Falls after hip arthroscopy for femoroacetabular impingement syndrome: Prevalence and risk factors for revision hip arthroscopy

Abstract

Purpose

The prevalence and clinical consequences of falls in the early post-operative period after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) remain unknown. The purpose of this study was to determine the prevalence of and risk factors for postoperative falls within 90 days of surgery in patients who undergo hip arthroscopy for FAIS and determine whether falls within 90 days are associated with increased risk of early revision surgery.

Methods

Consecutive patients who underwent primary hip arthroscopy for FAIS were included. Falls were defined by ground impact by body parts other than the feet, and near-falls were defined as sudden, forceful and unanticipated loading of the operative extremity without impact. Bivariate and multivariate analyses were conducted to identify associations between demographic or clinical factors and fall occurrence as well as revision surgery within 1 year.

Results

A total of 192 patients met inclusion criteria (median age 36.7 years, interquartile range [IQR] 23.4, 46.5; 72% female). Of these, 33 patients (17%) experienced a postoperative fall or near-fall (21 falls, 12 near-falls). Median time to fall was 16.5 days (IQR 8.3–44.5). Fall/near-fall patients had significantly higher rates of revision surgery within 1 year compared to controls (27% vs. 4%, p < 0.001; odds ratio [OR] = 9.4, 95% confidence interval [CI] 3.1–30.5). Fall/near-fall events were associated with worse baseline physical function (Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score [HOOS-PS], p = 0.047), lower mental health scores (Mental Health Inventory-5 [MHI-5], p = 0.04) and lower activity levels (University of California, Los Angeles [UCLA] score, p = 0.03). Hearing or visual impairment (OR = 6.6, 95% CI 1.9–23.3, p = 0.004) and higher HOOS-PS score (OR = 1.1, 95% CI 1.1–1.3, p = 0.02) were significant predictors of postoperative falls/near-falls.

Conclusion

Falls and near-falls within 90 days after hip arthroscopy were associated with higher rates of revision hip arthroscopy. Surgeons should counsel patients, particularly those with sensory impairments, regarding postoperative fall prevention and emphasize prompt reporting of any fall/near-fall events. Future studies are needed to determine whether reducing postoperative falls can decrease revision rates.

Level of Evidence

Level III.