Multi-center Analysis of Sports-Related Outcomes of Adolescents following Hip Arthroscopy

Abstract

Symptoms of hip pathology are becoming more commonly recognized in pediatric and adolescent athletes. Arthroscopic surgical approaches to correct morphological and structural abnormalities in adults have been introduced to younger patients to improve dysfunction and reduce the progression of hip pathology. However, a paucity in the literature exists regarding how the pediatric and adolescent athletes respond to hip preservation surgery and the impact hip arthroscopy may have on athletic activity. The purpose of this study was to describe the changes of functional and sports related outcomes of adolescents at 2 years following arthroscopic hip preservation surgery. De-identified patient data from a multi-centered hip arthroscopy registry from January 1, 2016 – January 1, 2017 was analyzed. The data was collected from 7 individual surgeon practices that each perform greater than 100 hip arthroscopy cases per year for a minimum of 8 years. A statistical software program (SPSS, IBM Inc.) computed paired t-tests with an a priori alpha set at 0.05 to determine significance of the change in scores from pre-operative to 2-years post hip arthroscopic surgery. Outcome measures included visual analog pain scales, Hip Outcome Score Sports subscale (HOS Sports), and International Hip Outcome Tool-12 scores. The magnitude to change in these outcome measures and the frequency of patients that surpassed Patient Acceptable Symptomatic State (PASS) scores was determined for the cohort. A chi square analysis was then conducted to determine changes in sports-related skills and activities from pre to post hip preservation surgery. There were 50 adolescent athletes (14 male; 36 female) included in the analysis. The most common sports were running (28%), lacrosse (6%), baseball (10%), swimming (10%), dance (8%), and cheerleading (8%). Sports related outcomes measured by the HOS Sports Subscale improved (p<0.001) from an average score of 43.7 (SD=21.3) to 90.0 (SD=10.0), with 54% meeting the PASS score. Running was the most commonly reported sport specific skill/activity that was categorized as extremely difficult or unable to do by 46% of athletes prior to surgery. This percentage dropped to 8% of athletes at 2 years post-surgery. The greatest improvements of sports specific activities were noted in jumping, landing, stop/start movements, and cutting/lateral movements in which 88% - 90% of the athletes reported either slight or no difficulty at all with these activities. Self-reported functional outcomes showed that the iHOT-12 improved (p<0.001) from an average score of 37.4 (SD 17.4) to 85.4 (SD=15.0), with 72% of patients meeting the PASS score. Pain visual analog scores also improved (p<0.001) from 39.7 (SD=21.7) to 12.4 (SD=15.8). The results of this study show that sport specific function of adolescent athletes greatly improves and is sustained 2 years following hip preservation surgery. Running was shown to be the most difficult sport specific skill to perform due to hip pathology prior to surgery, but improved after surgery. Other skills that showed large improvements after surgery included jumping, landing, stopping/starting, and cutting/lateral movements. Despite large improvements, some athletes may report sports related dysfunction at 2 years following hip preservation surgery.