EP6.105 Recovery from Hip Arthroscopy for Femoroacetabular Impingement: A Qualitative Study of Patients’ Experiences

Patients With Dysplasia Achieve Similar Outcomes and Survivorship to Nondysplastic Patients 10 Years After Hip Arthroscopy for Femoroacetabular Impingement

Sport participation has been associated with favorable outcomes following hip arthroscopy (HA) for femoroacetabular impingement (FAI) at short- and mid-term follow-up; however, few studies have evaluated the 10-year outcomes in this population. The purpose of this study was to compare patient-reported outcome measures (PROMs), the achievement of clinically significant outcomes, and reoperation-free survivorship between patients with and without regular preoperative sport participation who underwent HA for FAI and had a minimum of 10 years of follow-up. Data were prospectively collected for patients who underwent primary HA for FAI between January 2012 and September 2013. Patients who participated in weekly sport participation at the time of surgery ("athletes") were matched 1:1 to patients who denied sport participation ("nonathletes"), controlling for age, sex, and body mass index (BMI). Preoperative and 10-year postoperative PROMs were collected, including the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports (HOS-Sports) subscales, the modified Harris hip score (mHHS), and the visual analog scale for pain (VAS Pain) and satisfaction (VAS Satisfaction). Patient acceptable symptom state (PASS) achievement and reoperation-free survivorship were compared between the groups. Sixty-four athletes were matched to 64 nonathletes of similar age, sex, and BMI (p ≥ 0.411). In the athlete group, 85.9% were recreational-level athletes. The groups had similar preoperative PROMs, except for the HOS-ADL subscale, where the athlete group demonstrated a higher preoperative score (67.8 ± 16.7 versus 59.9 ± 21.1, p = 0.029). Both groups demonstrated a significant improvement in all PROMs (p < 0.001) at the minimum 10-year follow-up10.3 ± 0.4 years). At the time of the final follow-up, the athlete group demonstrated significantly higher scores across all of the measured PROMs (p ≤ 0.036). Athletes showed a higher cumulative PASS achievement compared with nonathletes for the HOS-ADL subscale (73% versus 50%, p = 0.033), the HOS-Sports subscale (85% versus 61%, p = 0.010), the mHHS (69% versus 43%, p = 0.013), and the VAS Pain (78% versus 51%, p = 0.006). Reoperation-free survivorship frequencies were 87.5% and 82.8%, respectively (p = 0.504). Athletes who underwent contemporary HA for FAI showed superior PROMs and PASS achievement compared with nonathletes at the 10-year follow-up. Athletes and nonathletes showed reoperation-free survivorship frequencies of 87.5% and 82.8%, respectively. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Evidence shows that psychological factors can hinder the rehabilitation process and contribute to suboptimal patient-reported outcomes following hip arthroscopy for femoroacetabular impingement (FAI). However, little is known about the impact of pre-operative and post-operative pain self-efficacy on patient-reported outcomes following hip arthroscopy for FAI. This study examined the relationship between pre-operative and post-operative pain self-efficacy and hip specific patient-reported outcomes following hip arthroscopy for FAI. The findings of this study may help identify modifiable attributes that could enhance post-operative outcomes. Methods: We analyzed patient-reported outcomes data collected from hip arthroscopy patients using Patient IQ, a patient engagement technology. Patients reported their pain self-efficacy prior to surgery and at 3-, 6- and 12-months post-surgery using the Pain Self-Efficacy Questionnaire (PSEQ). Patient-reported outcomes were assessed at 3-, 6-, and 12-months post-surgery using the iHOT33 and the Hip Outcome Score Activity of Daily Living (HOS ADL) Scale. We examined the relationship between pre-operative PSEQ scores and post-operative iHOT33 and HOS ADL scores using Spearman’s correlations. We examined the effect of post-operative PSEQ scores on the odds of achieving a minimally clinically important difference (MCID) for the iHOT33 and HOS ADL using linear regressions. Results: Of the 332 patients, most were female (n = 244, 73.5%) and White (n = 297, 89.5%). We found a significant relationship between pre-operative PSEQ scores and iHOT33 and HOS ADL scores, respectively, at 3- (r = 0.76, 95% CI = 0.61-0.86; r = 0.72, 95% CI = 0.56-0.83), 6- (r = 0.75, 95% CI = 0.56-0.86; r = 0.71, 95% CI = 0.53-0.83) and 12-months (r = 0.79, 0.63-0.89; r = 0.82, 95% CI = 0.69-0.90) post-surgery. No significant associations were found between post-operative PSEQ scores and the odds of achieving MCID. Conclusions: We observed a significant association of pre-operative PSEQ scores on hip-specific patient-reported outcomes at 3-, 6-, and 12-months following hip arthroscopy. Our findings suggest that self-efficacy-enhancing interventions may be a promising tool to improve hip-specific patient-reported outcomes following hip arthroscopy for FAI. Further research is needed to confirm our findings.

