Return to Work After Primary Hip Arthroscopy: A Systematic Review and Meta-analysis
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Background: Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy. Purpose: The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients’ ability to return to work, as well as time to return, was compared between selected studies. Where available, workers’ compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P < .05 was considered statistically significant. Results: Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers’ compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69). Conclusion: After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow–up.Keywords:
Hip Arthroscopy
Femoroacetabular Impingement
Abstract Purpose of Review This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. Recent Findings With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite early studies that condemned its use. Recent outcome data have demonstrated that hip arthroscopy is a viable option in BDH, with and without FAI, and has been gaining wider acceptance. Hip arthroscopy can address the concomitant soft tissue and bony intra-articular pathologies and obviate the necessity for other surgeries. Moreover, hip arthroscopy may be used as an adjuvant treatment to other procedures such as a periacetabular osteotomy (PAO). Summary Hip arthroscopy for BDH is an evolving procedure with promising short- and mid-term outcomes. The combination of BDH and FAI is becoming recognized as a problem in its own right, requiring dedicated treatment.
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Hip Arthroscopy
Femoroacetabular Impingement
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In the UK FASHIoN trial, the investigators, comparing hip arthroscopy with a conservative rehabilitation program for the femoroacetabular impingement (FAI) treatment, reported better patient-assessed function 12 months following surgery than rehabilitation. However, due to lacking of evidence-based general consensus for diagnosis of FAI, the results of this study should be interpreted with caution. This commentary highlights the precautious attention required for the rapid growth of hip arthroscopy in terms of both indications and utilization and calls for more basic science studies and long-term prospective trials with proper indications and validated criteria to closely compare hip arthroscopy with non-surgical attempts.
Femoroacetabular Impingement
Hip Arthroscopy
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Hip Arthroscopy
Femoroacetabular Impingement
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Background Arthroscopic management of femoroacetabular impingement (FAI) is an emerging technique. Traditionally FAI has been treated with open surgical dislocation, and more recently hip arthroscopy is becoming a tempting alternative. Methods We performed a systematic review of the literature to determine whether treatment with hip arthroscopy alone gives documented, reliable and prolonged relief of symptoms or alters the risk for degenerative changes. Computerized literature databases were queried for the years January 1950-February 2008 to identify articles of interest. We included studies in which FAI was a major or underlying diagnosis, hip arthroscopy was performed to treat the FAI, and there were reasonable data in terms of outcome measures before and after surgery. Results Short-term outcomes of FAI were uniformly successful in the investigated series. However, based on the systematic review it is premature to say that hip arthroscopy provides documented, reliable and prolonged relief for FAI. In addition, because of the lack of long-term data, it is unclear whether or not this technique alters the natural history of FAI. Conclusions Although hip arthroscopy seems to be a promising alternative to open surgical dislocation techniques, currently there is insufficient literature to support this modality as superior to open techniques. Level of Evidence: IV.
Femoroacetabular Impingement
Hip Arthroscopy
Evidence-Based Medicine
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One in four patients presenting with femoroacetabular impingement (FAI) has bilateral symptoms, and despite excellent outcomes reported after arthroscopic treatment of FAI, there remains a paucity of data on the outcomes following bilateral hip arthroscopy. This systematic review aims to examine the outcomes following bilateral (either 'simultaneous' or 'staged') versus unilateral hip arthroscopy for FAI. A systematic review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All studies comparing simultaneous, staged and/or unilateral hip arthroscopy for FAI were eligible for inclusion. Case series, case reports and reviews were excluded. All study, patient and hip-specific data were extracted and analyzed. The Newcastle-Ottawa Scale was used to assess study quality. A meta-analysis was not performed due to heterogeneity among outcome measures. A total of six studies, including 722 patients (42.8% male) and 933 hips were eligible for inclusion. The mean age across patients was 35.5. The average time between staged procedures was 7.7 months. Four of the six studies were retrospective cohort studies, while the remaining two were prospective in nature. The overall quality of the eligible studies was found to be good. No significant difference was noted among patient-reported outcomes (modified Harris hip score, hip outcome score and non-arthritic hip score), visual analog scale, return to sport, traction time and complications between those undergoing bilateral (simultaneous or staged) versus unilateral hip arthroscopy. Based on the current available evidence, bilateral hip arthroscopy (whether simultaneous or staged) exhibits similar efficacy and safety when compared with unilateral hip arthroscopy. However, further prospective study is required to confirm this finding.
Femoroacetabular Impingement
Hip Arthroscopy
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The purpose of this study was to compare the perioperative complications and traction times in femoroacetabular impingement hip arthroscopy with either a peripheral or central compartment starting point. Sixty patients with femoroacetabular impingement were treated with hip arthroscopy. Thirty patients had a peripheral compartment starting point and 30 had a central compartment starting point. Intra- and postoperative complications were documented along with traction times. The peripheral compartment starting group experienced 6 minor chondral injuries and 1 case of postoperative paresthesias. The central compartment starting group experienced 8 minor and 3 moderate chondral injuries, 2 labral penetrations, and 3 cases of postoperative paresthesias. Traction time averaged 46 minutes in the peripheral compartment starting group and 73 minutes in the central compartment starting group. Iatrogenic injury and traction times are decreased with peripheral vs central compartment starting in hip arthroscopy for femoroacetabular impingement. Consideration should be given for peripheral compartment starting in hip arthroscopy for the treatment of femoroacetabular impingement.
Hip Arthroscopy
Femoroacetabular Impingement
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