The Definition of Failure in Hip Arthroscopy May Include Factors Outside of Reoperation: A Systematic Review
Christopher D Bernard1, Eva Bowles1, Marcus Trotter1
1Department of Orthopaedics, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
Insights
Defining hip arthroscopy (HA) failure lacks standardization. This review found most studies define HA failure as needing further hip surgery, often conversion to total hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
Background:
- Hip arthroscopy (HA) is a common procedure for hip conditions.
- The definition of HA failure varies significantly in the literature.
- Lack of a standardized definition complicates outcome assessment and comparison.
Purpose of the Study:
- To systematically review current definitions of hip arthroscopy failure.
- To propose a standardized, multifactorial definition for HA failure.
Main Methods:
- Systematic literature search of Level I-IV studies on HA failure (Jan 2016-July 2021).
- Inclusion criteria: arthroscopic hip procedures with defined failure criteria.
- Exclusion criteria: open hip procedures, non-full-text articles.
Main Results:
- 85 studies met inclusion criteria.
- Most common failure definition: need for subsequent ipsilateral hip surgery (94.1%).
- Reoperation for failure often involved conversion to total hip arthroplasty (77.6%) or repeat HA (76.5%). Patient-reported outcomes like modified Harris Hip Score were used in 20% of studies.
Conclusions:
- Current literature presents numerous, inconsistent definitions of HA failure.
- A standardized definition should be multifactorial, incorporating unplanned procedures, patient-reported outcomes (PROs), and functional recovery.
- Proposed elements include subsequent surgeries, PROs (MCID, SCB, PAS), and return to function/sport.
Purpose:
To perform a systematic review about the varying definitions of "failure" of hip arthroscopy (HA) in the current literature and to provide a recommendation for the standardization of defining failure of HA.
Methods:
A systematic search of electronic databases was conducted to identity Level I-IV clinical studies on HA failure published between January 2016 and July 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of studies of patients who underwent an arthroscopic hip procedure and included a definition of failure. Studies with patients who underwent open hip procedures and non-full-text articles were excluded.
Results:
Of 1,290 titles, 85 (6.6%) met inclusion criteria and were analyzed in this review. The most common definition of HA failure used was the need for any subsequent ipsilateral hip surgery (80/85, 94.1%). Among studies that noted reoperation as a cause for failure, conversion to total hip arthroplasty was most frequently cited (66/85, 77.6%) followed by any other reoperation on the ipsilateral hip, including repeat HA, hip resurfacing, and hip periacetabular osteotomy (65/85, 76.5%). Multiple studies used subjective patient-reported outcomes, with use of the modified Harris Hip Score being the most common (17/85, 20%).
Conclusions:
There are numerous definitions of the term "failure" of HA used by authors in the peer-reviewed literature. A standardized definition of HA failure should be multifactorial. It may include any unplanned subsequent procedures; patient-reported outcomes with emphasis on minimal clinically important difference, substantial clinical benefit, and/or patient acceptable symptom state values; and the inability to return to normal function or sports.
Level Of Evidence:
Level IV, systematic review of Level III and IV studies.
