Table 1.
Summary of included studies evaluating effect of hip arthroscopy on hip osteoarthritis
| Study (first author, year) | Study characteristics | Sample characteristics | Effect size at followup | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total score using modified Downs and Black appraisal | Arthroscopic intervention for OA pathology | Classification of OA pathology | Sample size | Sex | Age (years)* | Duration of symptoms (months)† | Followup (months)* | Outcome | (95% CI) | Study conclusions (where effect size = ID) | |
| Byrd (2000) [9] | 10 | Chondral débridement | Chondral injury | 38 | 17 F; 18 M | 38 | 21 (1–156) | 24 | mHHS | ID | Labrum only mHHS preoperative 63; postoperative 94; improved 31 points Labrum and chondral injury mHHS preoperative 51; postoperative 69; improved 18 points |
| Byrd (2011) [8] | 12 | Chondral débridement, microfracture (n = 18) | Chondral damage Outerbridge I–IV | 100 | 33 F; 67 M | 34 | 30 | 24 | mHHS | ID | All patients mHHS preoperative 65; postoperative 87; improved 22 points (p < 0.001) Microfracture mHHS pre NR; post NR; improved 21 points |
| Fontana (2012) [16] | 13 | Group A Autologous chondrocyte transfer (n = 15) Group B Débridement (n = 15) |
Mild OA on radiograph (Tönnis 1–2) Chondropathy Outerbridge ≥ 3 |
30 | Group A 9 F; 6 M Group B 9 F; 6 M |
Group A 40.7 Group B 42.3 |
NR | 74 | HHS | ID | Group A HHS preoperative 48; postoperative 88; improved 40 points Group B HHS preoperative 46; postoperative 56; improved 8 points |
| Haviv (2010) [21] | 11 | RF ablation; débridement; microfracture (n = 29) | Preoperative radiograph < Tönnis Grade 3 Outerbridge 2–4 |
166 | 34 F; 132 M | 37 | NR | 22 | mHHS NAHS |
mHHS Grade 1 0.94 (0.63–1.25) mHHS Grade 2 0.67 (0.52–0.81) mHHS Grade 3 1.07 (0.78–1.36) NAHS Grade 1 1.14 (0.76–1.52) NAHS Grade 2 0.79 (0.62–0.96) NAHS Grade 3 1.06 (0.77–1.35) |
|
| Haviv (2011) [20] | 11 | RF ablation, débridement | Preoperative radiograph Tönnis Grade 0 only Outerbridge 2–4 |
81 | 61 F; 20 M | 44 | 12 weeks | 3 years | mHHS NAHS |
ID | Preoperative mHHS 61, NAHS 56; postoperative mHHS 80, NAHS 78; improved 19 and 22 points (p = 0.001) Pearson correlation coefficient chondropathy and synovitis to clinical outcome r = 0.45, p < 0.05 |
| Helenius (2001) [22] | 11 | Débridement | Preoperative radiographic changes Outerbridge 0–4 |
68 | 42 F; 26 M | 58 | 39 | 1.3 years | Pain “same, better, or worse?” | ID | Outerbridge 0–89% patients better Outerbridge 1–84% patients better Outerbridge 2–73% patients better Outerbridge 3–43% patients better |
| Horisberger (2010) [24] | 9 | Débridement, microfracture | Outerbridge ≥ 2, preoperative radiograph Tönnis ≥ 1 | 20 | 4 F; 16 M | 47 | NR | 3 years | NAHS | ID | 10 patients underwent THA at followup and did not complete NAHS Preoperative NAHS in remaining patients 47; postoperative NAHS 78; improved 31 points (p = 0.004) |
| Ilizaliturri (2007) [26] | 11 | Débridement, microfracture | Chondropathy secondary to pediatric hip disorder | 13 | 7 F; 6 M | 31 | 30 | WOMAC | ID | Preoperative WOMAC 78 points; postoperative WOMAC 87 points; improved 9 points (p < 0.001) | |
| Kamath (2009) [27] | 11 | Labral and chondral débridement | Outerbridge ≥ 1 | 52 | 32 F; 20 M | 42 | 22 | 58 | mHHS | ID | All patients mHHS pre 56.8; postoperative 80.4; improved 23.6 points; no significant effect on outcome for chondral pathology (p > 0.05) |
