The results of hip arthroscopy in the older adult: a systematic review of the literature

The indications for hip preservation surgery have expanded and now include treatment for hip pathology in older adults. While several studies have examined the effectiveness of hip arthroscopy in the treatment of osteoarthritis, there is no review of the results in older adults. The aim of this study was to review the results of hip arthroscopy in older adults and to identify the factors associated with failure of treatment.
An extensive search was carried out in the PubMed, Embase and Cochrane Library databases in March 2016 for studies reporting the results of primary hip arthroscopy in patients over 40 years of age. Inclusion in the review was based on age, on the patient-reported outcome and on the duration of follow-up.
Eight studies with 401 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) or a tear of the labrum were included in the review. Seven of the eight studies reported favourable results and significant postoperative improvement from surgery. The studies included showed a trend towards greater effectiveness with an increasing proportion of repair of the labrum compared with debridement of the labrum alone (debridement). The complication rate was comparable with that of previous reports relating to young patients. However, the overall reoperation rate was 20.8%. Conversion to hip arthroplasty ranged from 0% to 30%, with an overall conversion rate of 18.5% at a mean of 17.5 months after arthroscopy. The usual risk factors for conversion to arthroplasty were a low postoperative score and advanced osteoarthritis.
In conclusion, the authors of the study maintain that hip arthroscopy appears to be a safe and effective treatment for tears of the labrum and for femoroacetabular impingement in older patients who do not have significant underlying degenerative lesions. However, in this population there is a significant proportion of patients who will ultimately require hip arthroplasty. The results may be influenced by the type of treatment. There is a need for further high-quality studies in order to understand how these factors influence the results.
Source: “American Journal of Sports Medicine”, October 2016