What question did this study set out to answer?

This review aims to compare the clinical outcomes of arthroscopic versus mini-open surgery in managing femoroacetabular impingement.

February 26, 2026Open Access

Arthroscopy versus mini-open surgery for femoroacetabular impingement

Key Points

This review aims to compare the clinical outcomes of arthroscopic versus mini-open surgery in managing femoroacetabular impingement.
Conducted a systematic review following PRISMA guidelines.
Included clinical studies comparing arthroscopy and mini-open surgery for FAI.
Analyzed patient-reported outcomes like VAS and mHHS.
Calculated mean differences and odds ratios for outcomes.
Arthroscopic surgery showed statistically higher VAS and mHHS scores, though clinically minimal.
Higher risk of reoperation identified in the arthroscopy group (OR 8.9).
No significant difference in progression to total hip arthroplasty (OR 0.9).
Both approaches generated similar outcomes and complication rates at 34 months follow-up.

Abstract

Abstract Introduction Arthroscopic and mini-open surgery are both valid options for managing symptomatic femoroacetabular impingement (FAI). The current systematic review compared the clinical outcomes of arthroscopic surgery versus mini-open surgery for femoroacetabular impingement. The primary outcomes assessed included patient-reported outcome measures (PROMs) and the incidence of complications. Material and methods This systematic review followed the PRISMA statement. The Web of Science, PubMed, and Embase were accessed in June 2025 without additional filters or temporal constraints. All clinical studies concerning the surgical management of FAI were considered. Only investigations on arthroscopy or a mini-open surgical approach and those directly comparing the two techniques were included. Only studies with at least 6 months of follow-up were considered. The PROMs of interest were the visual analogue scale (VAS) and the modified Harris Hip Score (mHHS). Data on the reoperation rate and progression to total hip arthroplasty were collected. The mean difference (MD) and odds ratio (OR) measures were used for the comparisons. Results Data from 233 clinical studies (54,272 patients) were retrieved. The mean follow-up duration was 33.9 ± 22.7 months. The mean age was 35.0 ± 5.2 years and the mean body mass index (BMI) was 25.1 ± 2.1 kg/m 2 . Arthroscopic surgery showed higher VAS (MD 1.2/10; P = 0.02) and mHHS values (MD 3.3/100; P < 0.01); however, despite being statistically significant, these differences had minimal clinical relevance. A statistically significant increase in the risk of reoperation was observed in the arthroscopy group (OR 8.9; P < 0.01). No significant difference was observed in the progression to THA (OR: 0.9; P = 0.4). Conclusion Mini-open and arthroscopic surgery for symptomatic FAI achieve similar clinical outcomes and comparable complication rates at approximately 34 months follow-up. The mini-open approach was associated with a lower risk of reoperation. Future research should focus on long-term follow-up and standardized outcome measures to refine the understanding of these surgical options and enhance patient care.

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