Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients

Abstract

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. Purpose: To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. Results: A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort ( P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients ( P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). Conclusion: At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.

Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis

“…Nepple et al 14 demonstrated that in a group of 23 hips that underwent femoroplasty versus 17 that did not, at the 16-year follow-up 78% of those that received bony correction went on to THA-free survivorship compared with the 41% that did not. Husen et al 8 unequally compared 132 symptomatic hips that underwent arthroscopy with 982 asymptomatic hips at a mean follow-up of 12.5 years and found that 12% of the operative hips progressed to To ¨nnis grade 2 compared with 22% of the nonoperative hips. Not only did this study fail to use the asymptomatic contralateral hip as an individual control for nonoperative hips, but also femoroplasty was only performed 93% of the time, labral repair was performed 91% of the time, and capsular repair was performed 45% of the time.…”

Musculoskeletal Modeling and Movement Simulation for Structural Hip Disorder Research: A Scoping Review of Methods and Applications

“…Structural disorders of the hip, such as femoroacetabular impingement syndrome (FAIS) and hip dysplasia, are associated with abnormal intra-articular loading of the hip joint, which can result in pain, decreased hip function, and increased risk of osteoarthritis (Husen et al, 2023; Song et al, 2019). Understanding the relationship between movement strategies, muscle forces, and hip contact forces (HCFs) can provide insight into the mechanisms underlying the etiology and treatment effectiveness of structural hip disorders.…”

Hips in Retrospect

“…Two decades after Dr. Ganz's publication, hip arthroscopy studies with 10 or more years of follow-up are appearing with increasing frequency. 2,3,5,9,15,16 In this month's American Journal of Sports Medicine (AJSM), Lamba and colleagues 12 share with us their institution's early experience in the realm of hip arthroscopy. They report the results of the arthroscopic debridement of acetabular labral tears from 1996 to 2010 with a minimum 13-year follow-up.…”

“…Two decades after Dr. Ganz's publication, hip arthroscopy studies with 10 or more years of follow-up are appearing with increasing frequency. 2,3,5,9,15,16…”