Patients Age ≥40 Years Demonstrate Durable and Comparable Results to Patients Age <40 Years following Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up

Purpose

The purpose of the present study was to compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared to a propensity-matched control group of patients <40 years.

Methods

A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013.. Patients ≥40 years-old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years-old. Patient reported outcomes including Hip Outcome Score for Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip (mHHS), international Hip Outcome Tool – 12 (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction were collected. Rates of Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) achievement at 10-years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve.

Results

Fifty-three patients age ≥40 (age: 48.3 ± 5.8 years) were successfully matched to 53 patients age <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at minimum 10-years (p<0.001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-years postoperative) scores (p>0.05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (p>0.05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, p=0.363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, p=0.999), or conversion to THA (age ≥40: 13.2%, age <40: 3.8%, p=0.161) were identified. On Kaplan-Meier analysis, no significant difference (p=0.321) was demonstrated in overall gross-survivorship between cohorts.

Conclusion

Patients with age ≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared to a propensity-matched cohort of age <40 counterparts.

Level of Evidence

Level III, retrospective comparative prognostic trial