EP3.3 Hip Arthroscopy in Patients Age 40 or Older: An Updated Systematic Review

Abstract

Abstract Purpose To report conversion rates to total hip arthroplasty (THA), patient-reported outcome measures (PROMs), 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 for relevant level I or II studies, and pertinent data were abstracted from eligible studies according to PRISMA guidelines. Inclusion criteria were studies involving patients aged ≥ 40 years who underwent hip arthroscopy, published in English, and reporting at least one clinical or radiographic outcome. Results Six studies were included (one level I RCT, five level II cohort studies), encompassing 33,091 hip arthroscopy patients. Among five studies (n = 2,479), the pooled overall THA conversion rate in patients ≥ 40 was 17.99% at a weighted mean follow-up of 3.92 years. The two-year THA conversion rate was 11.13%, and the five-year conversion rate was 12.22%. Older patients (≥40 years) undergoing hip arthroscopy had significantly higher odds of conversion to THA compared to patients < 40 years, with ORs ranging from 2.68-4.39. Five studies reporting PROMs showed significant improvements that exceeded the minimal clinically important difference (MCIDs) at a follow-up period of two years; the weighted mean modified Harris Hip Score (mHHS) improved from 59.2 ± 11.7 to 80.0 ± 13.6, exceeding the MCID of 8-10. Studies reported statistically significant improvements in these scores postoperatively, with a pooled mean of 54.5% of patients achieving MCID on the mHHS. Functional outcomes (mHHS, HOS-ADL, HOS-Sport) were significantly worse in patients > 45 years compared to those < 45 years. Twenty-one procedure-related complications occurred among 1,807 hips in patients 40 and older, the two most common being superficial soft-tissue injuries and transient neuropraxia/nerve palsy. Conclusions Since 2016, higher-quality evidence confirms that hip arthroscopy in adults ≥ 40 years yields clinically meaningful PROM improvements with very low complication rates over an average follow-up of approximately 3.6 years; however, the risk of early conversion to THA remains substantial and increases steadily after age 40. Careful patient selection and counselling regarding the risk of subsequent arthroplasty are warranted.