Hip Resurfacing Research Articles

Crosswalks Between Knee and Hip Arthroplasty Short Forms: HOOS/KOOS JR and Oxford.

The Oxford Knee Score (OKS); Oxford Hip Score (OHS); Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); and Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) are well-validated and widely used short-form patient-reported outcome measures (PROMs) for assessing outcomes after total knee arthroplasty (TKA) and total hip arthroplasty (THA). We are not aware of the existence of any crosswalks to convert scores between these PROMs. We aimed to develop and validate crosswalks that will permit the comparison of scores between studies using different PROMs and the pooling of results for meta-analyses. We retrospectively analyzed scores from patients (486 in the knee cohort and 340 in the hip cohort) from the Syracuse Orthopedic Specialists Joint Registry who had completed the appropriate PROMs (OKS and KOOS JR in the knee cohort and OHS and HOOS JR in the hip cohort) as the standard of care before undergoing primary TKA or unicompartmental knee arthroplasty (UKA) between January 9, 2016, and June 19, 2017, or primary THA or hip resurfacing between November 29, 2010, and October 30, 2017, or when returning for postoperative care. Using the equipercentile equating method, we created 4 crosswalks: OKS to KOOS JR, KOOS JR to OKS, OHS to HOOS JR, and HOOS JR to OHS. To assess validity, Spearman coefficients were calculated using bootstrapping methods, and means for actual and crosswalk-derived scores were compared. There were minimal differences between the means of the known and crosswalk-derived scores. As calculated with the use of bootstrapping methods, Spearman coefficients between the actual and derived scores were strong and positive for both knee arthroplasty crosswalks (0.888 to 0.889; 95% confidence interval [CI], 0.887 to 0.891) and hip arthroplasty crosswalks (0.916 to 0.918; 95% CI, 0.914 to 0.919). We successfully created 4 crosswalks that allow conversion of Oxford scores to KOOS and HOOS JR scores and vice versa. These crosswalks will allow harmonization of PROMs assessment regardless of which of the short forms are used, which may facilitate multicenter collaboration or allow sites to switch PROMs without loss of historic comparison data. Level III. See Instructions for Authors for a complete description of levels of evidence.

Quality, but not quantity of physical activity is associated with metal ion concentrations in unilateral hip resurfacing.

Little is known about the influence of physical activity (PA) on metal ion concentrations in subjects with metal-on-metal hip arthroplasty. Implant wear is thought to be a function of use and thus of patient activity levels. It is hypothesized that daily habitual PA of patients with hip resurfacing arthroplasty (HRA) is associated with metal ion concentrations. Therefore a study was conducted in patients with a unilateral HRA at 10-years follow-up. Blood metal ion concentrations were determined. An acceleration-based activity monitor was used to measure PA in daily life. The cohort consisted of 12 males (75%) and 4 females (25%) with a median age at surgery of 55.5 ± 9.7 years [43.0-67.9] and a median follow-up of 9.9 ± 1.0 years [9.1-10.9]. The median cobalt and chromium ion concentrations were 25 ± 13 and 38 ± 28 nmol/L. A significant association between sit-stand transfers and high-intensity peaks with cobalt ion concentrations were found. Regarding PA and metal ion concentrations as a proxy of wear in HRA, specific activities like transfers or qualitative aspects of activity behavior like intensity, seem to matter more than the quantity of low-intensity activities like walking or cycling. This suggests that patients may safely engage in such activities to achieve important general health benefits and quality of life.

The clinical outcome of the Metha short hip stem: a systematic scoping review.

Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "short" AND "hip" AND "stem". From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7-35.2, mean age range: 44.4-60.4 years, mean follow-up range: 2-9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.

Hip resurfacing – what is its role in modern orthopaedics?

Hip resurfacing – what is its role in modern orthopaedics?

