Arthroscopic treatment of hip subspinous impingement: a real clinical improvement in the midterm?

Background: There is a limited literature available describing the various diagnostic modalities and treatment options for the management of subspine impingement (SSI). We developed a study to evaluate the clinical improvement at 1 year and 5 years, with iHOT 33 and HOS hip scores.

Questions: (1) Do patients with subspine compression improve with arthroscopic treatment clinically at short-term follow-up (1 year); (2) Is the improvement maintained in the mid-term (5 years)?

Methods: 43 young patients (21-65 years) with subspine compression (prominent anterior inferior iliac spine) treated arthroscopically between January 2010 and December 2021 were included. Patients completed the iHOT33, HOS-SPORT and HOS-ADL questionnaires before surgery, 1 year and 5 years follow-up. We evaluated pre- and postoperative differences at 1 year and at 5 years. Minimum clinically significant difference (MCID) and the substantial clinical benefit (SCB) were used to establish clinical improvement.

Results: Mean age was 37.38 years and 66% were males. Almost 75% and 70% of our patients exceed the MCID and the SCB respectively in all the questionnaires after 1 year follow-up. However, at 5 years follow-up, nearly 70% and 65% of the patients exceeded MCID and SCB respectively, therefore producing a slight worsening in the medium term.

Conclusions: We demonstrate that arthroscopic treatment of subspine impingement is effective. However, larger sample size and longer follow-up period are necessary to analyse long-term results to demonstrate this treatment as the "gold standard".