Migliorini Filippo, Vaishya Raju, Simeone Francesco, Memminger Michael Kurt, Betsch Marcel, Pasurka Mario
Department of Trauma and Reconstructive Surgery, University Hospital in Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy.
Arch Orthop Trauma Surg. 2025 Apr 24;145(1):267. doi: 10.1007/s00402-025-05890-0.
Femoroacetabular impingement (FAI) syndrome is a condition characterised by irregularities in the femur or acetabular rim, leading to hip pain, increased risk of osteoarthritis (OA), and potential need for total hip arthroplasty (THA). Non-surgical treatments are the first-line approach. However, arthroscopic surgery has become more prevalent due to its promising short- and medium-term outcomes. Recent meta-analyses suggest that hip arthroscopy may offer superior results compared to non-operative treatments, though follow-up periods in these studies have been limited to 12 months. This systematic review aims to evaluate the long-term effectiveness of arthroscopic management for FAI syndrome, hypothesising that it will significantly improve patient-reported outcomes (PROMs) over a follow-up period exceeding ten years.
The review focused on studies published in peer-reviewed journals with a minimum follow-up of 120 months and assessed outcomes such as PROMs and complication rates. It adhered to PRISMA guidelines and used the PICOT algorithm to evaluate the literature. Data extraction covered study characteristics, PROMs, and complications. Statistical analyses were conducted using IBM SPSS software to summarise continuous and dichotomous data.
Of 1,245 identified articles, 7 were included after rigorous screening. Risk of bias assessment with the ROBINS-I tool revealed a serious or moderate risk of bias due to confounding, although overall methodological quality was acceptable. Data from 478 patients showed significant improvements in PROMs from baseline to follow-up.
This systematic review indicates that arthroscopic management for FAI syndrome significantly improves PROMs with a mean follow-up of approximately 130 months. Nevertheless, 32% of patients required THA within ten years, underscoring the importance of careful patient selection and consideration of factors like OA and age. While conservative treatments such as physical therapy may yield comparable short-term outcomes, recent evidence suggests that arthroscopy provides superior results, particularly for younger patients and those without preoperative OA.
Level II, systematic review and meta-analysis.
股骨髋臼撞击症（FAI）综合征是一种以股骨或髋臼边缘不规则为特征的病症，会导致髋关节疼痛、骨关节炎（OA）风险增加以及可能需要进行全髋关节置换术（THA）。非手术治疗是一线治疗方法。然而，由于其在短期和中期的疗效前景良好，关节镜手术已变得更为普遍。最近的荟萃分析表明，与非手术治疗相比，髋关节镜检查可能会带来更好的效果，不过这些研究的随访期仅限于12个月。本系统评价旨在评估关节镜治疗FAI综合征的长期有效性，假设在超过十年的随访期内它将显著改善患者报告的结局（PROMs）。
该评价聚焦于发表在同行评审期刊上且随访期至少为120个月的研究，并评估了诸如PROMs和并发症发生率等结局。它遵循PRISMA指南并使用PICOT算法来评估文献。数据提取涵盖研究特征、PROMs和并发症。使用IBM SPSS软件进行统计分析以汇总连续和二分数据。
在1245篇已识别的文章中，经过严格筛选后纳入了7篇。使用ROBINS-I工具进行的偏倚风险评估显示，由于混杂因素，存在严重或中度偏倚风险，尽管总体方法学质量是可以接受的。来自478名患者的数据显示，从基线到随访，PROMs有显著改善。
本系统评价表明，对FAI综合征进行关节镜治疗在平均随访约130个月时能显著改善PROMs。然而，32%的患者在十年内需要进行THA，这凸显了仔细选择患者以及考虑诸如OA和年龄等因素的重要性。虽然物理治疗等保守治疗可能会产生相当的短期效果，但最近的证据表明，关节镜检查能提供更好的效果，特别是对于年轻患者和术前无OA的患者。
二级，系统评价和荟萃分析。
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