Hip resurfacing as an outpatient procedure: a comparison of overall cost and review of safety

Recent advancements in arthroplasty surgical techniques and perioperative protocols have reduced the duration of hospitalization and length of recovery, allowing surgeons to perform joint replacement as an outpatient procedure. This study aims to evaluate the cost-effectiveness and safety of outpatient hip resurfacing. Two experienced surgeons performed 485 resurfacing surgeries. We retrospectively compared clinical outcomes and patient satisfaction with published outpatient total hip results. Furthermore, we compared average insurance reimbursement with that of local inpatient hip replacement. No major complications occurred within 6 weeks. Of the 39 patients with previous inpatient experience, 37 (95%) believed their outpatient experience was superior. The average reimbursement for hip arthroplasty at local hospitals was $50,000, while the average payment for outpatient resurfacing at our surgery center was $26,000. We conclude that outpatient hip resurfacing can be accomplished safely, with high patient satisfaction, and at a tremendous financial savings to the insurer/patient.Level of evidenceIII

Wear of large diameter ceramic-on-ceramic hip bearings under standard and microseparation conditions

A novel Ceramic-on-Ceramic hip resurfacing implant offers a bone conserving treatment for young and/or active patients without the metal ion related issues associated with current Metal-on-Metal (MoM) hip resurfacing devices. BIOLOX delta ceramics are currently used as bearing surfaces in total hip replacement and have shown to be low wearing and biocompatible. Wear testing, however, has only been conducted in bearing diameters up to 36 mm and it is unknown how this material will perform tribologically and clinically in larger bearing diameters. The smallest (40 mm diameter) and largest (64 mm diameter) bearings of aceramic resurfacing implant size range were tested to ISO 14242-1 and ISO 14242-2 standards The largest size was also tested under microseparation wear conditions in a physiological hip simulator for 5 million cycles. The wear rate over the full 5mc was shown to not be influenced by the size of implant but at specific time points, there was a statistical significance, and in all cases steady state wear was low (≤0.5mm3/mc). The introduction of microseparation conditions increased the wear rate compared to standard conditions and produced stripe wear on the heads. The low wear and biocompatible nature of the BIOLOX delta material suggests it is a suitable material for use in hip resurfacing which may open this treatment option for patients who are currently not appropriate for MoM hip resurfacing.

Hip resurfacing arthroplasty for osteonecrosis of the femoral head: Implant-specific outcomes and risk factors for failure

BackgroundHip resurfacing arthroplasty (HRA) may be a suitable option for treating osteonecrosis of the femoral head (ONFH). However, concerns regarding the extent of osteonecrosis, amount of defect under the prosthesis, and implant-related complications remain. This study aimed to report implant-specific outcomes and risk factors for failure of HRA in ONFH. MethodsA total of 202 HRAs (166 patients) performed by a single surgeon were investigated. The stage, size, and location of ONFH were evaluated using preoperative radiographs and magnetic resonance images. Clinical, radiographic results, and serum metal concentrations of articular surface replacement (ASR) and non-ASR devices were compared. Logistic regression analysis was performed to identify the contributors of failures. The mean follow-up duration was 10.6 years. ResultsTwenty-six hips (12.9%) were operated with Birmingham Hip Resurfacing (BHR), 99 (49.0%) with ASR, and 77 (38.1%) with Conserve Plus. The mean Harris Hip Score improved from 52.1 to 93.2 at the final follow-up (P < 0.001). Revision-free survivorships of non-ASR and ASR implants were 99.0% and 82.4%, respectively (P < 0.001). In multivariate analysis, the use of ASR prosthesis, greater combined necrotic angle, and smaller head size were associated with revision surgery. A large combined necrotic angle was the only independent risk factor for mechanical failure at the femoral side (P = 0.029). ConclusionHRA for ONFH using BHR and Conserve Plus implants demonstrated favourable clinical outcomes with high revision-free survival rates at 10 years. However, care should be taken for large necrotic lesions that can lead to femoral neck fracture or aseptic femoral loosening. The translational potential of this articleThis study suggests HRA performed for appropriately selected patients with ONFH can show excellent long-term clinical results. Therefore, HRA should remain as one of the treatment options for ONFH, and further development of HRA implants should be continued.

