Arthroscopy versus mini-open surgery for femoroacetabular impingement : a systematic review of clinical outcomes

Abstract

Introduction

Arthroscopic and mini-open surgery are both valid options for managing symptomatic femoroacetabular impingement (FAI). The current systematic review compared the clinical outcomes of arthroscopic surgery versus mini-open surgery for femoroacetabular impingement. The primary outcomes assessed included patient-reported outcome measures (PROMs) and the incidence of complications. Material and methods

This systematic review followed the PRISMA statement. The Web of Science, PubMed, and Embase were accessed in June 2025 without additional filters or temporal constraints. All clinical studies concerning the surgical management of FAI were considered. Only investigations on arthroscopy or a mini-open surgical approach and those directly comparing the two techniques were included. Only studies with at least 6 months of follow-up were considered. The PROMs of interest were the visual analogue scale (VAS) and the modified Harris Hip Score (mHHS). Data on the reoperation rate and progression to total hip arthroplasty were collected. The mean difference (MD) and odds ratio (OR) measures were used for the comparisons. Results

Data from 233 clinical studies (54,272 patients) were retrieved. The mean follow-up duration was 33.9 ± 22.7 months. The mean age was 35.0 ± 5.2 years and the mean body mass index (BMI) was 25.1 ± 2.1 kg/m2. Arthroscopic surgery showed higher VAS (MD 1.2/10; P = 0.02) and mHHS values (MD 3.3/100; P < 0.01); however, despite being statistically significant, these differences had minimal clinical relevance. A statistically significant increase in the risk of reoperation was observed in the arthroscopy group (OR 8.9; P < 0.01). No significant difference was observed in the progression to THA (OR: 0.9; P = 0.4). Conclusion

Mini-open and arthroscopic surgery for symptomatic FAI achieve similar clinical outcomes and comparable complication rates at approximately 34 months follow-up. The mini-open approach was associated with a lower risk of reoperation. Future research should focus on long-term follow-up and standardized outcome measures to refine the understanding of these surgical options and enhance patient care.