Hip Arthroscopy in Patients Aged 60 Years or Older Is Associated With Short-Term Improvement but Variable Arthroplasty Conversion Rates: A Systematic Review.

Purpose

To systematically evaluate patient-reported outcomes (PROs), revision rates, and conversion to total hip arthroplasty (THA) after hip arthroscopy in patients aged ≥60 years with femoroacetabular impingement syndrome.

Methods

A systematic review of PubMed, MEDLINE, and Scopus was performed in March 2026 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies reported PROs after hip arthroscopy in patients ≥60 years. Randomized trials, cohort studies, and case series were eligible. Nonoriginal studies, case reports, and studies without PROs were excluded. The largest cohort was selected when overlap existed. Data extracted included patient characteristics, surgical techniques, PROs, and complications, including revision and THA conversion.

Results

Seven studies (199 patients, 204 hips) were included. Mean age ranged from 63.2 to 73.0 years, with follow-up from 1.0 to 4.4 years. Among reported cases, 55.6% were Tönnis grade 0, 32.3% grade 1, and 12.1% grade 2. The modified Harris Hip Score and Non-Arthritic Hip Score were most commonly reported, and all studies reported significant postoperative improvements. Revision arthroscopy was infrequent (0%-6%), with an aggregate rate of 2.5% (5/204 cases). THA conversion ranged from 0% to 30%, with an aggregate rate of 11.8% (24/204 cases). Studies with higher conversion rates reported low rates of capsular closure (13%), high rates of labral debridement (up to 77%), low rates of labral repair (20%), and greater prevalence of Tönnis grade ≥1 (up to 57%) and acetabular Outerbridge grade 3 to 4 lesions (up to 44%).

Conclusions

Hip arthroscopy for femoroacetabular impingement syndrome in patients ≥60 years may provide short-term functional improvement in carefully selected individuals with minimal osteoarthritis and preserved cartilage. However, outcomes are variable, with THA conversion rates from 0% to 30% and substantial heterogeneity across studies. Given short-term follow-up, lack of clinically significant outcome reporting, and variable surgical techniques, conclusions should be interpreted cautiously. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.