Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip

Abstract

Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.

Running Alterations Pre- and Postarthroscopy for Femoroacetabular Impingement Syndrome and Labral Tears

“…In addition, by 6 months, the UCLA activity scores indicated that they were just as active as the controls, as the 8/10 average score indicates "regularly participating in very active sports." Our HOS SS improved by 88% up to 82.6, and similar ranges have been reported in runners 2-5 years postoperatively (5,15) and elite athletes 2-3 years postoperatively (8). In these regards, it can be assumed that the patients in our study found a similar level of relief and recovery compared with individuals of similar age and dysfunction as reported in a recent large-scale FAIS meta-analysis (8).…”

Determination of the Prevalence of Knee and Hip Clinical Osteoarthritis in the Active Professional Male Footballer and Its Association with Pain, Function, Injury and Surgery

“…Several studies have observed that footballers develop knee and hip osteoarthritis later on in their active playing years and early on after retirement. Most would require surgical intervention at some stage [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Most of these studies diagnose OA based on radiological criteria (e.g., the Kellgren–Lawrence criteria) [ 21 ].…”

“…If one considers the hip joint and PTOA, arthroscopic hip procedures usually lead to short- and medium-term symptom improvement. However, there is inconclusive data on the long-term outcomes after these procedures [ 20 ].…”

Editorial Commentary: Earlier Hip Arthroscopy May Result in Improved Outcomes for Femoroacetabular Impingement Syndrome in Symptomatic Athletes: No Time Like the Present Could Mean Better Luck Next Year

“…9 Return to sport after hip arthroscopy in professional athletes is quite high, with 61-91% of professional football players, [12][13][14][15][16][17] 82-95% of professional baseball players, [12][13][14]17,18 81-87% of professional basketball players, and 90-96% of professional hockey players returned to sports at a professional level. [12][13][14]17 Similarly, NCAA Division one athletes return to sports at the same, or higher, nearly 90% of the time after hip arthroscopy. 19 One may consider why high-level athletes return at such higher levels than lower-level competitive athletes.…”