Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized clinical trials

Abstract

Abstract This study aimed to compare the efficacy and safety of arthroscopy with physiotherapy or joint lavage in patients with femoroacetabular impingement (FAI). A meta-analysis using PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases was performed in September 2022. We included studies focusing on patients with FAI who underwent arthroscopic surgery versus those who underwent physiotherapy or arthroscopic lavage. The outcomes were functional scores (iHOT-33 and HOS ADL) and adverse events. Randomized clinical trials were included in the study. The risk of bias in each study was assessed according to Cochrane guidelines for clinical trials. The data were combined using Review Manager version 5.4. (PROSPERO CRD42022375273). Six RCTs were included, from a pool of 839 patients (407 females). There were no significant differences between groups at 6 months regarding iHOT-33 (MD 4.68, 95% CI -0.07 to 9.44) and HOS ADL (MD 5.09, 95% CI -0.07 to 10.24). The iHOT-33 and HOS ADL scales showed significant differences at 12 months in favor of the arthroscopy group (MD 10.65, 95% CI 6.54 to 14.76) and (MD 8.06, 95% CI 1.05 to 15.07). MCID was not achieved through arthroscopy in functional variables. The rate of numbness was significantly higher in the arthroscopy group. Although the arthroscopy group demonstrated statistical superiority, the clinical significance based on the MCID remains controversial, and arthroscopy did not demonstrate clinical superiority.

Keywords

• Femoroacetabular impingement syndrome
• Arthroscopy
• Conservative treatment
• Physiotherapy
• FAI
• Meta-analysis