Mid-term Outcomes and Survivorship in Hip Arthroscopy for the Treatment of Labral Tears and Femoro-Acetabular Impingement in Patients Aged 50 Years or Older

Background: There is a paucity of literature reporting mid-term outcomes of hip arthroscopy in older patients. Our purpose was to report minimum five-year outcomes, survivorship, and risk factors for requiring conversion to total hip replacement (THR) in non-arthritic patients aged ≥50 years undergoing hip arthroscopy to treat labral tears and femoro-acetabular impingement (FAI).

Methods: Data were prospectively collected on patients that underwent hip arthroscopy to treat labral tears and FAI between February 2008 and December 2010. The inclusion criteria were age ≥50 years at surgery, arthroscopic treatment for labral tears and FAI, and preoperative patient-reported outcome (PRO) scores including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). The exclusion criteria were Tönnis grade > 0, Workman’s Compensation claims, previous hip conditions such as Legg-Calve-Perthes disease and SCFE, dysplasia, and previous ipsilateral hip surgeries.

Results: Of 32 eligible cases, 29 hips (27 patients; 90.6% follow-up) had minimum five-year follow-up (mean: 69.5 months). PROs and VAS demonstrated significant improvements from preoperatively to latest follow-up (p < 0.0001). Mean improvements were as follows: mHHS (20.2), NAHS (23.5), HOS-SSS (31.2), and VAS (-2.9). Mean patient satisfaction was 7.8. Two patients required a revision arthroscopy at a mean of 20.5 months. Survivorship at latest follow-up was 75.9%. Risk factors for THR conversion included higher preoperative alpha angle (p = 0.03) and lower lateral center-edge angle (p = 0.05). Two (6.9%) cases of lower extremity numbness and one (3.4%) case of pneumonia were documented.

Conclusions: In conclusion, hip arthroscopy for the treatment of labral tears and FAI in patients aged ≥50 years old is safe and demonstrates favorable outcomes at minimum five-year follow-up. According to the THR conversion rate and risk factors, patient selection in this age group should be rigorous.