Abstract
Objectives:
The role of hip instability in pre-arthritic hip disease is increasingly recognized, particularly in female patients. Generalized joint hypermobility (GJH) can be reliably assessed and quantified by the Beighton score with a score of 5 or greater is typically considered a marker of GJH. Given the female preponderance of symptomatic FAI, GJH may play a role in the pathophysiology of pre-arthritic hip pain as well as the outcomes of surgical treatment. The purpose of this study was (1) to determine the distribution of Beighton scores in a female cohort undergoing FAI surgery and (2) to determine if the Beighton score is correlated with patient-reported outcomes (PROs) in females undergoing hip arthroscopy for FAI.
Methods:
A prospective multicenter cohort study of 677 FAI patients undergoing primary hip arthroscopy was performed across 13 surgeons. The current study included a subgroup of 377 females from the larger cohort. Inclusion criteria were patients aged 14-45 years with idiopathic FAI. Exclusion criteria were the diagnosis of Ehlers-Danlos syndrome, previous ipsilateral hip procedures, lateral center edge angles less than 20 degrees, associated disorders, or Tönnis 2 or greater osteoarthritis. All patients underwent standardized hip arthroscopy with capsular closure/plication. The Beighton score (0-9) was self-scored by patients as has been shown to be a reliable method. Beighton scores were broken into five subgroups: 0-3 (normal), 4 (borderline GJH), 5-6 (mild GJH), and 7+ (moderate/severe GJH). PROs were measured at a minimum one-year follow-up. The modified Harris hip score (mHHS) was assessed relative to the minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Additional PROs included the HOOS domains of Pain and Sports/Recreation and the iHOT-12 score. Composite failure was defined as a reoperation for persistent symptoms or a failure to achieve either the mHHS, MCID, or PASS.
Results:
The mean Beighton scores in females was 4.1 with 56.9% having a Beighton score of 4 or greater. Mild GJH was present in 21.6%, while moderate/severe GJH was present in 22.2%. Overall, elevated Beighton scores were not predictive of inferior outcomes of hip arthroscopy for FAI in females and the presence of mild GJH was associated with superior outcomes relative to non-GJH and moderate/severe GJH subgroups. The rate of composite failure was lowest in the mild GJH group (6.2%) compared to the non-GJH group (9.7%), borderline (12.5%), and moderate/severe groups (13.6%), although this difference did not reach statistical significance. Females with mild GJH had significantly higher changes in iHot-12 and HOOS pain domain (p=0.012 and p=0.005, respectively).
Conclusions:
Over half of female patients undergoing FAI surgery have some level of underlying GJH as measured by the Beighton score. The presence of elevated Beighton scores did not appear to preclude excellent outcomes in females undergoing hip arthroscopy for FAI. Females with mild GJH actually demonstrated superior outcomes to other subgroups. Further longer-term outcomes are needed to better understand the role of GJH on the longevity outcomes of surgical treatment of FAI.
