Females and Males Achieved Comparable Outcomes and Clinical Benefits Following Primary Hip Arthroscopy with Labral Repair, but Age Affected Outcomes and Conversion to Total Hip Arthroplasty. A Short and Mid-Term Follow-Up Analysis with Dual Stratification

Published:February 17, 2022DOI:


      To report and compare, according to sex and age, minimum 2-and minimum 5-year patient-reported outcome scores (PROs) and survivorship in a large cohort of patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS).


      Data from February 2008 to September 2018 were reviewed. Patients aged 60 and younger who underwent primary hip arthroscopy with minimum 2-year follow-up were included. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous hip conditions, or any labral treatment different than repair. Minimum 5-year PROs were also collected. All patients included were divided into groups by sex. For further analysis, males and females were stratified according to age: < 21 years old, 21–30 years old, 31–40 years old, 41–50 years old, and 51–60 years old.


      In total, 1,326 hips had minimum 2-year follow-up, including 860 (64.9%) females and 466 males (35.1%), with a mean age of 31.6 years (range, 12.8-60.9 years) and a mean follow-up of 58.7 ± 28.9 months. Of those, 772 had minimum 5-year follow-up, 515 females (66.7%), and 257 males (33.3%) with a mean age of 31.7 years (range, 13.1-60.7 years) and a mean follow-up of 78.5 ± 23.0 months. All patients showed significant improvements in PROs at minimum 2-and 5-year follow-up (P < .001). Between sex analysis revealed comparable PROs at latest follow-up between females and males across any age group. Within sexes, and when sexes were combined, patients <21 years old had significantly better outcomes compared to other age groups. There were more females <21 years old that required revision arthroscopy than males <21 years old (P = .015). Conversion to total hip arthroplasty (THA) showed no significant difference between sexes (P > .05). Rates of THA were <21 years (.8%), 21-30 years (2.1%), 31-40 years (4%), 41-50 years (8.9%), and 51-60 years (14.3%).


      Following primary hip arthroscopy for FAIS, all patients reported significant improvements in all PROs at minimum 2-and minimum 5-year follow-up, with females and males achieving similar success. Age affected outcomes, with patients under 21 years old reporting better scores regardless of sex. Although the conversion rate to THA was similar between the sexes, it was lower in the younger ages groups in both sexes.

