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Improvements in Patient-Reported Outcomes and Few Reported Major Complications Following Hip Arthroscopy in Patients
Frederik Nicolai Foldager1,2, Julius David3, Lisa Urup Tønning1,2
1Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark.
Purpose:
To systematically review the literature to evaluate complications and patient-reported outcome measures (PROMs) after hip arthroscopy in patients with femoroacetabular impingement syndrome.
Methods:
Five databases were searched for studies reporting complications and PROMs after hip arthroscopy in patients with femoroacetabular impingement syndrome, excluding those with dysplasia or severe osteoarthritis. Complications included conversion to total hip arthroplasty, revision surgery, and nerve paresthesia. PROMs were assessed as mean changes from baseline in domains (pain, symptoms, activities of daily living, sports participation, quality of life, and composite scores). Descriptive subgroup analyses were performed by follow-up duration and capsular repair. Risk of bias was assessed using the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results:
Forty-two studies (5885 hips) were included. The unweighted proportions of complications were 2.1% for conversion to total hip arthroplasty (range, 0%-16.7%), 5.2% for revision surgery (range, 0%-22.3%), and 3.8% for nerve paresthesia (range, 0.8%-12.5%). PROMs (0-100 scale; higher scores indicate greater improvement) showed mean changes from baseline to follow-up ranging from 9.4 to 35.0 points for pain, 14.3 to 25.0 points for symptoms, 10.9 to 43.0 points for activities of daily living, 15.0 to 45.5 points for sports participation, 15.0 to 43.2 points for quality of life, and 10.3 to 47.6 points for composite scores. Evidence certainty was rated very low for complications and PROMs.
Conclusions:
Hip arthroscopy for femoroacetabular impingement syndrome is associated with low average rates of total hip arthroplasty conversion, revision surgery, and nerve paresthesia and with clinically meaningful improvements across PROM domains. However, the certainty of evidence is very low, and results should be interpreted with caution.
Level Of Evidence:
Level IV, systematic review and subjective synthesis of Level I to IV studies.