Midterm Outcomes of Arthroscopic Treatment for Concomitant Painful External Hip Snapping and Femoroacetabular Impingement Syndrome: A Minimum 5-Year Follow-up Study

Abstract

Background:

Painful external snapping hip (ESH) is estimated to affect 5% to 10% of the population. Hip arthroscopy treating ESH concomitantly with femoroacetabular impingement (FAI) has shown favorable short-term outcomes.

Purpose:

To report midterm outcomes of hip arthroscopy that concomitantly treats FAI and ESH, with a secondary comparison of these results to benchmark a control group of hips with FAI without ESH.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were retrospectively analyzed for patients who underwent hip arthroscopy as treatment for FAI and iliotibial band (ITB) and gluteus maximus tendon release as treatment for painful ESH between 2008 and 2019. Patients were included if they had complete pre- and postoperative patient-reported outcomes (PROs) and visual analog scale (VAS) for pain scores with a minimum follow-up of 5 years or if they had a documented endpoint (revision surgery or conversion to arthroplasty) during the study period. Rates of revision surgery and conversion to total hip arthroplasty were included in the analysis. Patients were propensity matched to a benchmark control group of patients with FAI without ESH at a 1:4 ratio by sex, age at surgery, body mass index, acetabular Outerbridge grade, labral treatment, and capsular treatment.

Results:

A total of 215 hips (211 patients) were included in the study. The ESH study group showed significant improvements in all assessed PROs, with 98% of patients reporting resolution of painful external snapping at the latest follow-up, and no patient requiring revision hip arthroscopy secondary to a persistent external snapping. When compared with the benchmark control group, patients with ESH had similar preoperative outcomes for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sports-Specific Subscale, 12-item International Hip Outcome Tool score, and VAS score with equivalent magnitudes of improvement. Additionally, similar postoperative scores across all PROs and patient satisfaction were met. The minimal clinically important difference and Patient Acceptable Symptom State for all evaluated PROs were met at similar rates. Similar rates of complication revision hip arthroscopy and conversion to hip arthroplasty were observed between the groups.

Conclusion:

Primary hip arthroscopy addressing FAI and painful ESH with ITB and gluteus maximus tendon release demonstrated significant improvement in all evaluated PROs, with 98% of patients reporting resolution of external snapping, and no revision surgery due to external snapping recurrence at the minimum 5-year follow-up. Functional outcomes and rates of clinically relevant threshold achievement were comparable to those of a propensity-matched benchmark control group with FAI without ESH.