Editorial Commentary: Return to Sport Is Not the Finish Line: Raising the Bar for Long-Term Outcomes After Hip Arthroscopy in Athletes.

Background: Outcomes of revision hip arthroscopy in the athletic population have not been well established. Purpose: (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. Results: A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group (P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). Conclusion: Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.

Periacetabular osteotomy (PAO), concomitant with hip arthroscopy, used as treatment for symptomatic hip acetabular dysplasia, has shown favorable outcomes at midterm follow-up. However, limited literature has evaluated outcomes and return to sport (RTS) rates in athletes with concomitant PAO and hip arthroscopy. The purpose of this study was to analyze functional outcomes and RTS rates of athletes who underwent PAO with concomitant hip arthroscopy for symptomatic hip dysplasia with a minimum 5-year follow-up. It was hypothesized that athletes undergoing PAO with concomitant hip arthroscopy would show favorable outcomes and high rates of RTS. Case series; Level of evidence, 4. Retrospectively analyzed data for all patients who underwent PAO concomitant with hip arthroscopy as treatment for painful hip dysplasia between November 2010 and December 2018. Included patients reported sports participation and had completed preoperative and a minimum of 5-year postoperative questionnaires for at least 1 of the following patient-reported outcomes (PROs): the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and patient satisfaction, or had a documented endpoint during the study timeframe. Clinically important thresholds were included in the analysis. An overall RTS analysis was conducted, and continuation of sport was analyzed at a minimum of 5 years postoperatively. A total of 28 patients (n = 29 hips) were included. Patients experienced significant improvements in mHHS, NAHS, HOS-SSS, iHOT-12, and VAS scores, and reported high patient satisfaction. A high percentage of patients reached the minimal clinically important difference for the evaluated PROs and reported a positive response to the patient acceptable symptom state anchor question. Of the 28 patients, 3 chose to stop playing due to lifestyle changes or loss of interest in the sport, 3 stopped because of a desire to prevent hip symptoms, and 1 stopped because of a doctor's recommendation. Among the remaining 21 patients who attempted to RTS, 18 (85.7%) returned to sports at some time postoperatively. Three patients (14.3%) did not return due to persistent hip symptoms. Moreover, of those who returned to sport, 14 (77.8%) continued to play for a minimum of 5 years postoperatively. Four hips (13.8%) required revision hip arthroscopy, and 1 (3.4%) underwent conversion to total hip arthroplasty. PAO with concomitant hip arthroscopy for symptomatic hip dysplasia resulted in significant improvements in functional outcomes, with a high percentage of patients achieving important clinical thresholds. There was a high rate of RTS, enabling a substantial number of patients to continue playing at a minimum 5-year follow-up.

IntroductionLimited literature reports midterm outcomes of hip arthroscopy in master athletes (MA). This study reports five-year outcomes of MAs after hip arthroscopy and compares their results to a nonathlete (NA) group.MethodsData was collected between February 2008 and April 2019 and reviewed for patients who underwent primary hip arthroscopy. Patients were excluded if they were under the age of 40, had previous ipsilateral hip pathology, dysplasia (LCEA < 18°), Tonnis grade > 1, or workers compensation claims. Patients included in the MA cohort reported participation in sports within 1 year before surgery and had five-year minimum follow-up. MAs were matched to NAs in a 1:1 ratio based on age, sex, BMI, and Acetabular Outerbridge Grade. Patient characteristics, intraoperative findings, surgical procedures performed, and PROs were compared between the groups. Additionally, rates of meeting clinically relevant thresholds and secondary procedures were compared.Results118 hips were included in the study, with 59 hips per group. The groups showed comparable demographics, intraoperative findings, and labral procedures. The MA group had higher preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS (p < 0.05). MAs met PASS and MOI for all evaluated PROs at higher rates. The study group met MCID for mHHS and HOS-SSS at higher rates when compared to the control group (p < 0.05). MAs underwent secondary arthroscopy at similar rates when compared with NAs (1.59% vs. 5.08%; p > 0.05) and had higher arthroplasty-free survivorship (94.92% vs. 71.19%, p < 0.01).ConclusionMAs demonstrated favorable outcomes after primary hip arthroscopy at five-year minimum follow-up. When compared with a matched control group of NA patients, MAs had better preoperative and postoperative PROs scores. Furthermore, MAs met clinically meaningful thresholds at higher rates and had higher arthroplasty-free survivorship when compared to the NA group.

