Age and Outcomes in Hip Arthroscopy for Femoroacetabular Impingement: A Comparison Across 3 Age Groups

Abstract

Background: Limited evidence exists concerning the effect of age on hip arthroscopy outcomes for femoroacetabular impingement (FAI). Purpose/Hypothesis: The purpose was to investigate patient-reported outcomes (PROs) and clinical failure rates across various age groups in patients undergoing hip arthroscopy for FAI. We hypothesized that older patients would experience lower improvements in PROs and higher clinical failure rates. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 109 of 130 eligible consecutive patients underwent hip arthroscopy for FAI with a minimum 5-year follow-up. Patients were stratified into 3 groups for comparison (ages 15-34, 35-50, and 51-75 years). Clinical survival rates to revision surgery or total hip arthroplasty (THA) were determined by Kaplan-Meier analysis, and PROs were assessed using analysis of variance. Regression analysis was used to determine factors associated with clinical failure and ΔPROs from baseline to 5 years. Results: The 5-year survival-to-revision rate was 71% (survival time, 69.2 months; 95% CI, 62.8 to 75.5 months). A significant difference in survival to THA was found between groups ( P = .030). Being in the older group versus the young and middle-aged groups predicted increased risk of THA conversion (hazard ratio, 5.7; 95% CI, 1.1 to 28.6; P = .035). Overall modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) improved from baseline to 5 years (mHHS, P < .001; NAHS, P < .001). Body mass index (mHHS: beta, −1.2; 95% CI, −2.2 to −0.3; P = .013; NAHS: beta, −1.6; 95% CI, −2.6 to −0.5; P = .005) and baseline PROs (mHHS: beta, −0.8; 95% CI, −1.1 to −0.4; P < .001; NAHS: beta, −0.7; 95% CI, −1.1 to −0.4; P < .001) were predictive of 5-year ΔPROs. A decrease was seen in minimal clinically important difference rates in middle-aged ( P = .011) and old ( P = .030) groups from 6-month to 5-year outcomes. Conclusion: Although hip arthroscopy for FAI yielded improvements in PROs regardless of age, middle-aged and older patients experienced greater declines in clinical outcomes over time than younger patients. Older patients remain good candidates for arthroscopy despite a greater risk for conversion to THA.

Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

“…This may have been in part due to the relatively small number of THR conversions, which underpowered the analysis. Although it is generally accepted that older age and the presence of OA may increase the risk of THR conversion, 17,24,29,32 in the current study where patients with Tönnis grades 2 and 3 were excluded, there was no correlation with increasing age and higher THR conversion rates. This would suggest that in the absence of OA, age may be less of a factor than was previously thought.…”

“…Predicting the likelihood of eventual failure and conversion to THR is necessary for clinical decision making. Some predictors of failure have been described previously and include age, 24 sex, 54 prolonged symptom duration and pain, 35 and more significant degenerative changes in the joint at the time of intervention. 7,44 The primary aim of this study was to report on the survivorship and clinical outcome of hip arthroscopy for symptomatic FAI at 10 years after intervention and to determine both patient characteristics and pathological parameters likely to predict failure.…”

Most Elite Athletes Who Underwent Hip Arthroscopy for Femoroacetabular Impingement Syndrome Did Not Return to the Same Level of Sport, but the Majority Were Satisfied With the Outcome of Surgery

“… 19 As a result, there is a risk of providing misleading results if studies include pooling of patients with a wide age range. 20 , 21 , 22 Furthermore, evaluating the current clinical treatment in young elite athletes with a high rate of return to sports is of great importance.…”

Hips 2021

“…At 10 years postoperatively the investigators noted a 10% revision rate, all cases of which involved female patients, that was significantly associated with global laxity and preoperative symptom duration. In a second study, Lin et al 13 report 71% 5-year survival in 109 patients, with failure defined as revision surgery or progression to arthroplasty. When they divided their patients into cohorts aged 15-34, 35-50, and 51-75, the investigators found that the oldest group was 5 times more likely to progress to arthroplasty.…”

“…Much additional clinical hip arthroscopy research has sought to identify other factors that might predict surgical outcomes, including general patient characteristics, preoperative hip anatomy, and preoperative or early postoperative pain or PROM levels. 5,11,13,[17][18][19][20] Most of these studies have been retrospective in design, so they identify associations that would need to be verified as truly predictive in future prospective studies. As New York Yankee great Yogi Berra is reported to have said, ''It's tough to make predictions, especially about the future.''…”