Background: Hip arthroscopy for femoroacetabular impingement (FAI) has been shown to improve patient outcomes, especially for returning to sport. Although previous studies often evaluated outcomes 2 years after hip arthroscopy, there has been no analysis of the progression of patient improvement over time or with respect to achieving the minimal clinically important difference (MCID). Hypothesis/Purpose: The purpose was to prospectively evaluate changes in patient-reported outcome (PRO) scores during the first 2 years after hip arthroscopy for FAI and to analyze when the MCID is achieved. It was hypothesized that clinically significant changes will be reached by 1 year after surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing hip arthroscopy for FAI were prospectively enrolled, and they completed the 12-Item Short Form Health survey (SF-12), modified Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score (HOOS) at preoperative baseline and 3 months, 6 months, 1 year, and 2 years after surgery. Mean scores and the percentage of patients reaching the MCID at each time point were analyzed via analysis of variance and Cochrane-Armitage trend tests. Results: A total of 129 hips from 122 patients were evaluated, revealing significant improvements after hip arthroscopy for FAI (PRO scores increased 19 to 45 points) with 95.8%, 93.6%, and 84.8% of patients achieving the MCID for HOOS-Sports, HOOS–Quality of Life (QoL), and HOOS-Pain, respectively, at 2-year follow-up. Analysis of PRO change showed that for all scores, the greatest improvement occurred from presurgery to postoperative 3 months, with lesser improvements at subsequent 6-month, 1-year, and 2-year time points (P < .001). The SF-12 physical component score, HOOS-Sports, and HOOS-QoL continued to show statistically significant improvements through 2 years, while other scores plateaued after 3 months. The percentage of patients achieving the MCID for HOOS-Sports, HOOS-QoL, and HOOS-Pain continued to increase over 2 years, but the percentage achieving the MCID did not increase after 3 months for all other scores. Conclusion: Hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery. The majority of improvement occurs within 3 months after surgery, but certain outcomes, such as returning to sport, QoL, and pain, can continue to improve through 2 years.

Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI (P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level (R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score (P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores (R = 0.39; P < .001) and negative correlations with 2-year patient outcomes (R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

BackgroundThe ligamentum teres (LT) has received attention in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). Indeed, a better understanding of the function of the LT and its implications for clinical outcomes in the presence of a torn LT is required. This systematic review analyses the patient-reported outcome measures (PROMs) and the complication rate when an intact or torn LT is encountered during HA for FAI.MethodsStudies that compared patients with an intact to those with a torn LT managed with debridement during hip arthroscopy for FAI were identified from the Web of Science, PubMed, and Embase. The minimum follow-up for inclusion was 24 months. The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias. Patient characteristics and PROMs were assessed at the baseline and last follow-up.ResultsThe systematic review identified two studies comprising 611 patients. No statistically significant difference was found in pain, Harris Hip Score, and the activities of daily living and sports subscales of the Hip Outcome Score between patients with an intact LT and those with a torn LT treated with debridement, both of whom underwent HA for FAI.ConclusionsIn patients undergoing arthroscopic management for FAI, an intact or torn ligamentum teres managed with debridement does not influence postoperative PROMs. Given the importance of the LT as a structure of the hip joint and the increasing interest in HA for FAI, further standardised studies will be a valuable source for surgeons encountering this pathology.

Objectives:The objective of the current study was to evaluate patient reported outcomes and return to sport in a cohort of distinctly recreational and amateur level athletes following hip arthroscopy for femoroacetabular impingement (FAI).Methods:Following IRB approval, clinical data was retrospectively retrieved for 66 consecutive FAI patients (26 men, 40 women) who had undergone hip arthroscopy and identified themselves as recreational or amateur athletes on intake forms. Two-year patient-reported outcomes (PRO) included a sport-specific questionnaire, modified Harris Hip Score (mHHS), and Hip Outcome Scores with Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales were analyzed.Results:The mean age and BMI of all subjects was 26.8 ± 7.6 years and 23.9 ± 3.2 kg/m2, respectively. Athletes had withdrawn from sport for an average of 9.5 ± 6.7 months prior to surgery and on average required 9.7 ± 5.1 months to return to sport. After two years, all mean PRO scores had improved significantly (Figure 1), and 57 patients (92%) had returned to play and continued participation. Patients who had withdrawn from sport for greater than 8 months before surgery returned to sport significantly more slowly than those who had withdrawn for less than 8 months (p=0.01). Greater withdrawal from sport prior to surgery also correlated with lower postoperative improvements in HOS-ADL and HOS-SS scores. Bivariate analysis revealed that increasing body-mass index (BMI) was associated with lower improvements in PROs.Conclusion:Recreational athletes, following hip arthroscopy for FAI, return to play at a high rate. Increasing BMI and preoperative withdrawal from sport both significantly prolong return to play and diminish two-year PROs. Most return-to-play studies following hip arthroscopy for FAI have focused on professional athletes, with limited generalizability to the average sports medicine surgeon practice. This is the first study of its kind to focus on the recreational athlete and demonstrates comparable return-to-play rates while increasing the generalizability to the average sports medicine practice.

Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair

To compare early outcomes of periacetabular osteotomy (PAO) with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement (FAI) and chondrolabral pathology using patient-reported outcomes measurement information system (PROMIS). Consecutive patients scheduled for PAO with concomitant hip arthroscopy (PAO + HA) or isolated hip arthroscopy (HA) between the ages of 15 and 30years old were prospectively included in the study. Based on power analysis, subjects were recruited until there were 22 subjects in the PAO + HA group. These subjects were then gender matched to the HA group. The PROMIS, with six subscales and two global health measures, were completed during preoperative and 6-month follow-up visits. One-way ANOVA was performed to compare intake information of age, symptom duration, body mass index, and Beighton scores as well as preoperative and 6-month postoperative PROMIS scores between the PAO + HA and HA. 22 consecutive subjects undergoing PAO + HA were all females (average age 20.0years) and matched to 22 consecutive females (average age 22.6) in the HA group. ANOVA did not find a significant difference between the two groups when comparing intact information, with exception of age (p = 0.04). A significant difference was also not identified (p ≥ 0.05) between the two groups on preoperative or 6-month postoperative PROMIS scores. The largest difference in 6-month postoperative scores between the two groups was 4.4 points on physical function subscale. Outcomes at 6months were not significantly different when comparing PAO + HA to HA for FAI and chondrolabral pathology in females under 30years of age. The more extensive surgery with a prolonged protective period associated with PAO do not seem to negatively impact outcomes at 6months when compared to HA. These finding support the use of PAO + HA, particularly if the patient and/or surgeon were concerned about prolonged disability, metal health issues, and/or higher pain levels that might be associated with the PAO procedure.

PurposeThe forgotten joint score-12 (FJS-12) is an outcome questionnaire designed to evaluate joint awareness. The responsiveness and validity of the English language version of the FJS-12 in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is not known.MethodsConsecutive patients undergoing hip arthroscopy for a diagnosis of FAI were prospectively followed up over a 1 year period. Patients completed preoperative and postoperative FJS-12, EuroQol 5 Dimension (EQ-5D-5L), and the 12-item international hip outcome tool (iHOT-12). We evaluated construct validity with Spearman correlation coefficients for the FJS-12, and responsiveness by way of effect size and ceiling effects.ResultsForty-six patients underwent hip arthroscopy, of which 42 (91%) completed post-operative PROMs at 1 year follow-up. Construct validity was strong with the iHOT-12 (r = 0.87) and also the EQ-5D-5L (r = 0.83). The median postoperative FJS score was 50.2 (IQR 64). The mean change in score for the FJS-12 was 31 points (SD 31) (p < 0.001), with an effect size (Cohen’s d) of 1.16. Preoperatively, three patients scored the lowest possible value resulting in a floor effect of 7.1%. Similarly, only three patients (7.1%) scored the best possible score post-operatively.ConclusionThis is the first evaluation of the joint awareness concept in the English language version of the FJS-12 following hip arthroscopy for FAI. The FJS-12 is a valid and responsive tool for the assessment of this cohort of patients.Level of evidenceII.

