Long-term Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Master Athletes: A Propensity-Matched Study With Mean 10-Year Follow-up

Abstract

Background:

Master athletes (MAs), defined as those aged ≥35 years actively participating in sports, have demonstrated superior short-term outcomes and reoperation-free survivorship after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared with nonathletic counterparts; however, their mid- and long-term outcomes remain unclear.

Purpose/Hypothesis:

The purpose was to evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship at long-term follow-up after primary HA for FAIS in MAs in comparison with a propensity-matched control group of nonmaster athletes (NMAs), defined as those aged ≥35 years who denied weekly sports activity. We hypothesized that MAs would demonstrate superior PROs, CSO achievement, and reoperation-free survivorship compared with NMAs.

Study Design:

Cohort study, Level of evidence, 3.

Methods:

Patients with minimum weekly preoperative sports participation aged ≥35 years who underwent HA for FAIS between January 2012 and October 2014 with long-term follow-up were propensity-matched 1:1 to patients aged ≥35 years who denied weekly preoperative sports participation, controlling for age, sex, and body mass index (BMI). PROs collected preoperatively and at 2-, 5-, and 10-year follow-up time points included the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Hip Outcome Score–Sports Subscale (HOS-SS), 12-item International Hip Outcome Tool (iHOT-12) score, modified Harris Hip Score (mHHS), and visual analog scale scores for pain and satisfaction. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were compared. Survivorship was compared using Kaplan-Meier analysis.

Results:

In total, 70 MAs were matched to 70 NMAs. Patient characteristics were similar between MAs and NMAs, including age (44.89 ± 7.7 vs 45.77 ± 6.9 years; P = .473), sex (60.0% vs 58.6% female; P = .496), and BMI (26.19 ± 4.9 vs 26.79 ± 4.4 kg/m²; P = .444). The mean follow-up duration was 10.32 ± 0.3 years. Preoperative PROs were similar between groups (P ≥ .114). MAs demonstrated superior 2-year HOS-ADL and iHOT-12 values (P ≤ .049). By the 5-year follow-up with durability to 10-year follow-up, PROs were similar between groups (P ≥ .065). Both groups demonstrated similar MCID and PASS achievement for all PROs (P ≥ .111). Both groups demonstrated similar time-dependent reoperation-free survivorship (P = .6).

Conclusions:

MAs undergoing primary HA for FAIS achieve comparable PROs, CSOs, and reoperation-free time-dependent survivorship to NMAs at long-term follow-up.