Mid-Term Outcomes and Survivorship of Hip Arthroscopy for the Concurrent Treatment of Labral Tears and Femoro-Acetabular Impingement in Patients Younger than 50 Years Old
Background: Literature reporting mid-term outcomes for patients aged < 50 years undergoing hip arthroscopy to treat femoro-acetabular impingement (FAI) and labral tears is limited. This study reports minimum five-year patient-reported outcomes (PROs), survivorship, and risk factors for requiring revision arthroscopy or total hip arthroplasty (THA).
Methods: Data were prospectively collected and retrospectively reviewed on 625 patients between February 2008 and December 2010. Inclusion criteria were age at surgery < 50 years, arthroscopy for the concurrent treatment of FAI and labral tears, and documented preoperative modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS). Patients with Tönnis grade > 0, Legg-Calve-Perthes, dysplasia, SCFE, AVN, Workman’s Compensation claims, or previous ipsilateral hip surgery were excluded.
Results: Of 190 eligible cases, 153 hips (138 patients) had minimum five-year follow-up (80.5%,). Mean age was 30.3 years. Mean PROs and VAS demonstrated improvement at follow-up (p < 0.0001): mHHS (17.8), NAHS (23), HOS-SSS (28.6), and VAS (-3.9). Mean satisfaction was 8.1. Twenty-four revisions were documented at a mean of 24 months. Revision risks included female gender (p = 0.002) and lower preoperative mHHS (p = 0.02), NAHS (p = 0.04), and HOS-SSS (p = 0.02). Survivorship at minimum five-years was 90.2%; 15 hips required conversion to THA at a mean of 34.5 months. THA risks included older age (p < 0.0001), higher BMI (p = 0.01), higher Tönnis angle (p = 0.0007), capsular release (p = 0.05), and lower preoperative mHHS (p = 0.0008), NAHS (p = 0.001), and HOS-SSS (p = 0.02).
Conclusions: Hip arthroscopy for the treatment of FAI and labral tears in patients aged < 50 years old demonstrates favorable mid-term outcomes. Several risk factors for requiring conversion to THA in this age group warrant cautious patient selection for arthroscopy.