Workers’ Compensation Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome Experience Worse Mid-Term Outcomes but Similar Return-to-Work: A Propensity-Matched Analysis at 5-Year Follow-Up

Horner, Nolan S.; Chapman, Reagan; Larson, Jordan H.; Hevesi, Mario; Nho, Shane J.

doi:10.1016/j.arthro.2023.03.023

Cited by 6 publications

(1 citation statement)

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“…Fourth, although cohorts were propensity matched with a caliper distance of 0.2, controlling for 98% of confounding variables, if there are unobserved covariates that influence both group assignment and the outcome of interest, then propensity matching may not completely balance the groups on these unobserved covariates, and bias may still be present in the experimental group. Fifth, although the 5-year follow-up rate of 66.3% is comparable with other 5-year studies, 4,5,12,19,39 additional selection bias was likely introduced due to loss of follow-up and inclusion only of patients who could be contacted, making conclusions difficult to discern. Sixth, all patients treated in the study had their surgeries performed by a single high-volume surgeon, which can introduce expertise bias into the analysis.…”

Section: Discussionmentioning

confidence: 67%

High-Level Competitive Athletes Who Undergo Hip Arthroscopy Demonstrate Durable 5-Year Outcomes and Lower Subjective Pain: A Propensity-Matched Analysis

Fenn,

Horner,

Ingawa

et al. 2023

Sports Health: A Multidisciplinary Approach

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Background: Hip arthroscopy (HA) has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes (CA) and non-CA at short-term follow-up. However, there is a paucity of literature investigating midterm outcomes comparing athletes with Controls. Hypothesis: Athletes would have significant improvements at 5 years, with favorable outcomes compared with their control counterparts, and high return-to-sport (RTS) rate. Study Design: Propensity-matched retrospective comparative cohort study. Level of Evidence: Level 3. Methods: CAs who underwent primary HA for FAIS from January 1, 2012 to April 30, 2017 were identified and propensity matched on a 1:4 basis to Controls by age, sex, and body mass index (BMI). Patient-reported outcomes (PROs) were collected preoperatively and at 5 years. Minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) rates were calculated using previously published thresholds. Rate and duration of RTS were collected retrospectively. Results: A total of 57 high-level CA (33 female, 24 male; age, 21.7 ± 4.2 years; BMI, 23.1 ± 2.8 kg/m2) were propensity matched to 228 Controls (132 female, 96 male; P > 0.99; age, 23.3 ± 5.8 years; P = 0.02; BMI, 23.8 ± 4.3 kg/m2, P = 0.24). Significant differences were observed in preoperative Hip Outcome Score Sports Specific and Activities of Daily Living (HOS-ADL) subscales (CA, 74.9 ± 13.7 vs Controls, 66.4 ± 18.4; P = 0.01) and modified Harris Hip Score (mHHS) (CA, 64.7 ± 12.9 vs Controls, 59.7 ± 14.3; P = 0.04). Both groups demonstrated significant postoperative improvements in all outcome scores measured ( P ≤ 0.01). At 5 years postoperatively, there were significant differences between groups in Visual Analog Scale (VAS) Pain (CA, 17.3 ± 17.6 vs Controls, 24.7 ± 25.9; P = 0.02). There were no significant differences in achieving MCID or PASS. Athletes RTS at a median of 25.2 weeks (Q1 22.4-Q3 30.7) with an overall RTS rate of 90%. Similar rates of revision were seen between CA patients (n = 3; 5.3%) and Control patients (n = 9; 3.9%) ( P = 0.66). Conclusion: CAs demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates after primary HA, which were comparable with those of Controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than Controls and achieve lower average self-reported pain at 5 years postoperatively. In addition, CA patients demonstrate high rates of RTS at a median of 25 weeks postoperatively. Clinical Relevance: This study provides insight into CA versus Control PROs and rates of achieving MCID and PASS at a midterm follow-up of 5 years. Furthermore, this study offers perception into RTS rate, both in general as well as specified to individualized sports.

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