RF5.5 Hip Arthroscopy in Patients Age 40 or Older: An Updated Systematic Review

(1) To report conversion rates to total hip arthroplasty (THA), PROMs, and complication rates in adults aged ≥ 40 years undergoing hip arthroscopy since 2016.

MEDLINE, EMBASE, and PubMed were searched from January 2016 to March 2025 for relevant level I or II studies, and pertinent data were abstracted from eligible studies. Inclusion criteria were studies involving patients aged ≥ 40 years who underwent hip arthroscopy, published in English, conducted on humans, and reporting at least one clinical or radiographic outcome. Studies with nonsurgical treatments, duplicate patient cohorts, fewer than three patients, or non-English text were excluded.

Six studies were included (1 level I RCT, 5 level II cohort studies), encompassing 33,091 hip arthroscopy patients (30,549 ≥ 40 years; 92.3%). Among five studies (n = 2,479), the pooled overall THA conversion rate in patients ≥ 40 was 17.99% (446/2,479). The 2-year THA conversion rate was 11.13%, and the 5-year conversion rate was 12.22%. Older patients (≥40–50 years) undergoing hip arthroscopy had significantly higher odds of conversion to THA compared to patients < 40 years, with ORs ranging from 2.5-3.6. Five studies reporting PROMs showed significant improvements that exceeded MCIDs. Mean modified Harris Hip Score (mHHS) improved from 59.2 ± 11.7 to 80.0 ± 13.6 (+20.7 points), exceeding the MCID of 8-10. Functional outcomes (mHHS, HOS-ADL, HOS-Sport) were significantly worse in patients > 45 years compared to those < 45 years, highlighting both an increased failure risk and diminished clinical benefit associated with older age. Twenty-one procedure-related complications occurred among 1,807 hips (1.16%), the two most common being superficial soft-tissue injuries (n = 4) and transient neuropraxia/nerve palsy (n = 3).

Since 2016, higher-quality evidence confirms that hip arthroscopy in adults ≥ 40 years yields clinically meaningful PROM improvements with very low complication rates; however, the risk of early conversion to THA remains substantial and increases steadily after age 50. Careful patient selection and counseling regarding the risk of subsequent arthroplasty are warranted.