Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis

Abstract

Background: No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. Study Design: Systematic review and meta-analysis. Methods: Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. Results: Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. Conclusion: The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.

The Natural Course of Recovery After Hip Arthroscopy for Femoroacetabular Impingement According to the International Hip Outcome Tool–12 and Hip Outcome Score Sports Subscale

“…5 However, optimal performance in return to preinjury performance may not be as high, with reports ranging from 30% to 80% return to full performance. 6,17,49 Additionally, there is currently a paucity of literature examining variations in patients' postoperative trajectories of recovery.…”

Return to Sport for Professional and Subelite Ice Hockey Players After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome

“…It is well known that longer symptom duration is associated with inferior outcomes after FAIS surgery and younger age has previously been associated with higher RTS. 14 , 16 , 26 The reason for the absence of relationship in this study may relate to the sample size of the study population.…”

“…There are multiple aspects affecting a player’s choice to RTS and players may retire for other reasons not related to hip pain. 26 Often, it is difficult to decide if persistent hip pain is the preventive factor for not returning to sport after surgery, and the reason why some athletes do not RTS remains unknown. Future prospective studies are warranted, including presurgical expectations of returning to sport and postsurgical evaluations of limitations to return, including the reason for not returning.…”

Revision Hip Arthroscopy in High-Level Athletes: Minimum 2-Year Outcomes Comparison to a Propensity-Matched Primary Hip Arthroscopy Control Group

“…Although outcomes of athletes who RTS are heavily studied, much less is known about athletes who fail to RTS or choose to retire from competitive sports. 67 Weber et al, 67 in a systematic review and meta-analysis, sought to determine the rate of nonreturning athletes who undergo hip arthroscopy and to explore the reasons for their inability to RTS. The investigators found that in the primary setting, the proportion of athletes who did not RTS because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001).…”