Recovery Curves After Hip Arthroscopy for Femoroacetabular Impingement Are Slower for Patients With Severe Ligamentous Laxity: A Propensity-Matched Study.

Abstract

Purpose: To evaluate the patient-reported outcome recovery trajectories of generalized ligamentous laxity (GLL) patients undergoing hip arthroplasty for femoroacetabular impingement and labral tears from preoperative to short- to mid-term follow-up and to compare these results to a propensity-matched control group without GLL.

Methods: Patients from a single-institution database who underwent primary hip arthroplasty for femoroacetabular impingement syndrome and labral tears between October 2012 and August 2022 were retrospectively reviewed. Included patients had preoperative and minimum 2-year follow-up patient-reported outcomes, including modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool-12, Hip Outcome Score-Sport Scale, and Visual Analogue Scale for pain. Patients with Beighton score ≥4 were propensity-matched to patients with Beighton score <4. A subanalysis was conducted comparing individuals with high Beighton (HB) scores of 8 or 9 to a non-GLL control group. Rates of achieving clinically relevant outcome thresholds including the patient acceptable symptomatic state (PASS) and minimum clinically important difference were collected.

Results: Three hundred forty-five GLL patients were successfully matched to 345 control patients. There were no differences in patient-reported outcomes at any time point. There were no differences in reoperation rates and a high percentage of minimum clinically important difference and PASS threshold achievement across both groups. Subanalysis comparing the HB and non-GLL groups showed a slower recovery for the HB group, with significantly higher pain scores at the 3-month (2.83 ± 2.15 vs 1.53 ± 1.37; P = .02) and 1-year (2.95 ± 1.99 vs 1.75 ± 2.50; P = .03) time points but reaching similar long-term outcomes. Patients in the HB group also had lower rates of PASS threshold achievement at 3 months (52.2% vs 76.0%; P = .02) compared with the control group but had comparable long-term outcomes.

Conclusions: Hip arthroplasty in patients with GLL yielded significant improvements at short- to mid-term follow-up, with a recovery trajectory comparable to that of patients without GLL. However, patients with higher Beighton scores of 8 or 9 exhibited a slower recovery curve with higher pain levels and lower rates of PASS threshold achievement, which then normalized in the mid-term.

Level of evidence: Level III, retrospective comparative control study.