Adhesions Post Hip Arthroscopy are Associated with Revision but Demonstrate Poorly Defined Criteria for Diagnosis and Operative Management: A Systematic Review.

PURPOSE: To evaluate the current body of evidence surrounding the diagnosis, management, and clinical outcomes of adhesions developed following hip arthroscopy (HA).

METHODS: A systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL was designed and conducted in accordance with PRISMA guidelines. Eligible studies included patients with confirmed adhesions following HA, with one or more of the following reported: i) diagnostic procedures and criteria employed, ii) indications for and details surrounding surgical management, and iii) clinical outcomes following the operative management of adhesions (e.g., patient-reported outcome measures (PROMs), etc.).

RESULTS: Nineteen studies involving a total of 4,145 patients (4,211 hips; 38% female) were included in this review. The quality of evidence was found to be fair for both comparative (mean = 17; range, 13-21) and non-comparative (mean = 10; range, 5-12) studies according to the Methodological Index for Non-Randomized Studies (MINORS) instrument, with the level of evidence ranging from IIB to IV. Adhesions were often diagnosed intra-operatively at the time of revision surgery (n = 10/19; 53%), with only three studies specifying the criteria used to adjudicate adhesions. The most common indication for operative management (i.e., release or lysis of adhesions) was persistent pain (n = 9/19; 47%), but this was often grossly stated for revision HA, rather than being specific to adhesions. PROMs were the most reported post-operative outcomes (n = 9/19; 47%), and generally demonstrated significant improvement from pre-operative assessment across the short-term follow-up period (range, 24.5 to 38.1 months). There was a paucity of objective measures of clinical improvement (n = 3/19; 16%), and an absence of mid-to-long term follow-up (i.e., 5-7 years, and ≥10-years, respectively).

CONCLUSION: Despite increasing evidence suggesting that adhesions are highly contributory to revision HA, there is ambiguity in the diagnostic approach and indications for operative management of adhesions. Additionally, while the operative management of adhesions post HA has demonstrated satisfactory clinical outcomes in the short term, there is a paucity of research elucidating the mid-to-long term outcomes, and minimal employment of objective assessment (e.g., biomechanics) of clinical improvement.