Systematic Review of Hip Arthroscopy for Femoroacetabular Impingement: The Importance of Labral Repair and Capsular Closure

Purpose To evaluate the safety and efficacy of hip arthroscopy for femoroacetabular impingement syndrome by assessing complications, comprehensive procedure survivorship, and the influence of labral and capsular management on procedure survivorship. Methods A systematic review of multiple medical databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All clinical outcome studies that reported on the presence or absence of reoperation after hip arthroscopy for femoroacetabular impingement syndrome were eligible for inclusion. Data pertaining to patient demographic characteristics, surgical technique (specifically labral and capsular management), patient-reported outcomes, complications, reoperation, and conversion to arthroplasty were extracted from each study. Results A total of 68 studies (7,241 hips) were included. Most were Level IV studies (63%). Complications occurred in 1.9% of cases. The most common complications were neurologic (53%), heterotopic ossification (24%), infection (15%), and thromboembolic (7%). Conversion to total hip arthroplasty (456 cases) was the most common reason for reoperation, followed by revision hip arthroscopy (226 cases) and periacetabular osteotomy (7 cases). The rate of arthroplasty conversion was lower than 10% in 43 of 59 studies reporting this outcome. The average interval to arthroplasty conversion was 58 months. Between 2009 and 2017, the performance of labral repair increased from 19% to 81% of cases and capsular closure increased from 7% to 58% of cases. Conclusions Arthroplasty conversion occurred in fewer than 10% of cases in the clear majority of series. Labral repair (compared with labral debridement) and capsular closure (compared with unrepaired capsulotomy) were associated with a lower risk of conversion to arthroplasty. Throughout the study interval, there were shifts in surgical technique favoring labral repair over debridement and capsular repair over unrepaired capsulotomy. The study is limited by selection bias because cases in which labral and capsular repair was performed may have had superior tissue that was more amenable to repair. Level of Evidence Level IV, systematic review.