Background: Prior studies have compared clinical outcomes in sport-participators and non-participators. The time to achieve clinically significant outcomes (CSOs) after hip arthroscopy (HA) across these groups remains unappreciated. Additionally, the relationship between early-term patient-reported outcome scores (PROs) and return to sport (RTS) remains misunderstood. Purpose: To compare the time to achievement of CSOs in sport participators and non-participators following HA for femoroacetabular impingement syndrome (FAIS), to identify predictors of earlier CSO achievement, and to assess the relation between PROs and RTS. Methods: Patients undergoing HA for FAIS between 01/2012 to 12/2018 with 6-month, 1-year, and minimum 2-year completion of Hip Outcome Score-Activities of Daily Living/Sports Subscale (HOS-ADL/SS) were identified. Those that endorsed routine sport participation were propensity-matched to those who denied sport participation by age, sex, and body mass index (BMI). Achievement of CSOs, including minimal clinically important difference, patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) was determined. Time to achievement of CSOs was compared between groups using Kaplan-Meier survival analysis. Cumulative CSO achievement at various time points were determined and compared. Cox hazard regressions were performed to identify predictors of early CSO achievement. RTS within 2-years of surgery was recorded, and the PROs of those that returned were compared to those that did not. Results: One-hundred and nineteen sport participators were matched to 119 non-participators. Sport participators had higher SCB achievement for HOS-ADL at 6 months (47.3% vs. 30.6%, p=0.008), with otherwise comparable cumulative CSO achievement (p≥0.069, for all). Kaplan-Meier analysis demonstrated earlier PASS (p=0.023) and SCB (p=0.011) achievement for HOS-ADL in sport participators. Increased BMI, no prior sport participation, and higher pre-operative HOS-ADL score were significant predictors for delayed PASS and SCB achievement for HOS-ADL SCB (p≤0.030, for all). 82.2% of patients successfully RTS at 8.2±3.1 months post-operatively. Those that RTS had higher HOS-ADL scores at 6-months and 1-year (p≤0.004) and higher HOS-SS scores at 6-months, 1-year, and 2-years (p≤0.008). Conclusions: Sport participators who underwent HA for FAIS demonstrated quicker time to achievement of PASS and SCB for HOS-ADL compared to non-participators. RTS was 82.2%, which was associated with higher postoperative PROs. Level of Evidence: Cohort, Level III

Background: Return to sports (RTS) rates and patient-reported outcomes (PROs) after hip arthroscopy in athletes with borderline dysplasia (BD) have not been established. Purpose: (1) To report minimum 2-year PROs and RTS rates in high-level athletes with BD who underwent hip arthroscopy for labral pathology in the setting of microinstability and (2) to compare clinical results with those of a matched control group of athletes with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for surgery performed between January 2012 and July 2018. Patients were considered eligible if they received a primary hip arthroscopy in the setting of BD (lateral center-edge angle, 18°-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Athletes with BD were matched to a control group of athletes with normal acetabular coverage (lateral center-edge angle, 25°-40°). Results: A total of 65 patients with BD were included in the study with a mean ± standard deviation follow-up of 47.5 ± 20.4 months. Athletes with BD showed significant improvement in all outcome measures recorded, demonstrated high RTS rates (80.7%), and achieved the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Outcome Score–Sport Specific Subscale at high rates (MCID, 90.8%; PASS, 75.4%). When compared with a propensity-matched control group with normal acetabular coverage, capsular plication was performed more commonly in the BD group (93.8% vs 82.7%; P = .037). PROs and RTS, PASS, and MCID rates were similar between the BD and control groups (P > .05). Conclusion: High-level athletes with BD who undergo primary hip arthroscopy for labral pathology in the setting of microinstability may expect favorable PROs and RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes with normal coverage.

