Despite its current widespread use, evidence to support the indications for hip arthroscopy lags behind: a review of current literature

Abstract

ImportanceHip arthroscopy is commonly used for diagnostic purposes and for treatment of a variety of hip pathologies. Despite its current widespread use, evidence to support the indications for its application may lag behind.ObjectiveReview the body of evidence for commonly accepted indications (ie, femoroacetabular impingement (FAI), labral tear, septic hip, loose bodies, extra-articular lesions, mild/moderate osteoarthritis, extra-articular impingement, abductor tendon tears and labral reconstruction) for hip arthroscopy based on recent systematic reviews.Evidence reviewA literature review was performed (in August 2015) using the PubMed database. The search results were filtered to include only the most recent (past 4 years 2012–2015) systematic reviews. Only articles that were selected for inclusion by these systematic reviews were included in this review of indications. Articles were then combined by indication and sorted by level of evidence and assigned a Grade of Recommendation.FindingsFair evidence exists to support the arthroscopic repair of acetabular labral tears and for the treatment of symptomatic FAI. Poor-quality evidence exists to support the use of hip arthroscopy in the treatment of extra-articular impingement, septic arthritis, mild/moderate osteoarthritis, abductor tendon tears and labral reconstruction. No recommendation could be made on the use of hip arthroscopy for ischiofemoral impingement, greater trochanter pelvic impingement and treatment for asymptomatic FAI.Conclusions and relevanceThere has been a large increase in published studies on hip arthroscopy; however, the studies published hitherto are generally of lesser quality and as such do not provide a higher Grade of Recommendation for most hip arthroscopy procedures.