Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

Abstract

Background: Although hip arthroscopy has been shown to have favorable results, there is a paucity of literature describing predictive factors of 5-year clinical outcomes. Purpose: To identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients whose outcomes at minimum 2-year follow-up were previously reported. In addition, to provide a comparison of short- and midterm predictive factors in outcome measures after hip arthroscopy. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 2 patient-reported outcomes: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Patients were excluded if they had any previous ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. Results: A total of 1038 patients met the inclusion criteria for the 2-year study, and 860 met our listed inclusion criteria for the 5-year study. The mean follow-up time was 62.0 months (range, 60.0-120.0 months). The bivariate analysis identified 10 variables (4 categorical and 6 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Age, BMI, revision hip arthroscopy, Tönnis grade, sex, trochanteric bursectomy, femoral head cartilage damage, and acetabular inclination were significant predictors of conversion to total hip arthroplasty. Conclusion: This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow-up in the literature to date. Seven variables were identified as being significant predictors of postoperative NAHS in the bivariate and multivariate analyses: preoperative NAHS, BMI, age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of 2- and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.

Predicting the Risk of Subsequent Hip Surgery Before Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Machine Learning Analysis of Preoperative Risk Factors in Hip Preservation

“…Several previous studies have investigated risk factors for progression to THA after hip arthroscopy. One study, 8 including 860 patients with 5-year follow-up data after hip arthroscopy, found significant predictors of progression to THA to include increased age, female sex, increased BMI, revision hip arthroscopy, increased Tönnis grade, intraoperative trochanteric bursectomy, increased cartilage wear of the femoral head, and increased acetabular inclination. A case-control study 1 using a logistic regression in a cohort of 1561 hip arthroscopy procedures with a mean follow-up of 4.9 years demonstrated increasing age to be the only significant included factor in predicting progression to THA, with increased BMI, female sex, non-White race, and previous hip arthroscopy failing to show predictive significance.…”

Hips 2021

“…Although all BMI groups saw a significant improvement in their pain levels, the morbidly obese group was less likely to achieve the minimal clinically important difference (MCID) for PROMs, and all 3 heftier groups were less likely to achieve the PASS and Substantial Clinical Benefit (SCB) than their normal BMI counterparts. The fourth study in this set, “Predictors of Clinical Outcomes After Hip Arthroscopy” by Domb et al, 5 also found age and BMI, among other factors, to be associated with 2- and 5-year outcome scores and conversion to arthroplasty in a series of 860 patients.…”

“…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.''…”

One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy

“…10,23,31 These benefits have been well documented at short-, mid-, and long-term follow-up. 20,57 Innovative techniques have allowed for the expansion of surgical indications. 63 One such area where the indications for arthroscopy are debated is in the treatment of hip dysplasia.…”