RF5.5 Hip Arthroscopy in Patients Age 40 or Older: An Updated Systematic Review
Bibliographic record
Abstract
Abstract Purpose (1) To report conversion rates to total hip arthroplasty (THA), PROMs, and complication rates in adults aged ≥ 40 years undergoing hip arthroscopy since 2016. Methods 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. Results 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). Conclusions 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.017 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".