Minimum 10-Year Outcomes of Adolescents Undergoing Contemporary Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: A Propensity Score-Matched Analysis.

Abstract

Background: Prior studies have shown that adolescent patients achieve more favorable outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared to adult patients at short-term and midterm follow-up, but a limited number of studies have compared these groups at a minimum 10-year follow-up.

Purpose: To compare patient-reported outcome (PRO) scores, achievement rates of clinically significant outcomes, and reoperation-free survivorship between adolescent and adult patients after hip arthroscopic surgery for FAIS at a minimum 10-year follow-up.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective chart review was performed on patients who underwent primary contemporary hip arthroscopic surgery for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, between January 2012 and November 2013 with a minimum 10-year follow-up. Adolescent patients (aged 10-19 years) were propensity score matched 1:1 to adult patients (aged ≥20 years), controlling for sex, body mass index, Tönnis grade, duration of pain, physical activity status, and back pain. PRO scores were collected preoperatively and at 10-year follow-up, including those for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. The cohort-specific minimal clinically important difference, Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) were calculated and compared between groups. Reoperation-free survivorship was compared.

Results: Overall, 50 adolescent patients (mean age, 17.0 ± 1.7 years) were matched to 50 adult patients (mean age, 33.0 ± 9.3 years) with a mean follow-up of 10.4 ± 0.4 years. No differences in preoperative PRO scores were observed. Adolescents achieved greater 10-year HOS-ADL, HOS-SS, mHHS, iHOT-12, VAS pain, and VAS satisfaction scores compared to adults (P < .05 for all). Adolescents showed superior achievement rates of the PASS (98% vs 79%, respectively; P = .015) and SCB (88% vs 67%, respectively; P = .035) for any PRO measure compared with adults. No differences in total hip arthroplasty-free survivorship (100% vs 94%, respectively; P = .083) or revision-free survivorship (90% vs 94%, respectively; P = .473) were found.

Conclusion: Adolescent patients treated with contemporary hip arthroscopic surgery for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, showed superior 10-year PRO scores and achievement rates of the PASS and SCB compared to a propensity score-matched group of adult patients, despite comparable short-term and midterm PROs.