Hip Arthroscopy for Global Acetabular Overcoverage Demonstrates Favorable Patient-Reported Outcome Scores and Low to Moderate Rates of Revision and Conversion to Total Hip Arthroplasty: A Systematic Review

Abstract

Purpose

To evaluate clinical outcomes of hip arthroscopy for patients with global acetabular overcoverage, as defined by a lateral center-edge angle (LCEA) >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle.

Methods

A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases in July 2024. Studies were included if they had a minimum 2-year follow-up and reported on outcomes of hip arthroscopy for patients with global acetabular overcoverage, which was defined as a LCEA >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle. The primary evaluated outcomes included patient-reported outcomes (PROs) and rates of revision and conversion to total hip arthroplasty (THA).

Results

Eight studies comprising 369 hips (58.5% female; age range: 31.2–42.4 years; follow-up range, 24.0–73.2 months) with global acetabular overcoverage treated with arthroscopy were included. For labral management, 0–30% of patients underwent debridement, 65–100% underwent repair, and 0–100% underwent reconstruction. Femoroplasty and acetabuloplasty were performed in 73.3–100% and 94.7–100% of patients, respectively. Six studies reporting both preoperative and postoperative PROs reported significant improvements in all PROs. Rates of revision and conversion to THA ranged from 1.5 to 27.3% and from 1.8 to 13.6%, respectively. Of studies comparing outcomes between patients with global overcoverage versus normal coverage, there were no significant differences in any PROs (4/5 studies), revision rates (5/5 studies), and conversion to THA rates (3/5 studies).

Conclusions

Hip arthroscopy for global acetabular overcoverage can allow patients to achieve significant improvements in PROs along with low to moderate rates of revision and conversion to THA that are comparable to patients with normal acetabular coverage

Level of Evidence

Level IV, systematic review of Level III and IV studies.