493 Hip Arthroscopy for the Primary Management of Femoroacetabular Impingement with Concomitant Chondral Lesions - a Systematic Review and Meta-Analysis

Abstract

Abstract Introduction Femoroacetabular impingement (FAI) is an important cause of hip pain in the young, active population. Treated by hip arthroscopy (HA), chondral lesions are frequently seen, and there are concerns that patients with chondral defects leading to hip osteoarthritis (OA) will not benefit from HA. This review analyses the use of HA in FAI patients with chondral lesions according to Outerbridge classification. Method A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science. From twenty-four included studies, patient related outcome measures (PROMs), total hip arthroplasty (THA) conversion rate, radiological outcomes were collected. Clinical studies of HA used for primary FAI management, classifying chondral lesions according to Outerbridge classification were included. Patients treated with open procedure, osteonecrosis, Legg-Calve-Perthes disease, previous ipsilateral hip fractures were excluded. Risk of bias was assessed using ROBINS-I. Results Improved post-operative PROMs included mHHS (n=18; mean difference:-2.42; 95%CI:-2.99 to -1.85; p<0.0001), NAHS (n=8; mean difference:-1.73; 95%CI: -2.23 to -1.23; p<0.0001), VAS (n=7; mean difference:2.03; 95%CI:0.93–3.13; p<0.0001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%). Patients had worse PROMs if they underwent HA with labral debridement (p=0.0149), have Outerbridge 3 and 4 lesions (p=0.0116), kissing lesions (p=0.0292). Reconstructive cartilage techniques were superior to microfracture (p=0.0416). Even in “kissing” lesions, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.0267). Conclusions This meta-analysis suggests that acceptable post-operative outcomes following HA in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved.