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Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications.

Methods

This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively.

Results

Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957).

Conclusions

Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter.

Level of evidence

Level IV.

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Abbreviations

FAI:

Femoroacetabular impingement

CENTRAL:

Cochrane Central Register of Controlled Trials

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

MINORS:

Methodological Index for Non-Randomized Studies

RCT:

Randomized-controlled trials

SD:

Standard deviation

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

LCEA:

Lateral Center–Edge Angle

MRI:

Magnetic resonance imaging

mHHS:

Modified Harris Hip Score

HOS-ADL:

Hip Outcome Score-Activity of Daily Living

HOS-SSS:

Hip Outcome Score Sport-Specific Subscale

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis

NAHS:

Nonarthritic Hip Score

VAS:

Visual Analog Scale

PASS:

Patient Acceptable Symptom State

MCID:

Minimally clinically important difference

RTS:

Return to Sport

BMI:

Body mass index

PC:

Peripheral compartment

CC:

Central compartment

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Acknowledgements

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No funding was received for the implementation of this study.

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Authors and Affiliations

  1. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Mithilesh V. Kumar

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Ajaykumar Shanmugaraj, Jeffrey Kay, Nicole Simunovic & Olufemi R. Ayeni

  3. Colorado Springs Orthopaedic Group, Colorado Springs, CO, USA

    Michael J. Huang

  4. Boston Sports & Shoulder Center, Waltham, MA, USA

    Thomas H. Wuerz

  5. McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

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  1. Mithilesh V. Kumar
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  2. Ajaykumar Shanmugaraj
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  3. Jeffrey Kay
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  4. Nicole Simunovic
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All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided the final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

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Correspondence to Olufemi R. Ayeni.

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ORA is an educational consultant for the Speaker’s Bureau of Smith & Nephew and Conmed.

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Kumar, M.V., Shanmugaraj, A., Kay, J. et al. Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 1095–1108 (2022). https://doi.org/10.1007/s00167-021-06647-z

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