Abstract
Introduction:Outcomes of hip arthroscopy for femoroacetabular impingement and concomitant moderate- to advanced hip osteoarthritis (Tönnis Grade II or greater) is still a matter of debate as findings in the literature are controversial. This study aims to investigate whether hip arthroscopy is effective in treating patients with femoroacetabular impingement and Tönnis hip osteoarthritis Grade II or greater.Methods and Analysis:The protocol follows the PRISMA-P guidelines. The systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42020210936. The search will include multiple databases: MEDLINE, EMBASE, Web of Science Core Collection and Cochrane library. The screening and selection process will be performed by two independent researchers based on predefined criteria. All studies published in English or German from inception to 1st of December 2020 that investigated outcomes of hip arthroscopy in patients with Tönnis grade II or greater of hip osteoarthritis will be considered eligible. The risk of bias and quality of articles will be assessed using the MINORS tool. Methodological inconsistency and heterogeneity will be explored using the I2 test. This assessment will be used to provide recommendations using the GRADE system.Ethics and Dissemination:Separate ethical approval is not required. This study will be a comprehensive and rigorous systematic review on all published articles reporting on outcomes of hip arthroscopy for femoroacetabular impingement and concomitant hip osteoarthritis Tönnis Grade II or greater. It will explore patient reported outcomes as well as radiological outcomes, complications, rates of revision surgery and rates of conversion to total hip replacement (THR). Results of the current review will be published in a peer-reviewed scientific journal and disseminated on research platforms according to copyright rules and rights.Highlights:Hip arthroscopy is used to treat femoroacetabular impingement and is effective in patients that have concomitant hip osteoarthritis Tönnis Grade 0 or 1.Outcomes of hip arthroscopy in patients with femoroacetabular impingement and in moderate to advanced osteoarthritis – Tönnis Grade 2 or greater, is a matter of debate.The purpose of the current systematic review is to elucidate, stratify and critical appraise the current evidence on outcomes in this patient subpopulation.
Highlights
Outcomes of hip arthroscopy for femoroacetabular impingement and concomitant moderate- to advanced hip osteoarthritis (Tönnis Grade II or greater) is still a matter of debate as findings in the literature are controversial
It is hypothe sized that femoroacetabular impingement may lead to earlier development of hip osteoarthritis (OA) [3]
Intraarticular damage is addressed with debridement, repair or reconstruction in cases of labral tears, and a debridement or microfracture with different biological regenerative techniques in cases of articular cartilage damage [10]. It is been well-reported, that hip arthroscopy (HA) is effective in achieving clinical improvement in patients with Femoroacetabular impingement (FAI) and concomitant OA of Tönnis Grade I, demonstrated by the results of large scale multicentre randomized controlled trials (RCT): the UK FASHIoN (RCT) [11] and the FAIT trial [12]
Summary
Outcomes of hip arthroscopy for femoroacetabular impingement and concomitant moderate- to advanced hip osteoarthritis (Tönnis Grade II or greater) is still a matter of debate as findings in the literature are controversial. FAI is treated either conservatively with activity-modification and physiotherapy [4] or with joint-preservation surgery, mainly hip arthroscopy (HA) or in specific cases, periacetabular osteotomies (PAO) or surgical hip dislocations [5] The aim of such surgery is to reshape the hip joint to prevent impingement (abnormal mechanical contact) [6] and normalise stresses in the hip joint [7] and address any concomitant extra-articular causes if present [8, 9]. Intraarticular damage is addressed with debridement, repair or reconstruction in cases of labral tears, and a debridement or microfracture with different biological regenerative techniques in cases of articular cartilage damage [10] It is been well-reported, that HA is effective in achieving clinical improvement in patients with FAI and concomitant OA of Tönnis Grade I, demonstrated by the results of large scale multicentre randomized controlled trials (RCT): the UK FASHIoN (RCT) [11] and the FAIT trial [12]
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