Abstract
PURPOSE: To perform a systematic review to directly compare hip arthroscopy and nonoperative treatment for femoroacetabular impingement syndrome (FAIS) with outcomes including the risk for developing hip osteoarthritis (OA) or undergoing total hip arthroplasty (THA) later in life. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify studies directly comparing hip arthroscopy and nonoperative treatment for FAIS. The search terms used were as follows: hip AND arthroscopy AND "femoroacetabular impingement" AND (osteoarthritis OR arthroplasty). Studies with a follow-up time <2 years were excluded. Outcomes measured were incidence rates for OA progression and THA conversion following treatment. RESULTS: Six studies (1 Level I, 2 Level II, 3 Level III) met inclusion criteria, with a total of 622 hips that underwent arthroscopy and 1,424 hips that underwent nonoperative treatment (control). Mean patient age ranged from 28.2 to 42.2 years in the arthroscopy group and 28.1 to 42.2 years in the control group. Mean follow-up ranged from 2.0 to 12.5 years. OA incidence rates ranged from 10.8% to 28.0% in the arthroscopy group and from 7.1% to 48.0% in the control group. Two studies found a significantly lower rate of OA in the arthroscopy group (P < .001 and P = .005), 1 study had less articular damage in the arthroscopy group at follow-up (P < .001), and 1 study showed a greater proportion of patients who progressed to Tönnis grade 3 changes in the arthroscopy group at follow-up (P < .001). THA conversion rates ranged from 0.9% to 7.0% in the arthroscopy group and from 0.0% to 10.5% in the control group. One study showed a significantly lower rate of conversion to THA in the arthroscopy group (P = .035). CONCLUSIONS: There is some evidence that patients with FAIS who undergo hip arthroscopy may have a lower rate of progression of OA and conversion to THA compared to similar patients initially treated nonoperatively. LEVEL OF EVIDENCE: Level III, systematic review of Level I-III studies.