      Level of Evidence

      III, retrospective comparative observation trial.
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        • Menge T.J.
        • Briggs K.K.
        • Rahl M.D.
        • Philippon M.J.
        Hip arthroscopy for femoroacetabular impingement in adolescents: 10-year patient-reported outcomes.
        Am J Sports Med. 2021; 49: 76-81
        • Kyin C.
        • Maldonado D.R.
        • Go C.C.
        • Shapira J.
        • Lall A.C.
        • Domb B.G.
        Mid- to Long-term outcomes of hip arthroscopy: A systematic review.
        Arthroscopy. 2021; 37: 1011-1025
        • Mehta N.
        • Chamberlin P.
        • Marx R.G.
        • et al.
        Defining the learning curve for hip arthroscopy: A threshold analysis of the volume-outcomes relationship.
        Am J Sports Med. 2018; 46: 1284-1293
        • Domb B.G.
        • Chen S.L.
        • Go C.C.
        • et al.
        Predictors of clinical outcomes after hip arthroscopy: 5-year follow-up analysis of 1038 patients.
        Am J Sports Med. 2021; 49: 112-120
        • Bloom D.A.
        • Fried J.W.
        • Bi A.S.
        • Kaplan D.J.
        • Chintalapudi N.
        • Youm T.
        Age-associated pathology and functional outcomes after hip arthroscopy in female patients: Analysis with 2-year follow-up.
        Am J Sports Med. 2020; 48: 3265-3271
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Salata M.J.
        • Mather R.C.
        • Nho S.J.
        Outcomes for hip arthroscopy according to sex and age: A comparative matched-group analysis.
        J Bone Joint Surg Am. 2016; 98: 797-804
        • Horner N.S.
        • Ekhtiari S.
        • Simunovic N.
        • Safran M.R.
        • Philippon M.J.
        • Ayeni O.R.
        Hip arthroscopy in patients age 40 or older: A systematic review.
        Arthroscopy. 2017; 33: 464-475.e3
        • Lin L.J.
        • Akpinar B.
        • Bloom D.A.
        • Youm T.
        Age and outcomes in hip arthroscopy for femoroacetabular impingement: A comparison across 3 age groups.
        Am J Sports Med. 2021; 49: 82-89
        • Domb B.G.
        • Martin T.J.
        • Gui C.
        • Chandrasekaran S.
        • Suarez-Ahedo C.
        • Lodhia P.
        Predictors of clinical outcomes after hip arthroscopy: a prospective analysis of 1038 patients with 2-year follow-up.
        Am J Sports Med. 2018; 46: 1324-1330
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J ann
        • McCarthy J.C.
        The nonarthritic hip score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Chandrasekaran S.
        • Gui C.
        • Walsh J.P.
        • Lodhia P.
        • Suarez-Ahedo C.
        • Domb B.G.
        Correlation between changes in visual analog scale and patient-reported outcome scores and patient satisfaction after hip arthroscopic surgery.
        Orthop J Sports Med. 2017; 5 (13) (23259671177247725)
        • Maldonado D.R.
        • LaReau J.M.
        • Perets I.
        • et al.
        Outcomes of hip arthroscopy with concomitant periacetabular osteotomy, minimum 5-year follow-up.
        Arthroscopy. 2019; 35: 826-834
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaulé P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66
        • Ogata S.
        • Moriya H.
        • Tsuchiya K.
        • Akita T.
        • Kamegaya M.
        • Someya M.
        Acetabular cover in congenital dislocation of the hip.
        J Bone Joint Surg Br. 1990; 72: 190-196
        • Barton C.
        • Salineros M.J.
        • Rakhra K.S.
        • Beaulé P.E.
        Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement.
        Clin Orthop Relat Res. 2010; 469: 464-469
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Rybalko D.
        • Close M.R.
        • Litrenta J.
        • Perets I.
        Outcomes of hip arthroscopic surgery in patients with Tonnis grade 1 osteoarthritis at a minimum 5-year follow-up: A matched-pair comparison with a Tonnis grade 0 control group.
        Am J Sports Med. 2017; 45: 2294-2302
        • Domb B.G.
        • Annin S.
        • Chen J.W.
        • et al.
        Optimal treatment of cam morphology may change the natural history of femoroacetabular impingement.
        Am J Sports Med. 2020; 48: 2887-2896
        • Mansor Y.
        • Perets I.
        • Close M.R.
        • Mu B.H.
        • Domb B.G.
        In search of the spherical femoroplasty: Cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.
        Am J Sports Med. 2018; 46: 2061-2071
        • Maldonado D.R.
        • Rosinsky P.J.
        • Shapira J.
        • Domb B.G.
        Stepwise safe access in hip arthroscopy in the supine position: Tips and pearls from A to Z.
        J Am Acad Orthop Surg. 2020; 28: 651-659
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Hawellek T.
        • Hubert J.
        • Hischke S.
        • et al.
        Calcification of the acetabular labrum of the hip: Prevalence in the general population and relation to hip articular cartilage and fibrocartilage degeneration.
        Arthritis Res Ther. 2018; 20: 104
        • Maldonado D.R.
        • Chen S.L.
        • Walker-Santiago R.
        • et al.
        An intact ligamentum teres predicts a superior prognosis in patients with borderline dysplasia: A matched-pair controlled study with minimum 5-year outcomes after hip arthroscopic surgery.
        Am J Sports Med. 2020; 48: 673-681
        • Lynch T.S.
        • Minkara A.
        • Aoki S.
        • et al.
        Best practice guidelines for hip arthroscopy in femoroacetabular impingement: Results of a Delphi process.
        J Am Acad Orthop Surg. 2020; 28: 81-89
        • Beck E.C.
        • Suppauksorn S.
        • Nho S.J.
        The role of comprehensive capsular management in hip arthroscopy for the treatment of femoroacetabular impingement syndrome.
        Arthroscopy. 2020; 36: 9-11
        • Riff A.J.
        • Kunze K.N.
        • Movassaghi K.
        • et al.
        Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure.
        Arthroscopy. 2019; 35: 646-656.e3
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Griffin D.W.
        • Kinnard M.J.
        • Formby P.M.
        • McCabe M.P.
        • Anderson T.D.
        Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.
