AJSM - 2026-03-25 - Journal Article
Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Clinical Outcomes at Long-term Follow-up.
Sparks CA, Monty TL, Brinkman JC, Barton KI, Nho SJ
Topics
Key Takeaway
Hip arthroscopy in acetabular dysplasia yields durable PRO improvements at mean 9.6–12 years follow-up, with THA conversion rates of 2.6–23.7% and revision rates of 2.6–15.2%, comparable to nondysplastic cohorts across all 4 comparative studies.
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Summary
This systematic review examined long-term PROs, CSO achievement, reoperation rates, and failure predictors after hip arthroscopy in acetabular dysplasia patients. Five studies (555 hips, mean age 30–41 years, follow-up 9.6–12 years) were included; all reported statistically significant mHHS improvement and CSO achievement. THA conversion ranged 2.6–23.7% and revision surgery 2.6–15.2%, with Tönnis angle as the most consistent failure predictor; 4 of 4 comparative studies found no difference in reoperation or THA conversion versus nondysplastic controls, though one study identified inferior HOS-SS and PASS achievement in the dysplasia group.
Key Limitation
Extreme heterogeneity in dysplasia definition and severity across the 5 included studies precludes determining which degree of dysplasia (borderline vs. moderate) drives the high end of the 2.6–23.7% THA conversion range.
Original Abstract
BACKGROUND
Hip arthroscopy has shown satisfactory outcomes for the treatment of intra-articular pathology and femoroacetabular impingement syndrome (FAIS) in the setting of acetabular dysplasia at short- and mid-term follow-up. However, the long-term outcomes remain less understood.
PURPOSE
To systematically review the literature to determine patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, reoperation rates, and predictors of failure in patients with acetabular dysplasia undergoing hip arthroscopy at long-term follow-up.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Three databases were searched around the following terms: hip arthroscopy, dysplasia, and long-term follow-up. Articles available in English, presenting original data, and reporting on a mean follow-up of ≥10 years after primary hip arthroscopy using either PROs, CSOs, or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using Methodological Index for Non-Randomized Studies (MINORS) assessment.
RESULTS
Five studies (555 hips) were included in the systematic review: patients had a mean age of 30 to 41 years, 13% to 88% of patients were female, and follow-up ranged from 9.6 to 12 years. MINORS assessment ranged from 11 to 21. All studies included PROs and reported statistically significant improvement for most PROs. The most frequent PRO was the Modified Harris Hip Score (mHHS) (n = 5). All studies reported CSO achievement, with mHHS and Hip Outcome Score-Sport Specific (HOS-SS) being the most common (n = 4). Revision surgery and conversion to THA ranged from 2.6% to 15.2% and from 2.6% to 23.7%, respectively across dysplasia cohorts. The most common definition of failure was conversion to THA, and Tönnis angle was the most common predictor of failure. Four studies made comparisons to a nondysplasia group, with 1 study finding inferior HOS-SS and inferior achievement of Patient Acceptable Symptom State across multiple PROs in the dysplasia group. All 4 comparative studies found no differences in rates of revision surgery or conversion to THA between groups.
CONCLUSION
Hip arthroscopy can reliably provide durable and clinically meaningful improvements for the treatment of intra-articular pathology and FAIS in patients with acetabular dysplasia at long-term follow-up, with comparable rates of revision surgery and conversion to THA to nondysplastic cohorts, although select dysplastic populations may demonstrate inferior patient-reported outcomes.