had higher overall survival rates despite being minimally performed. Most patients across all techniques demonstrated significant improvements in PROs.
Level Of Evidence:
Level IV, systematic review of Level III and IV studies.
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