The Effect of Preoperative Symptom Duration on 10-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Matched Analysis

Abstract

Background:

Patients with femoroacetabular impingement syndrome (FAIS) experiencing >2 years of pain before hip arthroscopy have been linked with worse short-term and midterm outcomes.

Purpose:

To examine the effect of preoperative pain duration on patient-reported outcomes (PROs), clinically significant outcomes, and reoperation rates in patients undergoing primary hip arthroscopy for FAIS.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A prospectively maintained surgical repository was reviewed to select patients who underwent primary hip arthroscopy for FAIS between January 2012 and October 2014 with 10-year follow-up. Patients who reported pain ≥2 years before surgery were propensity score matched 1:1 to patients reporting preoperative pain <2 years by age, sex, and body mass index (BMI). PRO scores collected included those for the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Achievement rates of the minimal clinically important difference and patient acceptable symptom state were compared. Reoperation-free survivorship was compared with Kaplan-Meier analysis.

Results:

A total of 164 patients who had a symptom duration ≥2 years (mean age, 35.9 ± 11.7 years; 64.0% female; mean BMI, 25.3 ± 5.2 kg/m²) were successfully matched to 164 patients who had a symptom duration <2 years (mean age, 35.8 ± 11.9 years; 64.6% female; mean BMI, 25.3 ± 4.7 kg/m²). Patient characteristics were similar between groups. Preoperative and 2-year PRO scores were similar between groups. At 10 years, the prolonged pain group had worse mHHS (P = .027), higher VAS pain (P = .002), and lower VAS satisfaction (P = .002) scores than the short pain group. The prolonged pain group also had significantly lower achievement rates of the minimal clinically important difference for the HOS-ADL (P = .024) and HOS-SS (P = .039) and lower achievement rates of the patient acceptable symptom state for the VAS pain (P = .006) and at least 1 PRO measure (P = .041). Reoperation-free survivorship did not differ between groups (P = .11).

Conclusion:

Patients with pain ≥2 years before undergoing primary hip arthroscopy for FAIS significantly improved at 10 years but experienced worse function, pain, satisfaction, and achievement of clinically significant outcomes, with similar survivorship, compared to a matched group of patients with preoperative pain <2 years.