Cartilage Defects Are Negatively Associated With Long-Term Hip Survivorship Following Contemporary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Analysis at Minimum 10-Year Follow-Up

Jimmy J Chan; Michael J Vogel; Jordan H Larson; Shane J Nho

doi:10.1016/j.arthro.2024.01.040

Cartilage Defects Are Negatively Associated With Long-Term Hip Survivorship Following Contemporary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Analysis at Minimum 10-Year Follow-Up

Arthroscopy. 2024 Feb 7:S0749-8063(24)00096-3. doi: 10.1016/j.arthro.2024.01.040. Online ahead of print.

Authors

Jimmy J Chan¹, Michael J Vogel², Jordan H Larson¹, Shane J Nho¹

Affiliations

¹ Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
² Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: nho.research@rushortho.com.

PMID: 38331365
DOI: 10.1016/j.arthro.2024.01.040

Abstract

Purpose: To identify the timing and risk factors associated with secondary surgery following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 10-year minimum follow-up.

Methods: A prospectively collected clinical repository was evaluated for cases of primary hip arthroscopy for FAIS between January 2012 and February 2013 with minimum 10-year follow-up. Patients who underwent secondary surgery were propensity matched 1:4 to patients who did not undergo secondary surgery, controlling for age, sex, and body mass index (BMI). The groups were compared on demographics, radiographs, intraoperative findings, operative procedures, and patient-reported outcomes. A Kaplan-Meier survivorship curve was generated. Among the reoperation-free survivors, minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) achievement were recorded for Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scale for Pain (VAS Pain).

Results: Twenty-four reoperation patients (67% female; age 40.1 ± 14.3 years; BMI 27.2 ± 5.5) were matched to 96 reoperation-free patients (62% female; age 37.0 ± 10.8 years; BMI 25.2 ± 4.7, P ≥ .111). Mean follow-up was 10.3 ± 0.2 years. No preoperative demographic differences were found between groups. The reoperation group showed more high-grade cartilage defects on the acetabulum and femoral head (33% vs 8%, P = .004; 29% vs 7%, P = .007). A bimodal distribution of time to reoperation was evidenced independent of the secondary surgery performed. Among the reoperation-free survivors, MCID and PASS achievement was as follows: HOS-ADL (69.1%, 62.1%), HOS-SS (69.9%, 74.4%), mHHS (73.3%, 58.1%), iHOT-12 (n/a, 63.8%), and VAS-Pain (80.2%, 62.6%).

Conclusions: Patients requiring reoperation following primary hip arthroscopy for FAIS demonstrated more severe cartilage defects and a bimodal distribution of time to reoperation.

Level of evidence: Level III, retrospective comparative case series.