Conservative treatment versus hip arthroscopy in patients with femoroacetabular impingement : a multilevel meta-analysis of randomized controlled trials.

Abstract

Aims: Femoroacetabular impingement (FAI) is a serious cause of hip pain with loss of function, and development of osteoarthritis of the hip. The aim of this multilevel meta-analysis of randomized controlled trials (RCTs) was to evaluate the outcomes of FAI patients treated conservatively compared with those treated with hip arthroscopy (HAS).

Methods: A systematic literature search of PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases was conducted up to 30 June 2024. In a frequentist multilevel meta-analysis with random effects model, means with 95% CIs were calculated separately in the conservative treatment subgroup and the HAS subgroup. A test for subgroup differences in meta-analysis was then performed to determine whether there was a statistically significant difference between the means of the two subgroups. Clinical assessment was based on Harris Hip Score (HHS), the International Hip Outcome Tool (iHOT), the Hip disability and Osteoarthritis Outcome Score (HOOS), the Hip Outcome Score Activities of Daily Living (HOS-ADL), and visual analogue scale (VAS) for pain.

Results: A total of 21 RCTs, including 674 patients in the conservative treatment subgroup and 1,125 patients in the HAS subgroup, met the inclusion criteria. The test for subgroup differences showed that the HAS subgroup had a statistically significant 6.5-point higher HHS ≤ 12 months post-intervention (F = 12.8; df = 1.5; p = 0.016) and a statistically significant 9.8-point higher iHOT ≤ 24 months post-intervention (F = 5.3; df = 1.1; p = 0.035) than the conservative treatment subgroup. Other functional (HOOS, HOS) and pain (VAS, NRS) outcome parameters analyzed did not show statistically significant differences.

Conclusion: This multilevel meta-analysis of 21 RCTs with a total of 1,799 FAI patients showed a statistically significant higher HHS ≤ 12 months post-intervention and iHOT ≤ 24 months post-intervention, favouring the HAS subgroup compared to the conservative treatment subgroup, without reaching minimal clinically important differences (MCIDs).