Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

Abstract

Background: Improvement in patient-reported outcomes (PROs) has been reported in the short term after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear in the setting of acetabular overcoverage. Yet, there is a paucity of information in the literature on midterm PROs. Purpose: To (1) report minimum 5-year PROs in patients who underwent primary hip arthroscopy for FAIS and acetabular labral tears in the context of acetabular overcoverage and (2) compare outcomes with those of a propensity-matched control group without acetabular overcoverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively analyzed on all patients who underwent hip arthroscopy for FAIS and labral tears between February 2008 and November 2013. Inclusion criteria were lateral center-edge angle >40° and minimum 5-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS). Exclusion criteria were previous ipsilateral hip surgery or conditions, active workers’ compensation claims, or lack of minimum 5-year outcomes. A 1:1 propensity-matched comparison was made between the study group and a control group without acetabular overcoverage (lateral center-edge angle, 25°-40°) based on age at surgery, sex, body mass index, Tönnis grade, laterality, and follow-up time. The minimal clinically important difference (MCID) was calculated for the mHHS, HOS-SSS, and NAHS. Secondary surgical procedures were recorded. Results: A total of 54 patients satisfied the inclusion criteria for the study group, of whom 45 (83.3%; 45 hips) had a minimum 5-year follow-up and were matched without differences in age at surgery, sex, body mass index, or follow-up time. The study and control groups demonstrated significant and comparable improvements for the mHHS (mean ± SD Δ, 24.06 ± 24.19 vs 26.33 ± 17.27; P = .625), NAHS (Δ, 31.22 ± 25.31 vs 27.15 ± 17.61; P = .399), and HOS-SSS (Δ, 33.16 ± 34.73 vs 34.75 ± 26.15; P = .557). The rates for achieving the MCID were similar for the study and control groups for the mHHS (76.7% vs 84.2%; P = .399), HOS-SSS (79.1% vs 75.8%; P = .731), and NAHS (81.4% vs 84.2%; P = .738). Need for revision surgery was similar ( P = .748). A lower conversion rate to total hip arthroplasty was reported for the study than for the control group (2.2% vs 15.6%; P = .026). Conclusion: In the context of FAIS, labral tears, and acetabular overcoverage, patients who underwent hip arthroscopy reported significant improvement in several PROs at minimum 5-year follow-up. Moreover, outcomes were comparable with those of a propensity-matched control group without acetabular overcoverage. Furthermore, the rate of achieving the MCID for the mHHS, HOS-SSS, and NAHS was similar between these groups.

Low Body Mass Index in Females May Portend Inferior Outcomes After Primary Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up

“…Labral tears were repaired, selectively debrided, or reconstructed according to the extent of tearing and labral characteristics. 18 An acetabuloplasty >2 mm was used to address pincer-type morphology (LCEA >40°) 32 ; otherwise, a minor acetabular rim trimming was performed to provide an adequate bleeding bony bed for labral repair/reconstruction healing. Femoroplasty was used to address cam-type morphology (alpha angle >55°).…”

Outcomes in Patients with Global Pincer Versus Focal Pincer Femoroacetabular Impingement Treated with Hip Arthroscopy: A Retrospective Study with a Minimum 2‐Year Follow‐Up

“…8,9 While focal pincer FAI can be treated with arthroscopic techniques effectively, global pincer FAI once required open surgery due to the technical difficulties of joint distraction, decreased access to the central compartment, and insufficient access to the posterior acetabulum. 10 Nevertheless, with the development of arthroscopic instrumentation and techniques, studies in recent years have shown that patients with global pincer FAI can be treated arthroscopically with satisfactory outcomes. 11 However, controversy remains whether the patients with global pincer have equivalent outcomes compared with patients with focal pincer.…”

Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study

“…10,26,28,81 Arthroscopic surgery of the hip has become an effective tool to address hip pathology, 32,47 proving satisfactory results in patient-reported outcomes (PROs) in mid-and long-term studies. 25,37,52,63,72 This has been achieved thanks to the development of novel techniques that offer safe and reproducible procedures with consistent results. 49,51,55 However, patients with workers' compensation (WC) claims undergoing surgery have been associated with inferior outcomes when compared with other patients without such claims.…”

“…10,26,28,81 Arthroscopic surgery of the hip has become an effective tool to address hip pathology, 32,47 proving satisfactory results in patient-reported outcomes (PROs) in mid- and long-term studies. 25,37,52,63,72 This has been achieved thanks to the development of novel techniques that offer safe and reproducible procedures with consistent results. 49,51,55…”