Background:Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain, which can prevent ice hockey players from sports participation. Hip arthroscopy is often performed to relieve pain and enable the player to return to sport (RTS) and return to performance (RTP).Purpose:To determine the RTS and RTP rates for ice hockey players at the professional and subelite levels after hip arthroscopy for FAIS.Study Design:Case series; Level of evidence, 4.Methods:High-level ice hockey players who underwent hip arthroscopy for FAIS between 2011 and 2019 were identified using a local hip arthroscopy registry. The player’s level was confirmed with ice hockey–specific web pages and was stratified as subelite or professional. Data on the players’ careers were extracted from these web pages. Player position was divided into goalkeepers, defensemen, and forwards. Data on participation in games included the season before onset of symptoms, the season before surgery, and the first and second seasons after surgery. RTS was defined as returning to ice hockey after surgery, and RTP was considered as returning to the same league at a comparable level to before symptoms.Results:A total of 80 ice hockey players were included. Comparing presymptom performance with the first season after surgery, the RTS rate was 72%, of which 94% of the players returned to the same or higher level of play. Comparing the presurgery season with the first season after surgery, the RTS rate was 78%. At the second season after surgery, 64% of players still played ice hockey, with a significantly higher return rate among professional players compared with subelite players (96% vs 69%; P = .014). Overall, 85% goalkeepers, 74% forwards, and 60% defensemen returned to sport. Only 28% played at least the same number of games during the first season after surgery as they did during the presymptom season.Conclusion:High-level ice hockey players who underwent hip arthroscopy for FAIS had a high RTS rate, in which the majority returned to the same league. However, only 28% played the same number of games the first season after surgery as they did at the presymptom level. Professional ice hockey players returned more frequently than players on the subelite level.

Hip arthroscopy has shown satisfactory outcomes for the treatment of intra-articular pathology and femoroacetabular impingement syndrome (FAIS) in the setting of acetabular dysplasia at short- and mid-term follow-up. However, the long-term outcomes remain less understood. To systematically review the literature to determine patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, reoperation rates, and predictors of failure in patients with acetabular dysplasia undergoing hip arthroscopy at long-term follow-up. Systematic review; Level of evidence, 4. Three databases were searched around the following terms: hip arthroscopy, dysplasia, and long-term follow-up. Articles available in English, presenting original data, and reporting on a mean follow-up of ≥10 years after primary hip arthroscopy using either PROs, CSOs, or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using Methodological Index for Non-Randomized Studies (MINORS) assessment. Five studies (555 hips) were included in the systematic review: patients had a mean age of 30 to 41 years, 13% to 88% of patients were female, and follow-up ranged from 9.6 to 12 years. MINORS assessment ranged from 11 to 21. All studies included PROs and reported statistically significant improvement for most PROs. The most frequent PRO was the Modified Harris Hip Score (mHHS) (n = 5). All studies reported CSO achievement, with mHHS and Hip Outcome Score-Sport Specific (HOS-SS) being the most common (n = 4). Revision surgery and conversion to THA ranged from 2.6% to 15.2% and from 2.6% to 23.7%, respectively across dysplasia cohorts. The most common definition of failure was conversion to THA, and Tönnis angle was the most common predictor of failure. Four studies made comparisons to a nondysplasia group, with 1 study finding inferior HOS-SS and inferior achievement of Patient Acceptable Symptom State across multiple PROs in the dysplasia group. All 4 comparative studies found no differences in rates of revision surgery or conversion to THA between groups. Hip arthroscopy can reliably provide durable and clinically meaningful improvements for the treatment of intra-articular pathology and FAIS in patients with acetabular dysplasia at long-term follow-up, with comparable rates of revision surgery and conversion to THA to nondysplastic cohorts, although select dysplastic populations may demonstrate inferior patient-reported outcomes.

