Staged and Simultaneous Bilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome Achieves Clinical Outcomes Comparable With Unilateral Surgery at a Minimum 2-Year Follow-Up: A Systematic Review.

PURPOSE: To synthesize the available evidence comparing patient-reported outcomes and reoperation rates between bilateral and unilateral hip arthroscopy in patients with femoroacetabular impingement syndrome, irrespective of whether bilateral procedures were performed in a staged or simultaneous manner. METHODS: A comprehensive and reproducible search of PubMed, Embase, and Cochrane databases was performed from inception to December 2025. Only comparative clinical studies evaluating bilateral (either staged or simultaneous) versus unilateral hip arthroscopy for femoroacetabular impingement syndrome with a minimum 2-year follow-up were included. Nonoriginal studies, including guidelines, technique articles, animal or biomechanical studies, reviews, and editorials, were excluded. Evaluated outcomes included patient-reported outcomes assessing functional recovery (modified Harris Hip Score, Non-Arthritic Hip Score, and 12-item International Hip Outcome Tool), sports participation (Hip Outcome Score-Sport-Specific Subscale), and pain (visual analog scale). Rates of revision hip arthroscopy and conversion to total hip arthroplasty, as well as achievement of the patient acceptable symptomatic state or the minimal clinically important difference, were also recorded. RESULTS: Ten studies were retrieved for analysis, comprising 1124 patients who underwent bilateral hip arthroscopy (2248 hips) and 3118 patients who underwent unilateral hip arthroscopy. In the bilateral group, 852 patients (1704 hips, 75.8%) underwent staged bilateral hip arthroscopy, whereas 272 patients (544 hips, 24.2%) underwent simultaneous procedures. At a minimum 2-year follow-up, mean modified Harris Hip Score, Non-Arthritic Hip Score, and 12-item International Hip Outcome Tool values representing functional recovery ranged from 71.6 to 100, 82.4 to 91.6, and 73.5 to 87.9 in the bilateral group and from 79.2 to 96, 84.6 to 88.9, and 73.9 to 86.4 in the unilateral group, respectively. Postoperative Hip Outcome Score-Sport-Specific Subscale ranged from 56.8 to 76.3 in the bilateral group and from 57.5 to 82.6 in the unilateral groups, whereas visual analog scale pain scores ranged from 17 to 24 and 14.4 to 21, respectively. Furthermore, revision hip arthroscopy rates ranged from 0% to 10.7% and from 0% to 11.9% in the bilateral and unilateral groups, whereas conversion to total hip arthroplasty occurred in 0% to 7.8% and 0% to 8.8% of cases, respectively. Similar minimal clinically important difference (46%-98%) and patient acceptable symptomatic state (49%-91%) achievement rates were found between groups in most of the studies. CONCLUSIONS: Bilateral hip arthroscopy (either staged or simultaneous) for femoroacetabular impingement syndrome yields clinical outcomes and reoperation rates comparable with those of unilateral hip arthroscopy at a minimum 2-year follow-up. LEVEL OF EVIDENCE: Level III, systematic review of Level III studies.