Does the Hip Capsule Remain Closed After Hip Arthroscopy With Routine Capsular Closure for Femoroacetabular Impingement? A Magnetic Resonance Imaging Analysis in Symptomatic Postoperative Patients

Background: Previous studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) in individuals 18 years of age and older. Long-term outcome data in the adolescent population, however, are limited. Purpose: To report 10-year outcomes after hip arthroscopy in adolescents with symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were analyzed on adolescent patients younger than 18 years of age who had hip arthroscopy between March 2005 and 2009 with a minimum 10-year follow-up. Patients were included if they were diagnosed with symptomatic FAI and an associated labral tear that was treated with repair. Patients were excluded if they had previous hip procedures, acetabular dysplasia (lateral center-edge angle, <20°), avascular necrosis, previous hip fracture or dislocation, or Legg-Calve-Perthes disease, or refused to participate. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. In addition, the HOS—Sport, modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and patient satisfaction were collected. Failure was defined as patients having to undergo revision arthroscopy. Results: There were 60 patients (70 hips) who met inclusion criteria and had a 10-year follow-up. The mean age of the cohort was 16 ± 1.2 years, with 21 male and 49 female hips. Seven hips (10%) required revision hip arthroscopy. All revisions occurred in female patients and were associated with global laxity as well as longer duration of symptoms before time of surgery. At a mean follow-up of 12 years (range, 10-14 years), patients who did not undergo revision surgery had significant improvements from preoperatively to postoperatively in HOS-ADL (from 64 to 92; P < .01), HOS–Sport (from 40 to 86; P < .01), mHHS (from 56 to 88; P < .01), and SF-12 Physical Component Summary (from 41 to 54; P < .01). The median patient satisfaction was 10 out of 10 (very satisfied). Conclusion: Hip arthroscopy for FAI with labral repair resulted in excellent patient-reported outcomes and satisfaction at a minimum of 10 years of follow-up. There was a 10% rate of revision surgery, which was associated with global laxity and longer duration of symptoms before surgery, which should be considered in patient selection.

Objectives:Pre-operative predictors of high functional level at two years following hip arthroscopy are unclear. We hypothesized that smoking status, comorbid disease (hypertension, diabetes, mental health diagnoses, prior surgeries, and spine pathology) would negatively affect outcomes at two-year follow-up while younger age, decreased body mass index (BMI), increased physical activity and shorter preoperative symptom duration would be able to predict outcomes after hip arthroscopy for femoroacetabular impingement (FAI).Methods:A prospectively collected registry was analyzed for all patients treated for FAI from 2012 to 2015. All patients had a minimum of 2-year follow-up with patient reported outcomes [PROs, including modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sport Specific (HOS-SS), Visual Analog Score (VAS)-Pain and satisfaction. Inclusion criteria were skeletally mature patients at the time of arthroscopy, signs and symptoms consistent with a diagnosis of FAI. Individuals with prior hip surgery, inflammatory arthropathy, and/or advanced osteoarthritis were excluded. Univariate and correlation analyses were performed to identify significant association and multivariate logistic regression analysis was used to identify significant predictors. Significance was set at α ≤ 0.05.Results:Of 1042 qualifying patients, 830 completed 2-year minimum follow-up (80%); mean age and body mass index (BMI) were 33.6±12.8 years and 25.4±11.3 respectively. The majority of patients were female (549, 66.1%), non-smokers (741, 89.3%), who participated in regular recreational sports (623, 75%). One-third (278, 33.5%) experienced preoperative symptoms longer than two-years while 157 (18.9%) experienced symptoms for one-to-two years, with 265 (31.9%) for 4-to-12 months, and 108 (13%) less than 4 months. Mean alpha angle and lateral center edge angle were 61.2±10.1 and 33.1±7.02, respectively. All patients demonstrated significant improvements in PROs following surgery: HOS-ADL (65.20±0.72 to 86.54±0.61; p<0.0001), HOS-SS (42.84±0.89 to 73.98±1.0; p<0.0001), and mHHS (57.4±0.58 to79.92±0.68; p<0.0001). In addition, VAS Pain was significantly decreased from 53.35±1.3 to 19.44±0.86 (p=0.032) with high two-year satisfaction at 81.11±28.28. Regression analysis identified the strongest predictors for high functioning outcomes in the HOS-SS were patients without a history of a mental health diagnoses (anxiety or depression; importance 0.29, p<0.0001) followed by younger age (importance 0.18; p<0.0001). Predictors for improved two-year HOS-ADL outcomes included shorter duration of symptoms (importance 0.22; p<0.0001) and decreased BMI (importance 0.164; p=0.001). Predictors for an improved mHHS included no pre-operative narcotic use (importance 0.19; p=0.001) and no history of a mental health diagnoses (importance 0.18; p=0.001). Predictors of HOS-ADL and mHHS were also significant predictors of a greater HOS-SS score (p=0.001 for all).Conclusion:Our results support the hypothesis that patients with mental health diagnoses, increased age and BMI, as well as prolonged preoperative symptom duration are predictors for inferior post-operative functional status at mid-term follow-up. Our results suggest that there are both modifiable and non-modifiable pre-operative factors that have the potential to predict a return to high functional status after hip arthroscopy for FAI.

