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

Abstract

Background Arthroscopy is increasingly used to improve pain and function in athletes with hip joint pathology. Surgical techniques have evolved to utilise arthroscopic femoral osteoplasty to address potential morphological contributors to pathology. Purpose Investigate pain and function outcomes following hip arthroscopy with and without femoral osteoplasty in individuals with intra-articular hip pathology. Study design Systematic review. Methods A comprehensive search strategy identifi ed studies that evaluated the outcome over at least 3 months following arthroscopy for intra-articular hip pathology, using patient-reported outcomes of pain and/or function. Methodological quality was evaluated (Downs and Black scale), and effect sizes calculated when suffi cient data were available. Results Twenty-nine studies of moderate methodological quality were included. Of 16 studies investigating arthroscopy alone, two studies showed large effects (3.12-5.46) at 1-2 years. Pain reduction and functional improvement (median 47%) were consistently reported by the remaining 14 studies up to 10 years postsurgery. Of 15 studies investigating arthroscopy with osteoplasty, nine papers showed mostly large effects (0.78-2.93) over 6-28 months. Adverse events were minimal (7% of participants, 12 studies, predominantly transient neuropraxia (83%)). Conclusion Current evidence indicates that hip arthroscopy can signifi cantly reduce pain and improve function in patients with intra-articular hip pathology. While benefi ts of arthroscopy alone can persist up to 10 years postsurgery, effects of osteoplasty beyond 3 years need to be established. Future studies should investigate rehabilitation in this population, and the impact of surgery on development of osteoarthritis. INTRODUCTIONIntra-articular hip pathology is a common cause of hip and/or groin pain, 1 2 and may be associated with considerable morbidity in young active populations. 3 4 In recent years, arthroscopic surgery has contributed to advancements in assessment and management of hip pathology; however, the complex anatomical nature and multifactorial sources of pain within the hip and groin regions continue to make diagnosis and management of such injuries a challenge to clinicians. 5 Hip labral tears have been identifi ed at arthroscopy in patients with moderate to severe groin pain, 3 and professional National Hockey League (NHL) players with long-standing hip and groin pain. 4 Ligamentum teres pathology has also been observed during arthroscopy in athletes presenting with hip and groin pain. 6 The total number of hip arthroscopies performed internationally is growing rapidly, with more than 30 000 procedures performed in 2008, and an expected annual increase of 15%. 7 Moreover, surgical techniques have advanced signifi cantly in recent years. Initial procedures typically involved debridement (eg, of the labrum and/or cartilage). With improvement in surgical techniques and advancement in understanding of hip pathology, the recent focus has been on addressing abnorm...

Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

“…A careful discussion should occur to weigh the risks against the benefits of im proved functional outcomes supported by current evidence. 6 The results from our series are in keeping with the complication rates reported in the literature. Sampson 2 suggested that hip arthroscopy was associated with a complication rate ranging from 1.6% to 5%.…”

Impairment of Dynamic Single‐Leg Balance Performance in Individuals With Hip Chondropathy

“…Recent studies indicate that younger adults with chondropathy (articular cartilage disease) at hip arthroscopy have reduced patient-reported outcomes of pain and function compared to those without chondropathy (2,3).…”

Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence

“…6 The current literature on the postoperative outcomes after hip arthroscopy shows a 10-year success rate with improvements in pain and function in recreationally active individuals and competitive athletes. [7][8][9] Despite a growing acceptance and rise in arthroscopic rates, a paucity of literature exists to investigate postoperative rehabilitation interventions. Specifically, evidence-based guidelines are limited to descriptive studies such as case reports and caseseries designs.…”