Hip Arthroscopy for Femoroacetabular Impingement: 1-Year Outcomes Predict 5-Year Outcomes

Abstract

Background: Limited evidence exists comparing short- and long-term patient-reported outcomes (PROs) and overall survival rates after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Hypothesis: Patients with high improvement (HI) versus low improvement (LI) at 1 year postoperatively would achieve higher PROs and better index procedure survival rates at 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between September 2012 and March 2014 with minimum 5-year outcome data were identified. Using the median 1-year change in modified Harris Hip Score (mHHS) as a threshold, HI and LI subcohorts were determined. Analysis of variance was used to compare PROs. Failure rates were determined using Kaplan-Meier and Cox proportional hazards model analyses. Regression analysis was used to identify factors associated with increasing 5-year change in mHHS and Nonarthritic Hip Score (NAHS). Results: Out of 108 eligible consecutive patients, 89 (82.4%) were included (mean [SD]: age, 43.3 [14.6] years; body mass index, 25.4 [4.5]). As compared with the LI group (n = 45), the HI group (n = 44) had a longer 5-year index surgery survival rate (mean ± SEM: 83.7 ± 3.3 months vs 68.5 ± 4.6 months; P = .012) and 5-year estimated survival rate (89% vs 71%). The HI group had a decreased risk of failure versus the LI group (hazard ratio, 0.15; P = .002). The HI group also had greater PROs than did the LI group at 1 year (mHHS: 94.8 ± 1.2 vs 72.6 ± 2.7, P < .001; NAHS: 94.0 ± 1.3 vs 75.6 ± 2.2, P < .001) and 5 years (mHHS: 86.9 ± 2.0 vs 77.6 ± 3.4, P = .017; NAHS: 92.6 ± 1.8 vs 82.7 ± 4.1, P = .020). As compared with the LI group, the HI group achieved higher rates of the Patient Acceptable Symptomatic State (PASS) and minimal clinically important difference (MCID) at 1 year (PASS: 95% vs 42%, P < .001; MCID: 100% vs 89%, P = .056) and 5 years (PASS: 77% vs 45%, P = .002; MCID: 86% vs 64%, P = .014). Linear regression demonstrated that being in the HI group (ΔmHHS, P = .041; ΔNAHS, P = .017) and decreasing body mass index (ΔmHHS, P = .055; ΔNAHS, P = .023) were associated with higher 5-year ΔPROs. Conclusion: Patients with FAIS and significant improvement in the first year after hip arthroscopy had superior 5-year outcomes versus patients with persistent symptom severity. Survival rates and PROs were significantly better in patients who achieved high early outcomes at the 1-year mark.