Arthroscopy - 2026-09-14 - Journal Article; Review
Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients Aged ≥40 Years Produces Durable Functional Improvement With Moderate Survivorship Compared With Younger Cohorts: A Systematic Review.
Lehman AC, Lee S, Berzolla E, Lezak BA, Youm T
Topics
Key Takeaway
Hip arthroscopy for FAI in patients ≥40 years yields durable mHHS improvement (baseline 40.5–73 improving to 72.9–96 at 5–10 years) with THA conversion rates of 2.9–13.2% across studies.
Summary Depth
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Summary
This systematic review evaluated mid- to long-term outcomes of primary hip arthroscopy for FAI syndrome in patients ≥40 years, searching PubMed, MEDLINE, and EMBASE for studies with younger comparator cohorts or age-stratified analyses. mHHS improved significantly across all cohorts at 5–10 years, and no consistent significant difference in MCID achievement was found between older and younger patients, though 2 of 4 comparative studies showed higher PASS rates in younger cohorts (P=.04). THA conversion ranged from 2.9% to 13.2%, reflecting meaningful but acceptable survivorship in this age group.
Key Limitation
The pooled older cohort spans ages 40–75 without subgroup analysis, making it impossible to determine whether outcomes and conversion rates differ meaningfully between patients in their 40s versus those in their 60s and 70s.
Original Abstract
PURPOSE
To evaluate mid- and long-term outcomes and survivorship after hip arthroscopy for femoroacetabular impingement syndrome in patients aged ≥40 years and, when available, compare these outcomes with younger cohorts.
METHODS
The electronic databases PubMed, MEDLINE, and EMBASE were searched for studies assessing the use of primary hip arthroscopy for femoroacetabular impingement syndrome in patients aged ≥40 years with either a younger comparator cohort (≤40 years) or age-stratified analyses permitting comparison. Study quality was assessed using the Newcastle-Ottawa Scale.
RESULTS
Nine studies including 451 patients (467 hips) with follow-up ranging 60 to 167 months were reviewed. Cohorts reported average ages between 40.1 and 75 years. Baseline modified Harris Hip Score (mHHS) values ranged from 40.5 to 73 and improved to 72.9 to 96 at final follow-up (5-10 years). Similar improvements were observed across secondary outcomes, including the Non-Arthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and Visual Analog Scale. Across 5 studies reporting midterm outcomes (minimum 5-year follow-up, n = 202 hips), heterogeneity in postoperative mHHS was moderate (I 2 = 41.8%). Reported rates of conversion to total hip arthroplasty ranged from 2.9% to 13.2%. Among studies reporting clinically meaningful outcomes, age-based differences were inconsistent. No significant differences were observed between older and younger cohorts in achievement of mHHS minimum clinically important difference across studies reporting comparative data. For mHHS patient acceptable symptom state, 2 studies reported higher rates of achievement in younger patients (P = .04), whereas 2 others found no significant age-based differences; several studies did not report comparative analyses.
CONCLUSIONS
Arthroscopic management of femoroacetabular impingement syndrome in patients aged ≥40 years results in significant and durable improvements in pain and function, with preservation of the native hip in most cases, although rates of conversion to total hip arthroplasty range from 2.9% to 13.2% across included studies.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.