Reliable enough to guide care? An umbrella review of hip arthroscopy meta‐analyses 2020–2025

Abstract Purpose Hip arthroscopy (HAS) evidence has expanded rapidly, but methodological quality and conclusions vary. This umbrella review of contemporary meta‐analyses published January 2020–October 2025 aimed to (i) identify eligible reviews, (ii) appraise methodological quality (AMSTAR 2) and review‐level risk of bias (ROBIS), (iii) quantify evidence overlap (corrected covered area, CCA) and (iv) map concordance of conclusions. Methods We searched PubMed/MEDLINE, Embase and Epistemonikos (2020–2025) for human HAS meta‐analyses with quantitative synthesis on clinical effectiveness and safety. Two reviewers independently screened records and extracted data (consensus/third‐reviewer adjudication). Quality was assessed with AMSTAR 2, risk of bias with ROBIS, and evidence overlap with CCA. No re‐pooling of primary data. Results From 5940 records, 44 meta‐analyses were included. AMSTAR 2 confidence was predominantly weak (≈7% high, 5% moderate; most critically low); ROBIS was low risk in just over half. Overlap was slight (low redundancy). Across randomised/comparative syntheses, HAS yielded superior short‐term improvements versus best‐practice nonoperative care—most consistently for iHOT‐33 at ~8–12 months—attenuating by ~24 months and not uniformly meeting MCIDs. Limited long‐term data suggest less radiographic osteoarthritis progression versus nonoperative care. Versus open procedures, functional outcomes were similar with fewer complications after HAS. Return‐to‐work was ~71% at ~115 days, return‐to‐sport was high (elite ~94% at ~6–7 months; broader cohorts ~89%). More recent evidence increasingly favours capsular closure and labral repair. Preoperative intra‐articular injection ≤3 months before HAS was associated with higher infection risk. Conclusion Evidence supports short‐term benefits and a good safety profile for HAS, yet certainty remains limited. Prioritise patient selection and standardised rehab; high‐quality long‐term studies are needed. Level of Evidence Level I, systematic umbrella review of meta‐analyses on hip arthroscopy.