Introduction:Hip pathology is being recognized with more frequency as source of disability and functional limitation in athletes. It has been stated that the overload made with certain positions during some sports activities can develop condral damage. Moreover, the sum of bone deformity and repetitive movements of the hip requiered in sports may increase the risk of causing injuries. These can be treated with hip arthroscopy. Despite of this, there is a lack of evidence about the time taken to return to sports activity and the level reached afterwards by those patients treated with this procedure.Objective:Describe the clinical evolution, the time taken to return to sports activity and the level reached a year after the treatment of femoroacetabular impingement (FAI) with hip arthroscopy in 23 athletes.Method:23 athletes were included in the study, defined as those patients with a minimum of 6 hours a week of sports practice, who were treated for FAI with hip arthroscopy between 2010 and 2015 by the same surgeon at our institution. The diagnosis was clinical (positive impingement test, hip pain and functional limitation of the hip), radiological (cam and pincer) and with magnetic nuclear resonance (labral tears). Preoperative modified Harris hip score was registered in all cases. Tonnis radiographic score was used. All patients had type 0 or 1 Tonnis hips. After 3 months of ineffective non operative treatment the arthroscopy was performed. Patients were treated in dorsal decubitus with orthopedic table. Labral reconstruction with anchors and femoral and acetabular osteoplasty was made. After surgery, patients were able to walk with support for 4 weeks and began physiotherapy. A year after surgery, all patients were questioned about the time taken to return to sports activity and the level of activity reached at that time compared to the one they had before symptoms appeared. The modified Harris hip score was also registered.Results:Ten patients played soccer as a main sport activity (44%), 3 basketball (13%), 3 martial arts (13%), 3 rugby (13%), 2 running (9%), 1 bicycling (4%) and 1 motocross (4%). The average time taken to return to sports activity was 4.7 months. 12 patients returned at 4 months (52%), 6 patients at 5 months (26%) and 5 patients at 6 months (22%). All patients were able to return to sports activity. Twenty patients reached the same level of activity they had before symptoms appeared (87%). Three patients did not get to previous activity level (13%). The averaged postoperative modified Harris hip score was 92 points (excellent). 20 patients (87%) scored excellent results and 3 patients (13%) regular ones. The average improvement after surgery of this score was 26 points.Conclusion:The treatment of FAI with hip arthroscopy in athletes allowed us to achieve excellent clinical results in 87% of the patients (modified Harris hip score). They took an average of 4.7 months to return to sports activities. 87% of them returned to the same level of practice they had before symptoms appeared.

Endoscopic Iliotibial Band Release During Hip Arthroscopy for Femoroacetabular Impingement Syndrome and External Snapping Hip Had Better Patient-Reported Outcomes: A Retrospective Comparative Study

Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (p = 0.0093). This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points). Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalised hip therapy group was not. Thirty-eight (24%) personalised hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomisation. Nineteen (12%) hip arthroscopy patients had a revision arthroscopy. Eleven (7%) personalised hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years. Study participants and treating clinicians were not blinded to the intervention arm. Delays were encountered in participants accessing treatment, particularly surgery. Follow-up lasted for 3 years. Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement in quality of life than personalised hip therapy, and this difference was clinically significant at 12 months. This study does not demonstrate cost-effectiveness of hip arthroscopy compared with personalised hip therapy within the first 12 months. Further follow-up will reveal whether or not the clinical benefits of hip arthroscopy are maintained and whether or not it is cost-effective in the long term. Current Controlled Trials ISRCTN64081839. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 16. See the NIHR Journals Library website for further project information.

