Hip Arthroscopy for Femoroacetabular Impingement Syndrome Improves Patient-Reported Outcome Scores Regardless of Smoking Status.

Abstract

Purpose: To compare outcomes of hip arthroscopy using Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients with a history of smoking versus nonsmokers.

Methods: Patients who underwent hip arthroscopy at our institution between January 2015 and June 2024 and had PROMIS data including physical function (PF), pain interference (PI), and depression scores were collected and split into 2 groups based on smoking history. Patients were included in this study if they were aged ≥18 years at the time of surgery and underwent hip arthroscopy for the treatment of femoroacetabular impingement syndrome, with preoperative PROMIS and postoperative PROMIS scores ≥1 year. The group of smokers was then propensity-matched to the group of nonsmokers based on age at surgery, body mass index, sex, race, and insurance status. Continuous variables were calculated as mean ± standard deviation and compared using 2-tailed t-tests while categorical variables were compared using chi-square analysis between the 2 groups. Mean clinically important difference was defined as one-half the standard deviation of preoperative PROMIS scores. Patient acceptable symptomatic state thresholds were 51.8 for PF and 51.9 for PI.

Results: Two hundred eighty-seven nonsmokers and 88 smokers met inclusion criteria and had minimum 1-year follow-up. Eighty-seven smokers (87 hips) were propensity-matched to 171 nonsmokers (171 hips). The mean follow-up time was 28.4 ± 16.2 months. There were no differences in the groups with regard to sex (P = .88), age at surgery (P = .25), race (P = .50), body mass index (P = .88), or insurance status (P = .96). There were no significant differences in procedures such as labral repairs, femoroplasties, or acetabuloplasties performed. Both groups experienced improvement from preoperative to postoperative PROMIS scores for all domains. The nonsmokers group showed significantly greater preoperative PF (P = .0053), PI (P = .0024), and depression (P < .001) scores and significantly greater postoperative PF (P = .0043), PI (P = .017), and depression (P = .0019) scores. No differences were seen in the achievement of mean clinically important difference between groups (PF: 52.9% vs 52.6%, P = .97; PI: 31% vs 33.9%, P = .64). No differences were seen in patient acceptable symptomatic state between groups (PF: P = .23, PI: P = .77).

Conclusions: Patients with a smoking history showed significant improvement in PROMIS scores following hip arthroscopy. Smokers began and ended recovery with lower PROMIS scores, indicating that smoking affects baseline status and final outcomes, despite comparable improvement. No differences were seen in the achievement of mean clinically important difference.

Level of evidence: Level III, retrospective comparative study.