Short Symptom Duration Is Associated With Superior Outcomes in Patients Undergoing Primary Hip Arthroscopy: A Systematic Review

To evaluate the effect of duration of preoperative hip pain symptoms on outcomes in patients undergoing primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS).A systematic review of the literature was conducted with the following keywords: "hip arthroscopy," "outcomes," "femoroacetabular impingement," "duration," "symptoms," "time," "delay," "earlier," and "timing" was performed in PubMed and Cochrane in May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for this review. When available, article information including the author, study type, study period, and follow-up, demographics, preoperative duration of symptoms, surgical outcome tools, and secondary surgeries were recorded.Six studies including 3,298 hips were included in this systematic review. Five studies had minimum 2-year follow-up and one study had minimum 5-year follow-up. Femoroacetabular impingement (including subtypes cam and pincer impingement) was a surgical indication in all six studies, and the most common indication for surgery. All six studies reported patient-reported outcome scores (PROs). All studies conducted statistical analyses comparing the duration of symptoms' effect on outcomes and found superior outcomes in patients with shorter duration of symptoms prior to hip arthroscopy. In three studies, mHHS, HOS-ADL, HOS-SS and VAS-Satisfaction ranged from 79.1-82.6, 86.3-88.4, 75-75.5. and 75.3-82.5, respectively in cohorts with2-year duration of symptoms, compared to 72-77.7, 79.6-84, 65.0-66.7, and 69.7-75.3 in2-year cohort. Similarly, in one study the2-year duration group was reported to have a conversion to total hip arthroplasty rate of 0.6% and an overall secondary surgery rate of 0.9%, while the2-year duration group had a conversion to total hip arthroplasty rate of 6.4% and an overall secondary surgery rate of 10.1%.Patients with hip pain symptoms of less than 2 years before arthroscopic treatment of FAIS have better outcomes than those patients who had a longer duration of symptoms. However, significant improvements can still be expected regardless of time between onset of symptoms and surgery.Level IV, systematic review of Level III and Level IV studies.