Purpose
To report minimum 5-year outcomes and risk factors for conversion to total hip arthroplasty
(THA) in patients ≥50 years old undergoing hip arthroscopy to treat labral tears and
femoroacetabular impingement (FAI).
Methods
Data were prospectively collected on patients who underwent hip arthroscopy to treat
labral tears and FAI between February 2008 and January 2012. The inclusion criteria
were ≥50 years old at surgery, arthroscopic treatment for both labral tears and FAI,
and preoperative patient-reported outcome (PRO) scores for modified Harris Hip Score
(mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale
(HOS-SSS), and Visual Analog Scale (VAS). The exclusion criteria were Tönnis grade
> 1 and previous hip conditions or surgeries.
Results
Of 103 eligible cases, 94 hips (91.3%) had minimum 5-year follow-up at a mean of 70.1 months
(range, 60.0-95.1 months). All PROs and VASs demonstrated significant improvement
at latest follow-up (P = .0001). Mean patient satisfaction was 8.4. All mean scores demonstrated durability
from 2 years to latest follow-up, and NAHS (P = .009), HOS-SSS (P = .02), and VAS (P = .04) continued to significantly improve. Fifty-one (54.3%) of cases reached patient
acceptable symptomatic state for mHHS, and 49 cases (52.1%) achieved minimal clinically
important difference for this outcome measure. Four cases (4.3%) required secondary
arthroscopy, and survivorship was 72.3%. Compared with survivors, the subgroup requiring
THA demonstrated higher body mass indexes (P = .01), had larger alpha angles (P = .0200) and smaller lateral center-edge angles (P = .0200), and had higher proportions of Tönnis grade 1 (P = .0012), acetabular Outerbridge grade ≥ 2 (P = .0500), and femoral head Outerbridge grade ≥2 (P = .0001).
Conclusions
Hip arthroscopy for the treatment of labral tears and FAI in patients ≥50 years old
demonstrates statistically significant PRO improvements at minimum 5-year follow-up.
However, due to potential for subsequent need for THA in a subset of this population,
surgeons should use rigorous selection criteria and counsel patients appropriately.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: October 06, 2018
Accepted:
May 15,
2018
Received:
October 27,
2017
Footnotes
See commentary on page 3010
The authors report the following potential conflicts of interest or sources of funding: B.G.D. receives support from Adventist Hinsdale Hospital, Amplitude, Arthrex, ATI, DJO Global, Kaufman Foundation, MAKO, Medacta, Pacira Pharmaceuticals, Stryker, and Orthomerica. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
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