Contemporary surgical approaches for hip resurfacing

Hip resurfacing and total hip arthroplasty have evolved and improved dramatically as surgical procedures in the last decade; allowing for improvement of patient function and quality of life. A better understanding of biomaterials, biomechanics; as well as, surgical approaches have minimized time to recovery, improved implants’ survival and decreased complications. In particular hip resurfacing as a bone conservation technique, has specific considerations when selecting the surgical approach and surgical instruments affecting the success of the surgery and the outcome in the young, active patient. We present a review of surgical approaches for hip resurfacing, considering that these approaches are also performed for total hip arthroplasty, however they are adjusted or modified for hip resurfacing with special considerations to preserving femoral head blood supply as well as proper component orientation.

Recent update on crosslinked polyethylene in total hip arthroplasty.

More than two decades after their clinical introduction, crosslinked polyethylenes (XLPE) have been widely adopted. Though concerns were initially raised regarding oxidation and brittleness, on a large scale, the first generation of XLPE continues to be highly effective 15 years after the surgery, even in a young and active population. Remelted XLPE might display lower wear rates than annealed XLPE. Second generation XLPEs, not only including sequentially irradiated and annealed but also associated with antioxidants, demonstrate encouraging short- to mid-term results. Registry data support clinical trial reports. Even in less favorable settings (lipped liners, dual mobility cups, revision surgery, hip resurfacing) results are promising. However, failures (fractures) have already been described. Therefore, a high level of surveillance remains crucial.

Decision Matrix-Guided Treatment of Infected Hip Resurfacing.

Infection can nullify the benefits of a successful hip resurfacing arthroplasty (HRA). Even with infection, it may be feasible to meet a patient's desire to retain the implant. The author reviewed records of 301 patients with infected hip resurfacing. Patients expressed their treatment preference using a decision matrix that considered treatment efficacy, consequences of treatment failure, probability of infection worsening, and treatment side effects. Patient interviews were analyzed to determine their experience with treatment. Treatment alternatives were (1) no surgery, oral antibiotics, and local incision care; (2) surgical debridement, IV antibiotics, and implant retention; (3) one-stage explantation, IV antibiotics, and reimplantation generally with conversion to total hip replacement; and (4) two-stage reimplantation with conversion to total hip replacement. Mean follow-up was 9 years (range, 2-34). Pretreatment qualitative themes found that some patients believed their early infection symptoms were not validated, leading to diagnostic delays. During treatment, themes centered on mobility and lifestyle limitations for those receiving revision surgery. Posttreatment themes were reduced function following revision compared to pretreatment function. Of the 301 patients, 199 (66%) had nonoperative care, with remission for 169 (85%); 40 (13%) had one-stage reimplantation and 36 (90%) had infection remission; 16 (5%) had two-stage reimplantation with remission in 14 (87%); and 46 (16%) had debridement and implant retention, with remission for 38 (83%). The matrix showed that patients with infected HRA preferred nonoperative care, which was successful for 85%. Qualitative themes found less patient distress with nonoperative treatment and the greatest patient distress with two-stage revision.

Hip Replacement or Hip Resurfacing with a Highly Cross-Linked Polyethylene Acetabular Bearing

