Hip Arthroscopy for Femoroacetabular Impingement Syndrome Yields Comparable Outcomes in Patients With and Without...

To characterize outcomes of femoroacetabular impingement syndrome patients with acetabular retroversion (AR) undergoing hip arthroscopy in studies reporting patient-reported outcomes (PROs), clinically significant outcomes, and reoperation rates.

A search of PubMed, Scopus, and Embase was performed. The Methodological Index for Non-Randomized Studies assessed methodological quality, and Cohen's kappa coefficient measured inter-rater reliability. Included studies (1) presented original data, (2) were in English, (3) reported ≥2-year follow-up after primary hip arthroscopy for femoroacetabular impingement syndrome using PROs or reoperation rates, (4) assessed AR via computed tomography or X-ray, and (5) were Levels I-IV. Exclusions comprised nonclinical studies, secondary indications, congenital/traumatic/dysplastic hips, revision or worker's compensation cases, periacetabular osteotomy procedures, and pediatric patients. Due to heterogeneity, meta-analysis and data pooling were avoided.

Of 750 studies, 8 met inclusion criteria. Six were Level III cohort studies, and 2 were Level IV case series. The Methodological Index for Non-Randomized Studies scores ranged from 18 to 22 (comparative) and 9 to 13 (noncomparative). Across 3630 patients, 1157 had AR and 2473 had normal version (NV). All groups showed improvements in PROs postoperatively. Mean postoperative modified Harris Hip Score (mHHS) scores ranged from 68.2 to 87.1 (AR) and 80.6 to 86.9 (NV). Minimal clinically important difference achievement for mHHS ranged 61.5% - 89.5% (AR) and 69.5% - 92.1% (NV). Patient acceptable symptom state achievement for mHHS ranged 28.4% - 81.6% (AR) and 25.5% - 82.0% (NV). Revision rates ranged 2.6% - 10.2% (AR) and 0% - 10.7% (NV). Total hip arthroplasty conversion ranged 1.2% to 2.6% (AR) and 1.0% to 2.6% (NV). High total I² values were observed for mHHS, 12-item International Hip Outcome Tool, Visual Analog Scale-Pain, and Hip Outcome Score-Sports Subscale, indicating variability. Subgroup analysis suggested that AR measurement methodology contributed to heterogeneity in Hip Outcome Score - Sports subscale.

Hip arthroscopy for femoroacetabular impingement syndrome in patients with AR identified on plain radiography alone leads to significant improvements in PROs that are comparable to NV patients. Reoperation rates were similar between groups in the majority of studies.

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