Identifying Independent Predictors of Achieving Clinically Significant Outcomes After Contemporary Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up

Abstract

Background:

Patients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve clinically significant outcomes (CSOs) at high rates. However, limited studies, to date, have identified independent predictors of achieving CSOs at a minimum 10-year follow-up, and even fewer studies have reported on patients treated with contemporary hip arthroscopic techniques, including chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair.

Purpose:

To identify independent predictors of achieving minimum 10-year CSOs after contemporary hip arthroscopic surgery for FAIS with chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients undergoing primary contemporary hip arthroscopic surgery for FAIS between January 2012 and November 2013 with a minimum 10-year follow-up were identified. Patient-reported outcomes (PROs) collected included scores for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, International Hip Outcome Tool–12, modified Harris Hip Score, and visual analog scale for pain. Cohort-specific thresholds for the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) were determined, and achievement rates were recorded. Patients achieving and not achieving each CSO for any PRO measure were compared. Stepwise multivariate logistic regression was used to identify independent predictors of achieving the MCID, PASS, and SCB for any PRO measure, with the odds ratio (OR) recorded.

Results:

A total of 294 patients with a minimum 10-year follow-up were included in this study. The mean age was 33.8 ± 12.3 years, and the mean body mass index was 25.0 ± 4.8 kg/m². Most patients were female (60.2%). The reoperation-free survivorship rate was 85.0%. Achievement rates for the MCID, PASS, and SCB were 91.4%, 77.6%, and 71.6%, respectively. Independent predictors of achieving CSOs were age (OR, 0.97-0.98; P ≤ .039), sport participation (OR, 1.84-2.18; P ≤ .042), psychiatric history (OR, 0.46-0.47; P ≤ .041), and high-grade chondral defects (OR, 0.25-0.39; P ≤ .019).

Conclusion:

Independent predictors of achieving 10-year CSOs after contemporary hip arthroscopic surgery with chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair were younger age, the presence of sport participation, the absence of a psychiatric history, and the absence of chondral defects.