Simultaneous Versus Staged Bilateral Hip Arthroscopy for Femoroacetabular Impingement: Minimum 2-Year Outcomes With a Unilateral Control Group.

Abstract

BACKGROUND One-fifth of patients with femoroacetabular impingement (FAI) have bilateral symptoms. Performing bilateral hip arthroscopy on the same day minimizes the overall rehabilitation period compared with staged bilateral surgery, but most studies of outcomes from simultaneous surgery are in small cohorts. PURPOSE/HYPOTHESIS The purpose was to compare clinical outcome and revision rates between patients undergoing simultaneous bilateral, staged bilateral, and unilateral arthroscopic surgery for FAI from a large single-surgeon cohort. It was hypothesized that there would be no between-group differences. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Simultaneous bilateral, staged bilateral, and unilateral primary hip arthroscopy procedures between June 2005 and December 2020 were identified. Patient-reported outcome measures including the 12-item International Hip Outcome Tool (iHOT-12) score, Non-Arthritic Hip (NAH) score, and Hip Disability and Osteoarthritis Outcome Score (HOOS) were collected preoperatively and at regular intervals postoperatively. Two-year follow-up scores were analyzed if they were available, or later follow-ups if they were not. Subsequent surgery rates were recorded utilizing a compulsory national joint replacement registry. RESULTS A total of 196 patients (392 hips) in the simultaneous bilateral and 111 patients (222 hips) in the staged bilateral groups were compared with 1529 patients in the unilateral group. The median duration between staged surgeries was 62 days (range, 14-350 days), and demographic characteristics were similar for those having simultaneous and staged procedures. Two-year minimum postoperative scores in all 3 groups were significantly improved from preoperative scores (P < .001). Improvements were similar between groups for all scores apart from HOOS-Sports (P = .03) and HOOS-Quality of Life (P = .03), which improved less in the staged compared with the other 2 groups, and for HOOS-Quality of Life only, which attained a lower follow-up score for staged (mean, 63.1 ± 24.7) compared with simultaneous (mean, 69.8 ± 22.7) procedures (P = .04 for post hoc pairwise comparison). For the iHOT-12 score (P = .04), HOOS-Sports (P = .02), and HOOS-QoL (P = .02), a lower proportion of patients receiving staged compared with other procedures achieved minimally important clinical differences. No differences between groups in revision or arthroplasty conversion rates adjusted for follow-up time were observed. CONCLUSION Patients undergoing simultaneous bilateral arthroscopy for FAI achieved similar 2-year follow-up outcomes compared with staged and unilateral arthroscopy and performed better than the staged group in Sports and Quality of Life subscales of the HOOS.