EP3.4 Labral Preservation and Baseline Osteoarthritis Influence Long-term Degenerative Outcomes after Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis
Abstract
Abstract Background Femoroacetabular impingement syndrome (FAIS) is a recognized risk factor for early hip osteoarthritis (OA), and hip arthroscopy (HA) is widely used as a joint-preserving intervention. While short- and mid-term outcomes are favourable, long-term effects of HA on structural degeneration and conversion to total hip arthroplasty (THA) remain unclear. This systematic review and meta-analysis evaluated long-term degenerative outcomes following HA for FAIS. Methods PubMed, MEDLINE, and Embase were searched from inception to October 12, 2025. Studies reporting mean follow-up ≥10-years and at least one degenerative endpoint (OA progression, new radiographic OA, or THA conversion) were included. Two independent reviewers performed screening, data extraction, and methodological assessment using the methodological index for non-randomized studies (MINORS). Random-effects meta-analyses generated pooled THA conversion rates, with subgroup analyses stratifying labral management and preoperative OA severity. Results Sixteen studies (2,432 patients; mean age 28–44 years; follow-up 10–20 years) were included. The pooled THA conversion rate was 16% (95% confidence interval [CI], 12%-21%). Labral-preserving cohorts demonstrated lower THA conversion (7%; 95% CI, 5%-9%). Preoperative OA strongly predicted failure, with THA conversion of 8% in Tönnis grade 0–1 hips compared with 27% in higher-grade OA. Two comparative studies showed no significant difference in THA conversion between HA and conservative management, although both reported less OA progression following HA. Conclusion At ≥10-year follow-up, HA for FAIS demonstrates variable long-term survivorship. Labral preservation and minimal preoperative OA are associated with improved outcomes, and limited comparative evidence suggests HA may mitigate OA progression compared with nonoperative care.