title: Outcomes of Hip Arthroscopy in the Older Adult: A Systematic Review of the Literature.
abstract: BACKGROUND
  The indications for hip preservation surgery have expanded to include treatment of hip pathology in older adults. While several studies have examined the efficacy of hip arthroscopy in the setting of osteoarthritis, there has been no review of outcomes in older adults.
  
  
  OBJECTIVE
  To review the outcomes of hip arthroscopy in older adults and identify factors associated with treatment failures.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library were searched through March 2016 for studies reporting outcomes of primary hip arthroscopy in patients older than 40 years. Inclusion in the review was based on age, patient-reported outcome (PRO) measures, and duration of follow-up. Two authors screened the results and extracted data for use in this review. Standardized mean difference was calculated to estimate effect size for PRO scores within studies.
  
  
  RESULTS
  Eight studies with 401 total patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) or labral tears were included in this review. Seven of the 8 studies reported favorable PRO scores and significant postoperative improvement with moderate to large effect size. The included studies demonstrated a trend toward higher effect sizes with an increasing percentage of labral repair compared to isolated labral debridement. The complication rate was comparable to that of previous reports involving younger patients; however, the overall reoperation rate was 20.8%. Conversion to hip arthroplasty ranged from 0% to 30%, with an overall conversion rate of 18.5% at a mean time of 17.5 months following arthroscopy. The most common risk factors for conversion to arthroplasty were low preoperative PRO scores and advanced arthritis.
  
  
  CONCLUSIONS
  Hip arthroscopy appears to be a safe and efficacious treatment for labral tears and FAI in older patients who do not have significant underlying degenerative changes. However, in this population, there is a significant proportion of patients who eventually require hip arthroplasty. Outcomes may be affected by type of treatment (ie, labral debridement vs repair). Additional high-quality studies are needed to understand how these factors affect outcomes.
authors.affiliation: Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Griffin
authors.affiliation: Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kinnard
authors.affiliation: Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Formby
authors.affiliation: Carondelet Orthopedic Surgeons and Sports Medicine, Overland Park, Kansas, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: McCabe
authors.affiliation: University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Terrence D
authors.initials: TD
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D006615:Hip / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: aging athlete; femoroacetabular impingement; hip arthroscopy; labral tear