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Systematic review
Femoral neck fracture is a rare complication after arthroscopic femoroplasty for femoroacetabular impingement with no known prognostic factors and few reported risk factors: a systematic review

Abstract

Importance Arthroscopic hip surgery established itself as a therapeutic option for the surgical treatment of hip diseases. There have been few reports about postoperative femoral neck fractures. We give an overview of risk factors that could lead to femoral neck fracture because existing reports of risk factors such as gender and fracture rates are oppositional in the recent literature.

Objectives This work aims to systematically review the current available articles reporting on the rare complication of femoral neck fractures after hip arthroscopy and/or arthroscopic femoroplasty mainly treating femoroacetabular impingement. Particularly, the questions that the authors aimed to answer were (1) What are the fracture rates after hip arthroscopy and/or arthroscopic femoroplasty? (2) Are there any negative prognostic factors that may lead to femoral neck fractures?

Evidence review The EMBASE, MEDLINE and PubMed databases were searched for articles addressing femoral neck fractures after arthroscopic femoroplasty. Articles selected in this review met six inclusion criteria. Descriptive statistics from the eight studies identified by the search were analysed.

Findings Fracture rates ranged from 0.07% to 1.9%. All publications demonstrated that risk increases with age. One study identified male sex as a risk factor, another found females were at risk. Another factor seems to be—at least for men—greater height. Two case reports showed increased risk with increased bone resection, one of which demonstrated that a resection depth ratio of >18% leads to a 25-fold increased risk of fracture.

Conclusion and relevance The fracture rate after hip arthroscopy is 0.08% and 0.12% after arthroscopic femoroplasty. Patients likely to be at risk are older than 45 years and/or tall men. Bone resection depth is one of the main risk factors. Male patients seem to have a minimally higher risk, but it is not yet clear whether sex is a risk factor. There is a lack of high-level evidence. Further research needs therefore to be done.

Level of evidence Level IV, systematic review of level II, III and IV studies.

  • Hip
  • Arthroscopy
  • Sports Medicine Research
  • Impingement
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