Summary

Hip arthroscopy with concomitant core decompression is associated with significantly high improvements in Harris Hip Score and VAS from baseline. The group undergoing arthroscopy also had significantly higher rates of survivorship.

Abstract

Introduction

Core decompression has historically been used to treat osteonecrosis of the femoral head (ONFH), which is a debilitating condition often leading to joint destruction and need for total hip arthroplasty (THA). The addition of hip arthroscopy can help treat labral tears, chondral lesions, synovitis, loose bodies while providing enhanced guidance for decompression and microfracture and advancing functional outcomes due to its minimal invasiveness.

Purpose

This systematic review aims to evaluate the effectiveness of core decompression combined with concomitant hip arthroscopy in improving outcomes for patients with ONFH and intraarticular pathology.

Methods

A literature search was conducted using PubMed, MEDLINE, and Cochrane library databases for studies published up until May 2024. Studies included were those that assessed outcomes of hip arthroscopy with concomitant core decompression. Comparative studies with a core decompression control cohort and core decompression with concomitant hip arthroscopy cohort were included. Articles were excluded if the arthroscopy was solely diagnostic. Quality assessment was performed using MINORS and ROBINS-I. Data extracted included demographics, surgical procedures, baseline and most recent patient-reported outcomes (PROs), and survivorship.

Results

Six studies met inclusion criteria (4 level III and 2 level IV), consisting of 632 hips with mean ages ranging from 35.5 to 41.1 years. Hips with more advanced osteonecrosis that underwent combined hip arthroscopy and core decompression demonstrated a significantly greater HHS than hips in the control cohort. 3 of 4 comparative cohort studies demonstrated significantly greater postoperative HHS for patients undergoing core decompression with concomitant hip arthroscopy. All 4 studies showed significantly higher rates of survivorship for hips in the arthroscopic group when compared to the control.

Conclusion

Hip arthroscopy with concomitant core decompression is associated with significantly high improvements in Harris Hip Score and VAS from baseline. The group undergoing arthroscopy also had significantly higher rates of survivorship.