Reliable enough to guide care? An umbrella review of hip arthroscopy meta‐analyses 2020–2025

TL;DR

This umbrella review evaluates the quality and consistency of recent hip arthroscopy meta-analyses to determine how reliable the evidence is for guiding clinical care.

Contribution

The study provides a comprehensive assessment of methodological quality and evidence overlap in hip arthroscopy meta-analyses from 2020–2025.

Findings

Most meta-analyses had weak methodological quality and low risk of bias in only half of the reviews.

Hip arthroscopy showed short-term benefits over nonoperative care but effects diminished by 24 months.

Capsular closure and labral repair are increasingly supported by recent evidence.

Abstract

Hip arthroscopy (HAS) evidence has expanded rapidly, but methodological quality and conclusions vary. This umbrella review of contemporary meta‐analyses published January 2020–October 2025 aimed to (i) identify eligible reviews, (ii) appraise methodological quality (AMSTAR 2) and review‐level risk of bias (ROBIS), (iii) quantify evidence overlap (corrected covered area, CCA) and (iv) map concordance of conclusions.

We searched PubMed/MEDLINE, Embase and Epistemonikos (2020–2025) for human HAS meta‐analyses with quantitative synthesis on clinical effectiveness and safety. Two reviewers independently screened records and extracted data (consensus/third‐reviewer adjudication). Quality was assessed with AMSTAR 2, risk of bias with ROBIS, and evidence overlap with CCA. No re‐pooling of primary data.

From 5940 records, 44 meta‐analyses were included. AMSTAR 2 confidence was predominantly weak (≈7% high, 5% moderate; most critically low); ROBIS was low risk in just over half. Overlap was slight (low redundancy). Across randomised/comparative syntheses, HAS yielded superior short‐term improvements versus best‐practice nonoperative care—most consistently for iHOT‐33 at ~8–12 months—attenuating by ~24 months and not uniformly meeting MCIDs. Limited long‐term data suggest less radiographic osteoarthritis progression versus nonoperative care. Versus open procedures, functional outcomes were similar with fewer complications after HAS. Return‐to‐work was ~71% at ~115 days, return‐to‐sport was high (elite ~94% at ~6–7 months; broader cohorts ~89%). More recent evidence increasingly favours capsular closure and labral repair. Preoperative intra‐articular injection ≤3 months before HAS was associated with higher infection risk.

Evidence supports short‐term benefits and a good safety profile for HAS, yet certainty remains limited. Prioritise patient selection and standardised rehab; high‐quality long‐term studies are needed.

Level I, systematic umbrella review of meta‐analyses on hip arthroscopy.

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