High Body Mass Index Does Not Adversely Affect Outcomes in High-Level Athletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 2-Year Follow-up

Abstract

Background: The effect of high body mass index (BMI) on outcomes in athletes has not been established. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores and return to sports (RTS) for high-level athletes with high BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to compare results with a propensity-matched control group of high-level athletes with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all professional, collegiate, and high school athletes who had a high BMI (>30) and who had undergone primary hip arthroscopy for FAIS between January 2010 and December 2018. RTS status and minimum 2-year PROs were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were also recorded. These patients were propensity matched in a 1:3 ratio to high-level athletes with a normal BMI for comparison. Results: A total of 30 high-level athletes with a high BMI were included with a mean follow-up of 49.4 ± 29.5 months. They demonstrated significant improvement from preoperatively to latest follow-up for mHHS, NAHS, HOS-SSS, and VAS ( P < .001). When outcomes were compared with a propensity-matched control group of 90 athletes with a normal BMI, athletes with a high BMI had worse acetabular cartilage injury and were more likely to undergo acetabular microfracture ( P < .001). Athletes with a high BMI demonstrated lower postoperative scores for NAHS when compared with athletes with a normal BMI (88.06 ± 9.37 [range, 60-100] and 90.25 ± 10.79 [range, 48.75-100], respectively; P = .049). Athletes with a high BMI also demonstrated worse postoperative scores for HOS-SSS when compared with athletes with a normal BMI (77.22 ± 18.31 [range, 22.22-100] and 82.38 ± 22.79 [range, 2.78-100], respectively; P = .038). Rates of achieving MCID for the high-BMI and normal-BMI groups were comparable in mHHS (90.0% and 77.8%, respectively; P = .185) and HOS-SSS (90.0% and 82.2%, respectively; P = .397). PASS rates were also comparable between the high- and normal-BMI groups for mHHS (90.0% and 87.8%, respectively; P > .999) and HOS-SSS (70.0% and 71.1%, respectively; P = .908). Athletes with a high BMI also returned to sports at a lower rate compared with athletes with a normal BMI, but this did not reach statistical significance ( P = .479). Conclusion: Athletes with a high BMI undergoing primary hip arthroscopy for FAIS demonstrated significant improvement in PROs and favorable rates achieving clinically meaningful improvement. When compared with a control group of high-level athletes with a normal BMI, they exhibited similar rates of achieving psychometric thresholds and RTS rates. At short-term follow-up, high BMI did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy.

Ten-Year Survivorship, Outcomes, and Sports Participation in Athletes After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

“…4 Although the BMI was well below the threshold for obesity, previous literature has reported that higher BMIs may not be associated with worse short-term outcomes after hip arthroscopy. 22 Interestingly, the present study reports high rates of cartilage damage, with over 30% of the athletes exhibiting ALAD grade 3 or 4 damage. This is consistent with a recent study by Owens et al, 40 who reported that basketball athletes at midterm outcomes exhibited >30% ALAD grade 3 or 4 damage and had a 3.6% conversion rate to THA.…”

External Validation of a Machine Learning Algorithm for Predicting Clinically Meaningful Functional Improvement After Arthroscopic Hip Preservation Surgery

“…With respect to calibration intercept and probability estimation, the algorithm was comparable and tended to overestimate the observed proportion of patients who achieved the MCID at 2 years at lower predicted probabilities (<0.4 in both studies). This may be partially explained by (1) the reproducibility and efficacy of hip arthroscopy procedures, (2) the higher median preoperative HOS-SS scores observed in the external validation sample, and (3) the observation of consistent functional improvements for these patients in the study populations and throughout the hip arthroscopy literature studying athletic populations 5,7,8,13,28 ; however, at higher probabilities (between 0.6 and 0.80), the algorithm in the current external validation study tended to slightly underestimate the observed proportion of patients who achieved the MCID at 2 years by up to 20% (Figure 2), while calibration remained good to excellent in this range in the development study. 13 This underestimation may be partially explained by the external validation sample size being smaller than the development study sample size despite statistical calculations confirming that the current sample size was sufficient.…”

5-Year Arthroscopy-Free Survivorship and Outcomes of Adolescents Undergoing Primary Hip Arthroscopy: A Comparison Between Traumatic and Atraumatic Injuries

“…Fourth, the type of injury was self-reported and within each report there may be a varying level of severity that was unable to be captured in this study. Fifth, Jimenez et al 21 noted that current PROs may not be able to accurately reflect the changes in function or status for a predominantly active population. As such, future studies with specific PROs targeted to assess adolescents may be beneficial when conducting further analysis comparing outcomes based on type of injury.…”

“…It is considered as the optimal method for group comparisons according to prior literature. 21 Hips were matched using R (Version 4.1.0; R Foundation for Statistical Computing) until no further matches could be made.…”

“…An a priori analysis was performed to determine that in a 1:2 matching ratio, 20 TI cases and 39 AHS cases were necessary to achieve at least 80% power based on an assumption that a mean difference of 8 points and SD of 10 points in HOS-SSS between groups was clinically significant. 21…”