Delayed arthroscopy for femoroacetabular impingement may negatively impact postoperative improvement and return to sport: a systematic review

Background Femoroacetabular impingement (FAI) is a common clinical syndrome with a high prevalence among athletes. Arthroscopy for FAI boasts excellent patient-reported outcomes (PROs) and return to sport (RTS), but predictors of outcomes have been identified. Existing studies suggest that delayed arthroscopy may be associated with inferior PROs, but evidence for sport-specific outcomes is lacking. Aim Our aim was to analyze the impact of timing on (i) postoperative outcomes and (ii) return to sport following primary hip arthroscopy for FAI through a systematic review. Methods Our systematic review queried Pubmed, Embase, and Cochrane Library. Studies examining patients aged 16 or older underdoing primary arthroscopy for FAI that stratified outcomes based on time to surgery were included. Studies that were unavailable in English, not primary research, or analyzing revision procedures or FAI secondary to other lesions were excluded. The heterogeneity inherent to the populations studied precluded meta-analysis. Results Of 849 studies identified, 24 met inclusion criteria, representing a population of 23 742. Late surgery was associated with lower rates of RTS, RTS at lower play levels, and lower HOS-SS scores but not with time to RTS. Studies reported inferior improvements in non-sport PROs in delayed arthroscopy compared to earlier intervention. Later surgery was associated with greater postoperative opioid use and greater rates of total hip arthroplasty. Conclusions Delayed arthroscopy for FAI may be associated with inferior sport-related outcomes and improvements in PROs compared to earlier intervention. Substantial heterogeneity existed between the included studies, but these associations were consistent across analytic methods.