Clinical Outcomes of Primary Versus Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis

Abstract

Background: As the incidence of primary hip arthroscopic surgery has increased, the incidence of revision hip arthroscopic surgery has also increased. Although many factors have been reported that predict clinical failure of hip arthroscopic surgery, the outcomes of primary versus revision hip arthroscopic surgery are unknown. Purpose: To perform a systematic review and meta-analysis comparing the outcomes of primary versus revision hip arthroscopic surgery. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: A search following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in the PubMed, Embase, and Cochrane Library databases. Studies were included if they compared the outcomes of primary versus revision hip arthroscopic surgery and had a minimum follow-up of 12 months. Data regarding study characteristics, patient characteristics, radiographic parameters, patient-reported outcomes, and adverse events were recorded. A meta-analysis was conducted using a random-effects model. Results: There were 11 studies included, with 6437 patients (56.1% female; mean age, 37.1 years) and 1151 patients (65.3% female; mean age, 35.2 years) undergoing primary and revision hip arthroscopic surgery, respectively. Preoperative and postoperative radiographic parameters were not clinically different between the primary and revision groups. Postoperative scores for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, modified Harris Hip Score, International Hip Outcome Tool–12, and Non-Arthritic Hip Score were significantly lower (all P < .001), and the visual analog scale for pain ( P < .001) score was significantly higher, after revision hip arthroscopic surgery. For the primary versus revision group, the rate of achieving the minimal clinically important difference ranged from 66.7% to 92% versus 47.4% to 90%, respectively, and the rate of achieving the Patient Acceptable Symptom State ranged from 52.6% to 79.4% versus 20% to 64%, respectively. The risk of complications ( P = .04) and conversion to total hip arthroplasty ( P < .001) was significantly higher after revision hip arthroscopic surgery. Conclusion: Patients undergoing revision hip arthroscopic surgery were less likely to achieve clinically significant improvements in postoperative patient-reported outcomes and exhibited a higher risk of complications and conversion to total hip arthroplasty compared with patients undergoing primary hip arthroscopic surgery. These findings suggest that outcomes are optimized in the primary setting, and surgeons should appropriately counsel patients regarding expectations after revision hip arthroscopic surgery.