Acceptable Symptom State after Surgery for Femoroacetabular Impingement Compared with Total Hip Arthroplasty

Abstract

The aim of the study was to examine whether patients undergoing total hip arthroplasty (THA) are better able to accept a given level of pain and disability than patients undergoing surgery for femoro-acetabular impingement (FAI). Before surgery, 417 THA and 162 FAI patients completed the Oxford Hip Score (OHS). At 12-months follow-up (FU), they were requested to complete the OHS again, rate the global treatment outcome, and state whether their symptom state was acceptable. Preoperatively, THA had worse (p<0.001) OHS scores than FAI. At 12 months, 99% THA and 86% FAI patients reported various degrees of improvement. The proportions of patients perceiving notable improvement and considering their current state acceptable were higher (p<0.0001) in THA (95-99%) than FAI (66-70%) and THA had greater (p<0.0001) improvements in OHS scores than FAI. The mean OHS score of the patients perceiving notable improvements at follow-up did not differ (p>0.05) between THA and FAI groups. Higher "success rates" in THA than FAI are not due to a better acceptance of pain and disability, because the OHS of patients considering their current state to be acceptable was similar for both groups. The difference is simply the result of more THA than FAI patients actually achieving an acceptable status after surgery.