AJSM - 2026-07-01 - Journal Article; Systematic Review; Meta-Analysis
Outcomes of Simultaneous Bilateral, Staged Bilateral, and Unilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis.
Thamrongskulsiri N, Morgan JT, Casanova F, Vega TF, Mirahmadi A, Chahla J
Topics
Key Takeaway
Across 4,040 hips, simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy for FAI syndrome produced no statistically significant differences in mHHS, NAHS, iHOT-12, VAS, revision rate, or THA conversion rate.
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Summary
This PRISMA-compliant systematic review and meta-analysis compared clinical outcomes across three surgical strategies for FAI syndrome: simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy. Nine comparative studies totaling 4,040 hips were analyzed for PROMs, complication rates, revision surgery, and THA conversion. No statistically significant differences were identified in any outcome measure across groups, though one study reported a lower THA conversion rate in the simultaneous cohort—a finding inconsistent across the remaining literature.
Key Limitation
The included studies are all Level III with inherent selection bias in surgical approach assignment, meaning sicker or higher-risk patients were likely steered away from simultaneous procedures, potentially confounding the equivalence finding.
Original Abstract
BACKGROUND
Femoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data.
PURPOSE
To compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome.
STUDY DESIGN
Systematic review and Meta-analysis; Level of evidence, 3.
METHODS
A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA).
RESULTS
Nine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature.
CONCLUSION
Simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile.
REGISTRATION
PROSPERO (CRD420251039957).