Hip Arthroscopy in Adults Aged 40 or Older Produces Clinically Meaningful Symptom Improvement but Carries a Substantial Risk of Conversion to Total Hip Arthroplasty: A Systematic Review
Helena Son, Benjamin Blackman, Joshua Dworsky‐Fried, Dan Cohen, Yoan Bourgeault‐Gagnon, Axel Öhlin, Nicole Simunovic, Iqbal Multani, Tyler M. Hauer, Craig S. Mauro, Olufemi AyeniPurpose
To report conversion rates to total hip arthroplasty (THA), patient‐reported outcome measures, and complication rates in adults aged ≥ 40 years undergoing hip arthroscopy since 2016.
Methods
MEDLINE, EMBASE, and PubMed were searched from January 2016 to March 2025, and pertinent data were abstracted from eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. To provide an updated synthesis without duplicating prior work, this review was limited to studies published from 2016 onward, following a previous systematic review that comprehensively evaluated outcomes of hip arthroscopy in patients aged 40 years and older through 2015. Inclusion criteria were studies involving patients aged ≥ 40 years who underwent hip arthroscopy, published in English, and reporting at least 1 patient‐reported outcome measure or clinical outcome. Exclusion criteria included studies that were not Level I, II, or III studies with nonsurgical treatments or studies with duplicate patient cohorts.
Results
Six studies were included (2 Level II cohort studies, 4 Level III cohort studies), encompassing 33,091 patients (30,549 ≥ 40 years; 92.3%). Among 5 studies (n = 2479), the overall THA conversion rate in patients ≥ 40 ranged from 5% to over 21%. The 2‐year THA conversion rate ranged from 9% to 13% in patients aged 40 to 60 years, and the 5‐year conversion rate was as high as 20.2%. Five studies reporting patient‐reported outcome measures showed significant improvements that exceeded the minimal clinically important difference at a follow‐up period of 2 years. Functional outcomes (Modified Harris Hip Score, Hip Outcome Score Activity of Daily Living Scale, Hip Outcome Score Sport Scale, and Nonarthritic Hip Score) were significantly worse in patients > 45 years compared with those < 45 years. Twenty‐one procedure‐related complications occurred among 1807 hips (1.16%) in patients 40 and older, the 2 most common being superficial soft‐tissue injuries (n = 4) and transient neuropraxia/nerve palsy (n = 3).
Conclusions
Although hip arthroscopy continues to display statistically and clinically significant postoperative improvements in patients aged 40 and older, the risk of conversion to THA remains substantially higher compared with younger populations.
Level of Evidence
Level III, systematic review of Level II and III studies.