Ten-Year Outcomes of Hip Arthroscopy for the Treatment of FAI and Labral Tears in Patients with a Workers' Compensation Claim.

Abstract

Background: Workers' Compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures. The purpose of this study was to determine the impact of WC on the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and labral tears and to compare these findings with those of a propensity-matched control group.

Methods: A retrospective analysis was conducted that included patients with a WC claim who underwent hip arthroscopy for FAI and labral tears between 2008 and 2013. Included patients had complete preoperative and minimum 10-year postoperative questionnaires for patient-reported outcomes (PROs) or a documented end point. Patients were propensity-matched to a control group without a WC claim in a 1:3 ratio on the basis of age at the time of surgery, sex, body mass index, acetabular Outerbridge grade, and capsular treatment. Clinically meaningful thresholds, complications, survivorship, work type, and return-to-work rates were analyzed.

Results: A total of 280 patients (WC group, 70; control group, 210) were included in the study. The WC group had a mean follow-up time of 123.9 ± 22.6 months. Compared with the matched control group, the WC group had worse preoperative PRO scores but a greater magnitude of improvement. The groups had similar (p > 0.05) rates of reaching the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values for the modified Harris hip score (MCID: 93.0% [WC group], 79.2% [control group]; PASS: 83.7% [WC], 77.8% [control]), the Non-Arthritic Hip Score (MCID: 90.7% [WC], 77.8% [control]; PASS: 74.4% [WC], 63.2% [control]), and the Hip Outcome Score Sport-Specific Subscale (MCID: 87.5% [WC], 72.3% [control]; PASS: 72.7% [WC], 55.6% [control]). In the WC group, 82.9% of patients returned to work, with a mean time to return to work of 8.0 ± 7.4 months. The WC group had a higher rate of revision hip arthroscopy than the control group, with a threefold relative risk (95% confidence interval, 1.6 to 5.7; p < 0.001) and a mean time to revision of 28.3 ± 37.1 months.

Conclusions: Hip arthroscopy for the treatment of FAI and labral tears in patients with a WC claim was associated with favorable outcomes and a high return-to-work rate at a minimum 10-year follow-up. These results were comparable with those of a benchmark control group. However, the WC group had a significantly higher rate of revision hip arthroscopy than the control group.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.