title: Arthroscopic Versus Open Treatment of Femoroacetabular Impingement: A Systematic Review of Medium- to Long-Term Outcomes.
abstract: BACKGROUND
  Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition.
  
  
  OBJECTIVE
  To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed.
  
  
  RESULTS
  A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P = .06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P < .001).
  
  
  CONCLUSIONS
  Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA nwachukwub@hss.edu.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Rebolledo
authors.affiliation: LESS Institute, Sports Medicine Department, Fort Lauderdale, Florida, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.affiliation: LESS Institute, Sports Medicine Department, Fort Lauderdale, Florida, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rosas
authors.affiliation: Houston Methodist Orthopaedics and Sports Medicine, Houston, Texas, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D001182:Arthroscopy; D057925:Femoracetabular Impingement / Q000601:surgery*; D006617:Hip Dislocation / Q000601:surgery; D006801:Humans; D011788:Quality of Life
keywords: femoroacetabular impingement; hip arthroscopy; open surgical hip dislocation; total hip arthroplasty