| Margheritini (1999) [35] | 9 | Débridement, removal loose bodies, synovectomy | OA diagnosed by radiograph, MRI, or arthroscopy (not specific) | 133 | 87 F; 46 M | 42 | NR | 18 | mHHS | 0.65 (0.54–0.76) | |
| McCarthy (2011) [36] | 13 | Resection, microfracture, removal loose bodies | Outerbridge 0 Outerbridge 1–2 Outerbridge 3–4 |
111 | 64 F; 47 M | 39 | NR | 13 years | NAHS | ID | NAHS followup only for non-THA hips (n = 62) 87 points Overall 10-year survivorship (patients not having THA) 63% Outerbridge Grade 1–2 10-year survivorship 80% Outerbridge Grade 3–4 10-year survivorship 12% OR needing THA 3.6 times if age > 40 years OR needing THA 20 times if acetabular Outerbridge 3–4 OR needing THA 58 times if femoral Outerbridge 3–4 |
| McCormick (2012) [37] | 13 | Débridement | Group 1 Outerbridge ≤ 3 nonarthritic (n = 80) Group 2 Outerbridge 4 arthritic (n = 45) |
125 | 75 F; 50 M | 43 < 40 years (n = 47); ≥ 40 years (n = 78) | NR | 4.2 years | mHHS mHHS HOS |
ID | Overall postoperative mHHS 84 points; postoperative HOS ADL 87 points; HOS sport 72 points Age < 40 years–39 people mHHS > 80; 8 people mHHS < 80 Age ≥ 40 years–32 people mHHS > 80; 46 people mHHS < 80 Group 1 Outerbridge ≤ 3 52 people mHHS > 80; 28 people mHHS < 80 Group 2 Outerbridge 4 19 people mHHS > 80; 26 people mHHS < 80 OR poor outcome 2.5 times if Outerbridge 4; 7 times if aged ≥ 40 years |
| Philippon (2009) [46] | 12 | Chondroplasty, microfracture | Joint space measured on preoperative radiograph Outerbridge 1–2 (n = 74)–mild Outerbridge 3 (n = 29)–moderate Outerbridge 4 (n = 9)–poor |
112 | 62 F; 50 M | 41 | 34 | 2.3 | mHHS (8) HOS ADL (5) HOS sport (6) NAHS |
ID | Preoperative mHHS 58; postoperative mHHS 84 points; improved 26 points Preoperative HOS ADL 70; postoperative HOS ADL 88; improved 18 points Preoperative HOS SP 43; postoperative 69 points; improved 26 points Preoperative NAHS 66; postoperative 81 points; improved 15 points 10 of 112 patients progressed to THA Postoperative mHHS joint space < 2.0 mm = 68 points; joint space ≥ 2.0 mm = 87 points (p = 0.002) Postoperative mHHS cartilage change mild = 87; moderate = 79; poor = 62 (p = 0.011) OR progressing to THA 39 times if preoperative joint space < 2.0 mm |
| Streich (2009) [51] | 12 | Chondral débridement | Outerbridge 0–1 (n = 30) Outerbridge 2–4 (n = 20) |
50 | 29 F; 21 M | 33 | NR | 34 | mHHS | ID | All patients preoperative mHHS 60; postoperative mHHS 72; improved 12 points Outerbridge 0–1 preoperative mHHS 63; postoperative mHHS 87; improved 24 points Outerbridge 2–4 preoperative mHHS 55; postoperative mHHS 52; worsened 3 points |
| Tzaveas (2010) [55] | 9 | Fibrin adhesive to chondral flap | Acetabular chondral flap delamination | 19 | 14 F; 5 M | 36 | NR | 12 | mHHS | 1.05 (0.58–1.52) | |
* Mean (SD); †range; OA = osteoarthritis; CI = confidence interval; RF = radiofrequency; mHHS = modified Harris hip score range 0–100 points, 100 points = best possible outcome; VAS = visual analog scale score range 0–10 points, 0 points = best possible outcome; HHS = Harris hip score range 0–100 points, 100 points = best possible outcome; NAHS = Non-arthritic Hip Score score range 0–100 points, 100 points = best possible outcome; WOMAC score range 0–100 points, 100 points = best possible outcome; HOS = Hip Outcome Score; ADL = activities of daily living; F = female; M = male; ID = insufficient data; Tönnis = preoperative grading of osteoarthritis using Tönnis scale; Outerbridge = intraoperative grading of chondral injury; NR = not reported; NS = not specific.