Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes.

Abstract

BACKGROUND Variables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined. PURPOSE To identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or professional sports within 1 year before surgery as well as the availability of preoperative and minimum 5-year patient-reported outcome scores for the modified Harris Hip Score, Nonarthritic Hip Score, HOS-SSS, and visual analog scale for pain. Exclusion criteria were age <18 or >50 years, workers' compensation status, previous ipsilateral hip surgery/conditions, Tönnis grade >1 osteoarthritis, or unwillingness to participate. Patients were stratified based on achievement of the PASS for the HOS-SSS at 5-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of achieving the PASS. Receiver operating characteristic analysis was utilized to determine clinically relevant threshold values. RESULTS A total of 105 athletes were included, of whom 84 achieved the PASS at a minimum 5-year follow-up and 21 did not. Patient characteristics, preoperative radiographic measurements, intraoperative findings, and intraoperative procedures were similar between groups (P > .05). Multivariate logistic regression identified postoperative alpha angle (odds ratio, 0.89; P = .021) and postoperative anterior center-edge angle (ACEA) (odds ratio, 1.20; P < .001) as independent predictors of achieving the PASS. Receiver operating characteristic analysis demonstrated excellent discrimination (area under the curve = 0.814), with thresholds <47° for the alpha angle and >26° for the ACEA associated with significantly higher rates of achieving the PASS (P < .05). CONCLUSION Postoperative alpha angle and ACEA were significant predictors of achieving the PASS for the HOS-SSS at a minimum 5-year follow-up in high-level adult athletes undergoing primary hip arthroscopy. These findings emphasize the importance of precise bony correction to optimize long-term patient-acceptable outcomes.