Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty

Kemp JL, Collins NJ, Makdissi M, Schache AG, Machotka Z, Crossley K. Br J Sports Med. 2011 Dec 22. [Epub ahead of print]

Over the past few years, hip arthroscopy has become more common and is evolving from basic debridement (e.g., of the labrum and/or cartilage) to osteoplasty of the femoral neck and/or acetabulum. While numerous systematic reviews have assessed patient-reported outcomes following hip arthroscopy, numerous new studies have been performed since the last review, which may influence the outcome (especially since surgical techniques evolve over time). Therefore, Kemp et al performed a new systematic review to examine the patient-reported outcomes of pain and physical function at least 3 months after hip arthroscopy for intra-articular joint pathologies among patients at least 17 years of age. The current systematic review excluded studies that performed arthroscopy for hip osteoarthritis because previous systematic reviews have demonstrated that this population has poor surgical outcomes after hip arthroscopy. Among 40 articles that matched the study’s inclusion criteria 11 were eliminated because of low quality scores. Sixteen papers investigated the outcomes of hip arthroscopy without femoral osteoplasty (13 were retrospective). These studies included a variety of pathology but consistently demonstrated improvements in pain and function for up to 10 years. Fifteen studies examined the outcomes of hip arthroscopy with femoral osteoplasty (9 were prospective). These studies demonstrated an improvement in patient-reported outcomes up to 28 months. When reported (12 studies, 700 patients), the incidence of adverse events were low (7% of participants) and were mostly transient reduced sensation. This systematic review did not identify any eligible randomized clinical trials.

The authors concluded that the current evidence indicates that hip arthroscopy can improve patient-reported pain and function among patients with intra-articular hip pathology. It is important to note that within this systematic review hip arthroscopy with femoral osteoplasty was not evaluated beyond 3 years meaning the long-term outcomes deserve further research. While these findings look exciting and may support the use of hip arthroscopy it is important to note that the impact of hip arthroscopy, especially with osteoplasty, deserves more research to assess its efficacy compared to other treatment options and to determine how the surgery influences the development of hip osteoarthritis. It remains unclear if hip arthroscopy is delaying the onset of hip osteoarthritis by managing intra-articular pathology and/or femoro-acetabular impingement or exacerbating the situation. This is a considerable concern if the arthroscopic procedure fixes a lesion but the surgery or rehabilitation does not address the underlying cause of the lesion. Over the next few years, it will be important for hip arthroscopy and other surgical approaches to undergo thorough review via well designed clinical trials (e.g., comparative effectiveness trials) and to determine the long-term efficacy of these procedures based on patient-reported outcomes and objective functional and structural measures. Do you recommend hip arthroscopy and if so, under what circumstances do you find it most effective?

Written by: Jeffrey Driban
Reviewed by:  Stephen Thomas

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Kemp JL, Collins NJ, Makdissi M, Schache AG, Machotka Z, & Crossley K (2011). Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. British Journal of Sports Medicine PMID: 22194221