Background:Most surgeons strongly prefer total hip arthroplasty (THA) over hip resurfacing arthroplasty (HRA). However, it is unknown whether patients prefer the results of 1 procedure over the other. The purpose of this study was to answer 3 questions: (1) Do patients with an HRA on 1 side and a THA on the other notice a difference? (2) Do patients have a preference? (3) What are the reasons for their preference?Methods:Between 1998 and 2012, 332 patients underwent staged bilateral hip arthroplasties with cementless THA on 1 side and HRA on the other, with a highly cross-linked polyethylene acetabular component used for both. Patient preferences, Harris hip scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded by blinded examiners. Patients provided reasons for their preference in semi-structured interviews using both quantitative and qualitative measures.Results:The mean follow-up was 11 years (range, 7 to 21 years). Of 324 patients with complete data, 279 (86%) preferred the HRA, 19 (6%) preferred the THA, and 26 (8%) had no preference. The most common reasons for preference for the HRA were better balance (n = 143), felt more normal (n = 141), better activity participation/more reliable hip during sports (n = 139), and stronger on stairs (n = 129). A fair or poor outcome was reported by the patient after 4 HRAs and 7 THAs. The remainder of the patients reported improved function and satisfactory pain relief and range of motion for both hips.Conclusions:In conclusion, most patients in this study preferred the side on which the HRA had been done. Since essentially all current hip prostheses perform well, a paired bilateral study may be the optimal way to determine patient preferences and values of HRA compared with THA.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Local and systemic consequences of metal-on-metal hip resurfacing implants

Hip resurfacing arthroplasty (HRA) has a long clinical history and has utilized a variety of bearing material combinations with mixed clinical success. This paper reviews the local and systemic consequences of metal-on-metal hip resurfacing implants. Local tissue reactions cover a spectrum from no clinically adverse effects to adverse complications leading to revision associated with pain, osteolysis, or pseudotumor formation. Factors affecting the local tissue response to any implant include surgical, implant and patient factors. Metal particle size, shape and volume are important to the response around metal-on-metal implants. Surgical placement, particularly of the acetabular component, is important to the generation of wear debris. The number of patients with a sensitivity to the cobalt or chromium constituents of metal-on-metal implants is thought to be low and the cause and effect between patient sensitivity and implant failure is considered to be uncertain. Systemic toxicity from chronic exposure to the ions from metal-on-metal implants is still extremely rare although studies into potential cardiac or neurologic effects have suggested that subtle changes may be present that warrant continued and larger follow-up studies of longer-term cohorts.

Surgical considerations to avoid adverse mechanics

Surgeons performing hip resurfacing arthroplasty (HRA) or planning to do so need to understand the surgical considerations that can help them avoid adverse mechanics and therefore possibly avoidable complications. We review the key features that must be considered when selecting patients for HRA, the importance of implant selection, surgical factors to minimise wear including both femoral and acetabular positioning and also surgical approach.

Numerical study of the mechanical behavior of the system “bone-endoprosthesis” under different physiological loading

Degenerative diseases of the musculoskeletal system significantly worsen the quality of people’s life. To replace only the damaged part of the hip joint hip resurfacing arthroplasty is used. For a safe selection of the prosthesis design, choosing mechanical characteristics of the implant and determination of the range of safe loads for the system “bone-endoprosthesis” it is worth to use computer simulation. This paper presents a numerical study of the mechanical behavior of the system “bone-endoprosthesis” under different physiological loads. The influence of the types of load on the stress-strain state is analyzed. The working range of physiological loads of the bone-endoprosthesis system is determined.

Is There a Role for Preclosure Dilute Betadine Irrigation in the Prevention of Postoperative Infection Following Total Joint Arthroplasty?

