One-Year Outcomes Predict 10-Year Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Abstract

Background:

While both short- and long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been reported, the predictive relationship between the two has yet to be established.

Purpose:

To determine whether the degree of improvement in patient-reported outcomes observed at 1 year postoperatively predicts long-term outcomes at 10 years after primary hip arthroscopy for FAIS.

Study Design:

Cohort study; Level of evidence, 3

Methods:

Patients who underwent primary hip arthroscopy for FAIS by a single surgeon at a single institution with 10-year follow-up were identified. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at baseline and 1, 2, 5, and 10 years postoperatively. Patients were classified as either high improvement (HI) or low improvement (LI) based on if they achieved the median 1-year change in mHHS from baseline. Chart review was performed to collect surgical details such as operative procedures, complications, and revision surgery. Outcomes were compared between groups over time using repeated-measures analysis of variance. Failure rates were determined using Kaplan-Meier and Mantel-Cox log-rank analyses.

Results:

A total of 129 patients with a mean age of 41.0 ± 13.5 years and mean body mass index of 25.0 ± 4.3 kg/m² were included. Both the HI and LI groups demonstrated significant improvement in mHHS and NAHS from baseline at all follow-up time points (P < .001). The HI group had significantly higher outcome scores at all time points up to 10 years after arthroscopy compared with the LI group (P = .018). Additionally, a greater proportion of patients in the HI group achieved the Patient Acceptable Symptom State and minimal clinically important difference compared with the LI group at the 10-year follow-up (P = .018). Rates of overall complications, revision arthroscopy, and conversion to total hip arthroscopy were significantly higher in the LI group (P = .013, P = .009, and P = .004, respectively). The mean hip survival time after the index operation was shorter for the LI group (11.9 ± 0.5 years) than for the HI group (13.2 ± 0.2 years) (P = .002).

Conclusion:

Patients who experienced greater improvement in the first year after hip arthroscopy had superior 10-year outcome scores, fewer complications, and lower rates of reoperation compared with those who experienced minimal improvement in the same period.