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

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.