        Am J Sports Med. 2017; 45: 1928-1936
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. L. Erlbaum Associates, Mahwah, NJ1988
        • Cooper A.P.
        • Basheer S.Z.
        • Maheshwari R.
        • Regan L.
        • Madan S.S.
        Outcomes of hip arthroscopy. A prospective analysis and comparison between patients under 25 and over 25 years of age.
        Br J Sports Med. 2013; 47: 234-238
        • White B.J.
        • Patterson J.
        • Scoles A.M.
        • Lilo A.T.
        • Herzog M.M.
        Hip arthroscopy in patients aged 40 years and older: Greater success with labral reconstruction compared with labral repair.
        Arthroscopy. 2020; 36: 2137-2144
        • Domb B.G.
        • Linder D.
        • Finley Z.
        • et al.
        Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.
        Arthroscopy. 2015; 31: 231-238
        • Lindner D.
        • Botser I.
        • Chen A.
        • et al.
        Two-year follow-up of hip arthroscopies: A matched control study comparing patients over 50 years to patients under 30 years (SS-32).
        Arthroscopy. 2013; 29: e15-e16
        • Perets I.
        • Chaharbakhshi E.O.
        • Mu B.
        • et al.
        Hip arthroscopy in patients ages 50 years or older: Minimum 5-year outcomes, survivorship, and risk factors for conversion to total hip replacement.
        Arthroscopy. 2018; 34: 3001-3009
        • Byrd J.W.T.
        • Jones K.S.
        Arthroscopic acetabular labral repair in patients over the age of 60 years: A matched case-control study.
        Arthroscopy. 2019; 35: 1406-1410
        • Beck E.C.
        • Nwachuckwu B.U.
        • Jan K.
        • Nho S.J.
        Hip arthroscopy for femoroacetabular impingement syndrome in adolescents provides clinically significant outcome benefit at minimum five year follow-up.
        Arthroscopy. 2021; 37: 1467-1473.e2
        • Byrd J.W.T.
        • Jones K.S.
        • Gwathmey F.W.
        Femoroacetabular impingement in adolescent athletes outcomes of arthroscopic management.
        Am J Sports Med. 2016; 44: 2106-2111
        • Litrenta J.
        • Mu B.
        • Chen A.W.
        • Ortiz-Declet V.
        • Perets I.
        • Domb B.G.
        Radiographic and clinical outcomes of adolescents with acetabular retroversion treated arthroscopically.
        J Pediatr Orthop. 2019; 39: 510-515
        • Utsunomiya H.
        • Briggs K.K.
        • Dornan G.J.
        • Bolia I.K.
        • Locks R.
        • Philippon M.J.
        Predicting severe cartilage damage in the hip: A model using patient-specific data from 2,396 hip arthroscopies.
        Arthroscopy. 2019; 35: 2051-2060.e13
        • Saadat A.A.
        • Lall A.C.
        • Battaglia M.R.
        • Mohr M.R.
        • Maldonado D.R.
        • Domb B.G.
        Prevalence of generalized ligamentous laxity in patients undergoing hip arthroscopy: A prospective study of patients’ clinical presentation, physical examination, intraoperative findings, and surgical procedures.
        Am J Sports Med. 2019; 47: 885-893
        • Maldonado D.R.
        • Chen J.W.
        • Yelton M.J.
        • et al.
        Achieving successful outcomes of hip arthroscopy in the setting of generalized ligamentous laxity with labral preservation and appropriate capsular management: A propensity matched controlled study.
        Am J Sports Med. 2020; 48: 1625-1635
        • Stone A.V.
        • Mehta N.
        • Beck E.C.
        • et al.
        Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome.
        J Hip Preserv Surg. 2019; 6: 33-40
        • Domb B.G.
        • Chen S.L.
        • Shapira J.
        • Maldonado D.R.
        • Lall A.C.
        • Rosinsky P.J.
        The evolution of hip arthroscopy: What has changed since 2008—A single surgeon’s experience.
        Arthroscopy. 2020; 36: 761-772
        • Kaplan D.J.
        • Samim M.
        • Burke C.J.
        • Baron S.L.
        • Meislin R.J.
        • Youm T.
        Decreased hip labral width measured via preoperative magnetic resonance imaging is associated with inferior outcomes for arthroscopic labral repair for femoroacetabular impingement.
        Arthroscopy. 2021; 37: 98-107
        • Maerz T.
        • Nepple J.J.
        • Bedi A.
        • et al.
        Sex differences in clinical outcomes following surgical treatment of femoroacetabular impingement.
        JBJS. 2021; 103: 415-423
        • Shapira J.
        • Kyin C.
        • Go C.
        • et al.
        Indications and outcomes of secondary hip procedures after failed hip arthroscopy. A systematic review.
        Arthroscopy. 2020; 36: 1992-2007
        • Go C.C.
        • Kyin C.
        • Maldonado D.R.
        • Domb B.G.
        Surgeon experience in hip arthroscopy affects surgical time, complication rate, and reoperation rate: A systematic review on the learning curve.
        Arthroscopy. 2020; 36: 3092-3105
        • McClincy M.P.
        • Wylie J.D.
        • Yen Y.M.
        • Novais E.N.
        Mild or borderline hip dysplasia: Are we characterizing hips with a lateral center-edge angle between 18° and 25° appropriately?.
        Am J Sports Med. 2019; 47: 112-122
        • Irie T.
        • Espinoza Orías A.A.
        • Irie T.Y.
        • et al.
        Computed tomography-based three-dimensional analyses show similarities in anterosuperior acetabular coverage between acetabular dysplasia and borderline dysplasia.
        Arthroscopy. 2020; 36: 2623-2632
        • Larson C.M.
        Editorial Commentary: “The earth is not flat”: Progressing from plain radiographs to three-dimensional imaging when evaluating hip disorders.
        Arthroscopy. 2020; 36: 2633-2634
        • Wyatt M.
        • Weidner J.
        • Pfluger D.
        • Beck M.
        The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A new measurement associated with instability in borderline hip dysplasia?.
        Clin Orthop Relat Res. 2017; 475: 861-869
        • Bali K.
        • Smit K.
        • Ibrahim M.
        • et al.
        Ottawa classification for symptomatic acetabular dysplasia assessment of interobserver and intraobserver reliability.
        Bone Joint Res. 2020; 9: 242-249
        • Safran M.R.
        Microinstability of the hip-gaining acceptance.
        J Am Acad Orthop Surg. 2019; 27: 12-22