BackgroundConflicting evidence exists surrounding the use of preclosure irrigation solutions in primary total joint arthroplasty (TJA). We aimed to determine the role of dilute betadine lavage in preventing early infection after primary TJA. MethodsWe retrospectively reviewed primary TJAs between 2010 and 2018. Dilute betadine lavage was introduced to our practice in November 2014. We included 3513 total hip arthroplasties, 3932 total knee arthroplasties, and 1033 hip resurfacings (HRs). In group 1 (n = 5588), surgical wounds were irrigated with saline; group 2 used dilute betadine solution (n = 2890). Subanalyses using propensity matching based on known risk factors of infection—age, body mass index, American Society of Anesthesiologists grade, diabetes, and procedure—were completed. ResultsThere were 48 acute infections in group 1 (0.9%) and 23 in group 2 (0.8%) (P = .762). HR without betadine had the highest acute infection prevalence (P = .028). When groups in the whole cohort were propensity score–matched, group 1 had more acute infections than group 2 (P = .033). The effect of betadine was isolated to HR patients. After excluding HR cases, betadine continued to reduce the acute infection rate when compared with the no betadine group, but this was not statistically significant (0.4% vs 0.8%; P = .101). Likewise, we did not find a significant difference in total hip arthroplasty and total knee arthroplasty patients (P = .796). ConclusionThere was a decreased infection rate in the betadine group overall when groups were propensity-matched. Because the reduction in the acute infection rate was clinically significant, we feel this practice is an effective means to prevent infections.

The porosity of the bone cement interface of 96 human femoral heads prepared for hip resurfacing.

The porosity of the femoral head prepared for hip resurfacing has not been previously described. This is important as greater pore size increases the penetration of bone cement and excessive cement penetration can cause osteonecrosis. 96 osteoarthritic femoral heads were harvested at total hip arthroplasty and prepared for hip resurfacing. The porosity of the bone cement interface in hip resurfacing was calculated from digitised black and white photographs using MatLab software. The mean porosity was 0.63. Increased porosity was associated with larger femoral heads in both the coronal and sagittal dimensions and cysts in the femoral head. It was not associated with gender, age, body mass index (BMI), smoking, alcohol or corticosteroid consumption. The porosity of the femoral head has been shown to be 0.63. Future studies of cementing techniques in hip resurfacing should include this porosity in their designs. The surgeon prior to hip resurfacing should consider altering his cementing technique when cysts are present on the preoperative radiographs.

What Are the Benefits of Hip Resurfacing in Appropriate Patients? A Retrospective, Propensity Score-Matched Analysis.

Hip arthritis is one of the major causes of disability worldwide. Hip resurfacing arthroplasty (HRA) has emerged in recent years as an alternative to total hip arthroplasty (THA), but complications of HRA have limited the patient population to younger male patients with primary osteoarthritis and large hip anatomy. How the functional benefits of HRA in this population compare with those of THA is not entirely clear. The primary aim of this study was to determine whether there were differences in hip disability and patient satisfaction with surgery between these two groups at 2 years after surgery, using patient-reported outcome measures (PROMs) and subjective measures of patient satisfaction. Additionally, we sought to determine whether there were differences in post-operative discharge disposition, revision rates, or adverse events. We searched an institutional database to identify patients undergoing unilateral HRA or THA between January 2007 and July 2011 who met today's recommended criteria for HRA: younger male patients with large-enough hip anatomy to make surgery viable (a femoral head of at least 48 mm in HRA patients and, in THA patients, an acetabular shell size of 54 mm, the minimum outer shell size that could accommodate a femoral head component of 48 mm; for matching purposes, acetabular shell size in THA was used as a surrogate for the femoral head size used in HRA). We used propensity score matching to control for potentially confounding pre-operative variables and administeredtheHip Disability and Osteoarthritis Outcome Score (HOOS) survey, including its subdomains, at the 2-year mark. We also assessed differences between groups in Lower Extremity Activity Scale scores, 12-item Short Form Health Survey results, and answers regarding satisfaction with surgery. We calculated minimal detectable change, minimum clinically important change, and substantial clinical benefit using anchor-based techniques for multiple outcome measures. There were 251 patients in each group. HRA patients scored significantly higher than THA patients on the 2-year HOOS sports and recreation (92 versus 87, respectively) and on rates of overall satisfaction (94% versus 89%, respectively). The HRA group also had a greater chance of achieving minimum clinically important change (18.75 points) in the HOOS sports and recreation subdomains than the THA group (97% versus 91%). No significant difference was found in 6-month adverse event rates. HRA patients also had a significantly shorter mean hospital stay, a higher rate of discharge to home, and a lower incidence of a "significant" limp after surgery. HRA may provide a functional benefit in sports and recreation and greater satisfaction in patients who meet the current criteria for HRA. Because these benefits may be small, pre-operative counseling should focus on balancing the possible functional benefits against the longer-term risks associated with metal-on-metal bearings.