Objectives:The purpose of this study was to compare the clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) based on sex and age.Methods:A total of 150 patients undergoing hip arthroscopy for FAI by a single fellowship-trained surgeon were prospectively analyzed, with 25 patients categorized in each of the following groups: A) females ≤30 years,B) females 31-45 years, C) females >45 years, D) males ≤30 years, E) males 31-45 years and F) males >45 years. Primary clinical outcomes included the Hip Outcome Score Activity of Daily Living (HOS-ADL) and Sport-Specific Subscales (HOS-SS), the modified Harris Hip Score (mHHS), and clinical improvement at final follow-up. Statistical analysis was performed utilizing ANOVA with post-hoc Tukey HSD tests, with P<0.05 considered significant.Results:One-hundred forty of 150 patients (93%) were available for follow-up at an average 2.72±0.43 years (minimum, 2 years), with no differences in follow-up rates between the 6 groups (P<0.05). All groups demonstrated significant improvements in HOS-ADL, HOS-SS, and mHHS outcomes at final follow-up (P<0.001). Females >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to females ≤30 (P<0.0001, P=0.001, P<0.0001 respectively) and females 30-45 (P=0.015, P<0.0001, P=0.001 respectively). Similarly, males >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to males ≤30 (P=0.012, P=0.015, P=0.022 respectively) (Figure 1). Males >45 scored significantly better than females >45 on the HOS-SS (P=0.013) and the mHHS(P=0.024). Incorporating both sexes, patients >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to patients ≤30 (P<0.0001, P<0.0001, P<0.0001, respectively) and patients 30-45 (P=0.005, P<0.0001, P=0.008, respectively).Conclusion:While all patients had significant improvements in all outcomes following hip arthroscopy for FAI, patients >45 years performed worse compared to patients in younger age groups, with females >45 years demonstrating the poorest outcome scores. This data can be used to counsel patients preoperatively and to individualize care to optimize outcomes following hip arthroscopy for FAI.

Studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) with associated labral tears. The purposes of this study were to report 10-year outcomes and hip survival following hip arthroscopy for FAI and to compare labral debridement with labral repair. Prospectively collected data on patients followed for a minimum of 10 years after hip arthroscopy for FAI with either labral debridement or labral repair performed by a single surgeon were retrospectively analyzed. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. Mann-Whitney U tests were used to compare outcomes between groups, and Wilcoxon signed-rank tests were used to compare preoperative with postoperative scores. Survival analysis was performed using a multivariate Cox proportional hazards model. Seventy-nine patients who underwent labral repair and 75 who underwent debridement were included in the study, and 94% (145) were followed for ≥10 years. Fifty patients (34%) underwent total hip arthroplasty (THA) within 10 years following the arthroscopy. Older patients, hips with >2 mm of joint space preoperatively, and patients requiring acetabular microfracture had significantly higher prevalences of THA. The multivariate Cox proportional hazards model showed that increased age (hazard ratio [HR] for 31 years to 51 years = 3.06, 95% confidence interval [CI] = 1.69 to 5.56, p < 0.001), a joint space of ≤2 mm (HR = 4.26, 95% CI = 1.98 to 9.21, p < 0.001), and acetabular microfracture (HR = 2.86, 95% CI = 1.07 to 7.62, p = 0.036) were independently associated with an increased hazard rate for THA. When the analysis was adjusted for these factors, there was no significant difference in the HR between treatment groups (HR = 1.10, 95% CI = 0.59 to 2.05, p = 0.762). There was also no significant difference in postoperative outcome scores between groups. The debridement group demonstrated a significant increase, between the preoperative and postoperative evaluations, in the HOS-ADL score (from 71 to 96; p < 0.001), HOS-Sport score (from 42 to 89; p < 0.001), modified Harris hip score (mHHS) (from 62 to 90; p < 0.001), and Short Form-12 physical component summary (SF-12 PCS) score (from 43 to 56; p < 0.001). The repair group also demonstrated a significant increase in the HOS-ADL score (from 71 to 96; p < 0.001), HOS-Sport score (from 47 to 87; p < 0.001), mHHS score (from 65 to 85; p < 0.001), and SF-12 PCS score (from 41 to 56; p < 0.001). The median patient satisfaction score was 10 (very satisfied) in both groups. Hip arthroscopy for FAI with labral debridement or repair resulted in significant improvements in the patient-reported outcomes and satisfaction of patients who did not eventually require THA. Higher rates of conversion to THA were seen in older patients, patients treated with acetabular microfracture, and hips with ≤2 mm of joint space preoperatively, regardless of labral treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.