Midterm Outcomes of Primary Hip Arthroscopy in Athletes Older Than Age 40: A Propensity-Matched Controlled Study

Abstract

Background:

Master athletes (MAs), or athletes older than age 40 years, make up a patient population whose midterm outcomes after primary hip arthroscopy are largely unstudied.

Purpose:

To report minimum 5-year outcomes of MAs after primary hip arthroscopy and compare their results to a matched nonathlete (NA) control group.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were collected between February 2008 and April 2019 and reviewed for all patients who underwent primary hip arthroscopy. Patients were excluded if they were younger than age 40 years and had previous ipsilateral hip pathology, dysplasia (lateral center-edge angle <18°), Tönnis grade >1, or workers’ compensation claims. Patients included in the MA cohort reported participation in sports within 1 year before surgery and had a 5-year minimum follow-up. MAs were matched to NAs in a 1:1 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics, radiographic measurements, intraoperative findings, surgical procedures performed, and patient-reported outcomes (PROs) were compared between the groups. Additionally, rates of meeting clinically relevant thresholds and secondary procedures were compared.

Results:

A total of 118 hips were included in the study, with 59 hips per group. The groups showed comparable demographics, intraoperative findings, and labral procedures. The MA group had higher preoperative and postoperative values for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) (P < .05). MAs met the Patient Acceptable Symptom State and maximum outcome improvement for all evaluated PROs at higher rates. Additionally, the study group met the minimal clinical important difference for the mHHS and HOS-SSS at higher rates when compared with the control group (P < .05). MAs underwent secondary arthroscopy at similar rates to the NAs (1.59% vs 5.08%; P > .05) and had higher arthroplasty-free survivorship (94.92% vs 71.19%; P < .01).

Conclusion:

When compared with a propensity-matched control group of NA patients, MAs had better preoperative and postoperative PRO scores. However, the magnitudes of improvement in PROs were comparable between the groups. Furthermore, MAs met clinically meaningful thresholds at higher rates and had higher arthroplasty-free survivorship when compared with the NA group.