Background: Femoroacetabular impingement syndrome (FAIS) often affects athletes who participate in high impact activities and can be treated with hip arthroscopy. Returning to sport (RTS) is a common postoperative expectation and depends on both physical and psychological readiness. The Hip-Return to Sport after Injury (Hip-RSI) is a validated tool used to assess an athlete’s psychological readiness to RTS, and specifically evaluates the constructs of emotions, confidence in performance, and risk appraisal. Psychological readiness to RTS at different stages of recovery following hip arthroscopy for FAI has not yet been described. The purpose of this study was to assess Hip-RSI in physically active patients at 3, 6, and 12-months after hip arthroscopy. Methods: This was a retrospective study on prospectively collected data from a single-surgeon hip registry. Patients who underwent hip arthroscopy and completed the Hip-RSI at minimum one postoperative time point from June 2021-December 2023 were identified. Chart review was conducted to obtain demographics. Those who were not physically active before surgery were excluded. Participants were then allotted into the 3, 6, and/or 12 month group based on completion of Hip-RSI. Descriptive statistics were calculated at each time point. A one-way analysis of variance (ANOVA) was performed to identify differences between Hip-RSI scores between the 3, 6, and 12-months groups. Results: Seventy-six patients met inclusion criteria (3-month cohort N=47, average age 25.61±12.79; 6-month cohort N=37, average age 25.67±11.92; 12-month cohort N=25, average age 24.3±11.55). Hip-RSI total scores were significantly higher in the 12-month group compared to 3-month (75.73±25.19 vs. 52.24±25.5, p = 0.001) and 6-month groups (75.73±25.19 vs. 52.87±28.72, p = 0.002). A similar trend was found when assessing questions pertaining to emotions and confidence, with the 12-month group being significantly higher than the 3-month (74.23±26.89 vs. 48.31±24.52, p&amp;lt;0.001 and 76.44±24.88 vs. 53.07±21.17, p=0.004, respectively) and 6-month (74.23±26.89 vs. 48.90±30.77, p=0.001 and 76.44±24.88 vs. 23.66±32.77, p=0.008). However, no differences in risk appraisal were observed between 3, 6, and 12-month groups. Conclusion: Psychological readiness to RTS was significantly higher at 12-months than at 3 or 6-months after hip arthroscopy for symptomatic FAIS. Our results suggest that psychological recovery may develop on a timeline independent of physical recovery. This highlights an opportunity for clinicians to monitor psychological readiness throughout the recovery process in order to maximize patients’ ability to successfully RTS.

ObjectiveTo determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH).MethodsRetrospectively review the preoperative and minimum of 2‐year follow‐up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age‐ and gender‐matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient‐reported outcomes (PROs) including international Hip Outcome Tool (iHOT‐33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS‐pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS‐satisfaction score of two groups at 2 years postoperatively were also analyzed.ResultsThe prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22–48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty‐three age‐ and sex‐matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT‐33, mHHS, and VAS‐pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3‐month and 24‐month follow‐up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS‐satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2‐year follow‐up.ConclusionAlthough abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

BackgroundPatients with Femoroacetabular Impingement Syndrome (FAIS) may experience persistent hip problems following arthroscopic FAIS surgery (HA), with total hip replacement surgery (THR) being the last option.PurposeTo 1) investigate the conversion rate of HA-treated FAIS-patients from a Danish cohort. 2) investigate factors that might affect conversion: age, sex, joint space width, hip osteoarthritis degree (Tönnis grading system), cam morphology (radiographic alpha angle measurement) and chondral damage of the femoral head and the acetabulum. 3) Describe patient reported outcomes after THR.Materials and MethodsPatients above 18 years registered with arthroscopic surgery due to FAIS between January 2012 and November 2023 were identified in (DHAR). Cases registered with a positive impingement test, radiological cam and/or pincer morphology on a standing anterior-posterior radiograph, no signs of hip osteoarthritis were eligible. All patients were invited to participate in a REDCap controlled survey. If they responded “yes” to the entry question: Have you had total hip replacement? they were immediately hereafter asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Osteoarthritis Outcome Score (HOOS) questionnaires (0-100 scores, 100 being no problems).Results5113 patients were eligible and received the survey. 2364 (46%) responded. 406 patients (8%) had a THR at 1 to 10 years after their primary hip arthroscopy, 199 responded the questionnaires. Converted cases reported median HAGOS scores of: Pain: 75, Symptoms: 75, Activities of daily living: 70, Sport: 53, Participation in Sport: 50, Quality of life: 50. HOOS scores were: Pain: 80, Symptoms: 81, Sport: 63 and Quality of life: 50. Compared to patients undergoing primary hip arthroscopy and primary THR, hip-related quality of life was inferior in converted cases. Higher age at HA, joint space width below 3 mm, Tönnis arthrosis grade > 1 and high grades of femoral cartilage injury might be risk factors for receiving THR after FAIS surgery.ConclusionsA low number of conversions to THR (8%) was demonstrated. Converted cases reported good outcomes after THR surgery, similar to those who underwent primary FAIS surgery and primary THR, although an inferior Hip-related quality of life was found in the studied patient group.

