Long-Term Outcomes of Hip Arthroscopy in Workers' Compensation Patients Compared to Non-Workers' Compensation Patients: A Propensity-Matched Study at Minimum 10-Year Follow-up

Abstract

Background:

Workers’ compensation (WC) patients often experience inferior outcomes compared with non-workers’ compensation (non-WC) patients after orthopaedic procedures. Long-term outcomes for contemporary hip arthroscopy in this group remain unclear.

Purpose:

To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survival between WC and non-WC patients undergoing hip arthroscopy for labral tear/femoroacetabular impingement syndrome at a minimum 10-year follow-up.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent hip arthroscopy between January 2012 and February 2015 with ≥10-year follow-up were included. WC patients were propensity-score matched with non-WC patients on age, sex, and body mass index. PROs were assessed preoperatively and at 2-, 5-, and 10-year postoperatively, including Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport-specific (HOS-SS), Modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and reoperation rates were compared.

Results:

A total of 37 WC hips were matched with 108 non-WC hips. Both cohorts demonstrated significant improvements in all PROs from baseline (P < .001). Preoperatively, WC patients had lower HOS-ADL (46.9 vs 63.5; P < .001) and mHHS scores (47.4 vs 57.3; P = .004), but similar HOS-SS and VAS-Pain scores (P≥ .076). At 2 years, WC patients reported lower HOS-ADL, HOS-SS, mHHS, and iHOT-12 scores (P≤ .047). At 5 years, HOS-ADL and HOS-SS remained lower in WC patients (P≤ .004), whereas other PROs were comparable (P≥ .160). At 10 years, no significant between-group differences persisted (P≥ .057). WC patients achieved higher MCID rates for HOS-ADL (94.7% vs 68.8%; P = .021) and mHHS (87% vs 62%; P = .038), with comparable MCID and PASS rates for other PROs. Both cohorts demonstrated similar reoperation-free survivorship (P = .383). Overall, 33 WC patients (91.7%) returned to work at a mean time of 8.7 ± 5.2 months postoperatively.

Conclusion:

At a minimum 10-year follow-up, WC patients demonstrated sustained improvement and outcomes comparable to non-WC patients after primary hip arthroscopy. Although WC status is associated with inferior preoperative and early postoperative outcomes, long-term symptom resolution, functional improvement, and joint preservation can be expected in appropriately selected patients treated with contemporary hip arthroscopy techniques.