Patient-Reported Outcomes in Athletes Following Hip Arthroscopy for Femoroacetabular Impingement with Sub-analysis on Return to Sport and Competition Level: A Systematic Review.

PURPOSE: To identify present trends in demographics, surgical indications, preoperative findings, and surgical treatment of athletes undergoing hip arthroscopy for FAI and (2) to investigate the outcomes in this patient population, including patient-reported outcome scores (PROS), return-to-sport (RTS), complications, and reoperation data at minimum 2-year follow-up in the athletic population.

METHODS: Cochrane, Embase, and Pubmed databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to distinguish articles that reported PROS after hip arthroscopy in athletes. Athletes were defined as anyone who played a sport for minimum 2-years at any level. The standardized mean difference was calculated to compare the effect size of hip arthroscopy on various PROS.

RESULTS: Eighteen studies, with 904 athlete hips and a collective study period of January 1993-April 2017, were included in this systematic review. Across all studies, the mean age and body mass index (BMI) ranged from 15.7-36.7 years and 20.3-26.3 kg/m2, respectively. The follow-up range was 24-240 months. Mean preoperative alpha angle ranged from 57.7o -80.0o . Athletes most commonly underwent femoroplasty and labral management. At latest follow-up, the modified Harris Hip Score (mHHS) were excellent in 6 studies (range, 92.1-98), good in ten studies (range, 84.2-88.5), and fair in one study (77.1). Each studies' individual athletic cohort showed significant improvement on the mHHS, Non-Arthritic Hip Score, the Hip Outcome Score-Activities of Daily Living, the HOS-Sport-Specific Subscale, visual analog scale for pain, and International Hip Outcome Tool at latest follow-up (P<.05). The RTS rate ranged from 72.7-100%, with 74.2-100% of these athletes returning to preinjury or higher level.

CONCLUSION: Athletes undergoing arthroscopic hip surgery in the setting of FAI, not only exhibit significant functional improvement, but also have a high rate of return to sport at the same or higher competition level compared to preinjury level.