Return to golf after hip arthroscopy: a systematic review of the literature

Key points

1. 01Across the included studies, 90 of 95 golfers (94.7%) returned to golf after hip arthroscopy
2. 02Professional golfers returned at 100% (26/26) and amateurs at 92.8% (64/69)
3. 03Mean time to return was 4.7 months for professionals and 7.2 months for amateurs
4. 04Patient-reported hip scores and pain improved after surgery, and drive distance increased
5. 05Evidence is limited: only 4 small case series, all Level 4, with fair-to-poor methodological quality

How it was conducted

Design

Systematic review (PRISMA), no meta-analysis feasible

Databases

PubMed and Embase, searched October 18, 2023

Included studies

4 studies, all Level 4 (retrospective or prospective case series)

Participants

95 golfers (96 hips), mix of professional and amateur

Indications

Femoroacetabular impingement, labral damage, hip pain impeding daily activity or golf

Quality assessment

Modified Coleman Methodology Score, mean 53 (fair-poor)

What they found

• 90 of 95 golfers (94.7%) returned to golf
• Professional golfers returned at 100% (26/26); amateurs at 92.8% (64/69)
• Mean time to return: 4.7 months for professionals, 7.2 months for amateurs
• Of the 5 who did not return, 1 cited fear of reinjury and 4 had no specific cause
• Waterman et al: 28 of 29 (96%) returned to the same or better performance level
• Newman et al: average drive distance increased significantly at 1, 2, and 5 years postoperatively, while greens in regulation were unchanged
• Waterman et al outcome scores improved pre to post: HOS ADL 65.9 to 91.5, HOS Sports 38.2 to 79.7, Modified Harris Hip 54.8 to 84.2, VAS pain 7.3 to 1.7
• Ortiz-Declet et al outcome scores improved pre to post: HOS Sports 47.7 to 64.4, Modified Harris Hip 62.8 to 79, VAS pain 5.8 to 2.5
• Mean MCMS quality score across studies was 53 (fair-poor)

Limitations

• Only 4 studies with a combined 95 patients, so the evidence base is very thin
• All included studies were Level 4 (case series) with fair-to-poor methodological quality (mean MCMS 53)
• No meta-analysis was possible and several outcome and timing data points were not reported
• Findings may be biased toward favorable results given the small retrospective samples

Why it matters

For patients

If you play golf and are considering hip arthroscopy for impingement, you can expect a very high chance of returning to the course, typically within about 6 to 7 months.

For clinicians

Counsel golf-playing FAI patients that return is highly probable (~95%) with a 6 to 7 month target, and consider a structured golf-specific rehabilitation protocol such as Waterman's 16 to 20 week 4-phase program.

For readers

This is the first systematic review on returning to golf after hip arthroscopy, but its conclusions rest on a small, low-quality evidence base and should be read as encouraging rather than definitive.