Correction: Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now?

Background The number of total hip arthroplasties (THA) is rising in many industrialized nations. At the same time, the evidence regarding different types of prostheses and fixation techniques is constantly evolving. Therefore, this study aimed to analyze changes in THA by these advancements during the last decade. Methods A retrospective analysis of data provided by the Federal Statistical Office of Germany from 2007 to 2016 was conducted using codes from the German procedure classification system and associated International Statistical Classification of Diseases and Related Health Problems codes. THA procedures were evaluated according to diagnoses, sex, and age of patients, along with the distribution of different prosthesis types. Additionally, changes in these parameters over time were analyzed. Results From 2007 to 2016 a total of 2 157 041 primary THA procedures were performed in Germany, with an increase of 14.4% over this period. Overall, cementless standard THA (STHA) was used most frequently (50.0%), followed by hybrid variants (18.8%), hemiarthroplasties (15.9%), cemented standard THA (cSTHA; 9.2%), cementless short-stem THA (ssTHA; 4.8%), and hip resurfacing (HR; 0.9%) techniques. During the study period, the number of cSTHA and HR decreased significantly, whereas the use of STHA and ssTHA rose substantially, with a significantly higher application of these procedures in the elderly population. While osteoarthritis of the hip joint was the main indication for THA, several procedure-specific differences were identified. Conclusion The present data clearly demonstrate an increase in the use of cementless fixation for THA in Germany during the last decade and document a rise in ssTHA in recent years with, in contrast, the use of HR decreasing to a minimum.

Randomized controlled trial comparing 9 different hip resurfacing designs with a follow-up of 5 years

Background: A randomized controlled trial (RCT) comparing nine different hip resurfacing designs was set up at an independent hip resurfacing center to assess the possible differences between the designs. There was one operating surgeon. All surgeries were performed between 2007 and 2011. Methods: The RCT was set-up to include 180 patients scheduled for a unilateral hip resurfacing arthroplasty (HRA) who had no other metal implants and normal renal function, randomized to receive 1 of 9 different HRA designs (20 per group). Surgical data (instrumentation), clinical and radiographic outcome and metal ion levels in whole blood and serum chromium (Cr) and cobalt (Co) at preoperative, 3, 6, 12, 24 and 60 months intervals were compared. Results: During the course of the study three designs were discontinued: the ASR after withdrawal from the market and the DUROM and MITCH because of cup fixation problems. Patients already recruited and operated were kept in the study for follow-up. The other groups were ACCIS, ADEPT, BHR, Conserve Plus, Conserve Plus Aclass, and RECAP. A total of 129 patients were included in the RCT. There was no significant difference in gender between the HRA groups (P=0.435). There were more men (61.1%) included than women (38.9%). There were 9 revisions (7%) at a mean of 31.3 months (range, 11–60 months). Harris Hip Scores had a range of 86–100 (mean 98) with a median of 100 over 5 years. There was a high correlation between the whole blood and serum levels for Cr and Co (P Conclusions: Clinical and radiographical follow-up showed little differences. Overall the revision ratio, at a minimum of 8 years of follow-up was 7%. Thus, in our series, the implants of 9 different hip resurfacing designs, including the ones that were withdrawn from the market, have globally performed well with <1% failure per year. In general, metal ion levels below the proposed acceptable limits were found with all HRA designs. The difference in ion levels between the resurfacing designs may reflect differences in clearance, metallurgy and coverage angle. Outliers occurred more often with designs with a smaller coverage angle. The lower ion levels with the DUROM design are probably related to its highest coverage angle and its metallurgy.

Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes.

Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m2. Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.