Isolated Hip Arthroscopy Provides Comparable Mid‐ to Long‐Term Outcomes in Borderline Hip Dysplasia and Normal Hips: A Systematic Review and Meta‐analysis
Arthroscopy The Journal of Arthroscopic and Related Surgery · 24 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This informs surgeons and patients whether borderline dysplastic hips can be safely treated arthroscopically without incurring worse durability compared to normally covered hips, which is a common intraoperative decision point in young active patients with FAIS.
The evidence
This systematic review and meta-analysis pooled four retrospective cohort studies (478 hips total: 157 with borderline hip dysplasia [BDH], 321 with normal acetabular coverage) undergoing isolated hip arthroscopy for FAIS, with follow-up of 5 to over 10 years. Pooled patient-reported outcomes (modified Harris Hip Score, HOS subscales, pain VAS) showed no statistically significant differences between BDH and control groups, and revision rates (14.0% vs 20.9%, OR 0.61, P=.07) and conversion to hip replacement (1.9% vs 4.7%, OR 0.45, P=.22) were also not significantly different, though the point estimates favoured BDH patients numerically.
modified Harris Hip Score: Mean difference -2.39 (95% CI -7.34 to 2.55; mHHS). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Meta-analysis of observational studiesDesign starting point: 37.4
Raised the score
- Prospectively registered+5.1
- Comprehensive literature search+3.4
Lowered the score
- Pools observational studies−6.8
Score capped at 40. The conclusions are not supported by the reported results.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedMet
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Compared against an accepted alternative
- +1.7
- Prospectively registered
- +5.1
- Pools observational studies
- −6.8
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Publication bias assessed
- +2.5
- Methodological cap
- −11
- Final rigour score rounded
- 40 / 100
Study design sets the starting point and a ceiling of 78. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that revision and conversion-to-THA rates were numerically lower (though not statistically significant) in the BDH group, how should surgeons weigh capsular plication and labral preservation techniques when counselling BDH patients about arthroscopy versus periacetabular osteotomy?
2.Should adjunct radiographic parameters like the FEAR index or femoral version be incorporated into preoperative decision-making for BDH patients even though none of the included studies reported them?
Original publication title
Isolated Hip Arthroscopy Provides Comparable Mid‐ to Long‐Term Outcomes in Borderline Hip Dysplasia and Normal Hips: A Systematic Review and Meta‐analysis