As many as 10% of primary hip arthroscopies end up with a revision arthroscopy procedure when treating patients suffering from femoroacetabular impingement syndrome (FAIS). In general, revision procedures are indicated because of residual impingement, but only a few studies present outcome data from revision hip arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip arthroscopy cohort and describe potential causes of failure after the primary hip arthroscopy. It was hypothesized that subjective outcomes improve after revision hip arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes. Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM's), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients. One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements (p < 0.05) in all PROMs was demonstrated, but FAIS patients in the primary hip arthroscopic cohort demonstrated significantly higher outcomes, in all PROMs, when compared at one-year follow-up. Scar tissue, residual osseous impingement and insufficient healing of the labral repair were reported as the main reasons for revision surgery. The conversion to total hip arthroplasty was low (6.4%). Revision hip arthroscopy in FAIS patients improves subjective outcomes significantly, although they are poorer than after primary FAIS hip arthroscopy. Main reasons for revision arthroscopy was scar tissue, residual femoroacetabular impingement and insufficient healing of labral repair. Level III.

BackgroundMasters athletes (MAs), defined as those aged 35 and older actively participating in sports, have demonstrated superior short-term outcomes and reoperation-free survivorship after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared to non-athletic counterparts; however, their mid- and long-term outcomes remain unclear.Hypothesis/PurposeTo evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship at long-term follow-up following primary HA for FAIS in MAs in comparison to a propensity-matched non-masters athletes (NMAs) control group, defined as those aged 35 and older who denied weekly sports activity. We hypothesized MAs would demonstrate superior PROs, CSO achievement, and reoperation-free survivorship compared to NMAs.Study DesignCohort, Level of Evidence III.MethodsPatients with minimum weekly preoperative sports participation over the age of 35 who underwent HA for FAIS between 1/2012-10/2014 with long-term follow-up were propensity-matched 1:1 to patients who denied weekly preoperative sports participation over the age of 35 controlling for age, sex, and body mass index (BMI). PROs collected preoperatively and at 2-, 5-, and 10-year follow-up timepoints included Hip Outcome Score-Activities of Daily Living and Sports Subscale (HOS-ADL/HOS-SS), 12-item International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and Visual Analog Scale (VAS) for Pain and Satisfaction. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were compared. Survivorship was compared with Kaplan-Meier analysis.ResultsIn total, 70 MAs were matched to 70 NMAs. Demographics were similar between MAs and NMAs, including age (44.89±7.7 vs. 45.77±6.9 years, P=0.473), sex (60.0% vs. 58.6% female, P=0.496), and BMI (26.19±4.9 vs. 26.79±4.4 kg/m2, P=0.444). Average follow-up duration was 10.32±0.3 years. Preoperative PROs were similar between groups (P≥0.114). MAs demonstrated superior 2-year HOS-ADL and iHOT-12 scores (P≤0.049). By 5-year follow-up with durability to 10-year follow-up, PROs were similar between groups (P≥0.065). Both groups demonstrated similar MCID and PASS achievement for all PROs (P≥0.111). Both groups demonstrated similar time-dependent reoperation-free survivorship (P=0.6).ConclusionsMAs undergoing primary HA for FAIS achieve comparable PROs, CSOs, and reoperation-free time-dependent survivorship to NMAs at long-term follow-up.Key TermsMasters Athletes, Hip Arthroscopy, Femoroacetabular Impingement Syndrome, Long-term Outcomes