Outcomes After Arthroscopic Osteochondroplasty for Femoroacetabular Impingement Secondary to Systematic Review

Purpose: To determine the efficacy of arthroscopic osteochondroplasty for patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods: A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 1, 2019. Data including patient demographics, slip severity according to Southwick, outcomes, and complications were retrieved from eligible studies that reported a minimum 3-month followup of arthroscopic osteochondroplasty for FAI secondary to SCFE. Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess quality of studies. Heterogeneity and quality were evaluated using P values and the I2 statistic. Results: Six studies (90 hips) were analyzed. The range of MINORS scores was 8 to 11. Most studies were level of evidence 4 (n = 4, 66.7%), with more men than women (n = 5, 83.3%). The ranges of age, body mass index, and follow-up length after surgery were 10 to 42 years, 17.5 to 32.3 kg/m2, and 3 to 56 months, respectively. The Modified Harris Hip Score (mHHS) was the most commonly used score to report on clinical outcomes (n = 2 studies, 28 hips) with a significant improvement following surgery. Three studies reported an improvement in internal rotation (IR) of the hip with a range of improvement of 17 degrees to 32 degrees, with low heterogeneity (I2 = 0% and P = .531). Five studies reported a significant correction of the a angle, with range of improvement of 19.9 degrees to 37.3 degrees. The range of postoperative a angle was 32 degrees to 67 degrees, and 3 studies achieved appropriate postoperative a angle (40 degrees to 50 degrees), with low heterogeneity (I2 = 8.4% and P = .336). The total number of complications was 8 (1 major complication) and there were 6 revisions, with low heterogeneity. Conclusion: Arthroscopic osteochondroplasty for FAI secondary to SCFE provides good short- to medium-term outcomes and improves IR of the hip, with the ability to potentially correct the a angle with a low rate of complications and revision. Level of Evidence: IV, systematic review of level II to IV studies.