The effect of prior hip arthroscopy on outcomes of total hip arthroplasty: a systematic review of comparative studies

Abstract Background Hip arthroscopy is increasingly used to treat femoroacetabular impingement, labral tears, and related disorders in young and active patients. As its indications have expanded, more patients subsequently undergo total hip arthroplasty (THA). Whether prior ipsilateral hip arthroscopy adversely affects the results of THA remains unclear. This systematic review assessed whether previous hip arthroscopy influences (1) perioperative findings, (2) postoperative complications and revision-related events, and (3) postoperative functional outcomes after THA. Methods A systematic review was performed according to PRISMA principles. PubMed, ScienceDirect, Google Scholar, Embase and Cochrane Library were searched for English-language comparative studies published between 2010 and 2025 evaluating THA after prior ipsilateral hip arthroscopy versus THA without prior arthroscopy. Extracted data included study design, patient characteristics, perioperative findings, postoperative complications, revision-related events, and patient-reported outcomes. Methodological quality was assessed using MINORS. Because of substantial heterogeneity in study design, follow-up, and reported outcomes, a narrative synthesis was performed. Results Eighteen retrospective comparative studies were included, comprising 28,477 arthroplasty patients, including 8,437 with prior hip arthroscopy. Perioperative differences were generally limited, although several studies reported longer operative time and, less consistently, greater blood loss after prior arthroscopy. Most studies found no clear differences in infection, fracture, leg-length discrepancy, or heterotopic ossification. Evidence regarding revision-related outcomes was heterogeneous: several matched cohorts and database studies reported higher rates of revision, loosening, dislocation, reoperation, or infection, particularly when THA was performed within 1 year of arthroscopy or after arthroscopy in osteoarthritic hips, whereas other studies found no increase. Functional outcomes improved substantially in both groups, although some studies reported slightly lower postoperative scores or satisfaction after prior arthroscopy. Conclusion Prior ipsilateral hip arthroscopy does not appear to compromise subsequent THA in most patients. Perioperative differences were generally limited, and functional improvement after THA remained substantial overall. Evidence regarding postoperative complications and revision-related events was heterogeneous, with some studies reporting higher risk in selected patients, particularly when THA was performed within 1 year of arthroscopy or after arthroscopy in already degenerative hips.