Abstract
PurposeThe purposes of this study were to (1) evaluate the effect of age on clinical outcomes of arthroscopic femoroacetabular impingement (FAI) with labral preservation surgery and (2) identify predictors of poor postoperative clinical outcomes.MethodsEighty-four patients who underwent hip arthroscopic treatment for FAI between 2009 and 2013 were retrospectively reviewed. Patients were divided into three groups based on age. The Advanced age group consisted of patients over 70 years old, the Middle age group consisted of patients in their 50s and 60s, and the Younger age group consisted of patients less than 50 years of age. Total hip arthroplasty (THA) conversion, radiographic progression of osteoarthritis and patient-reported outcomes including modified Harris Hip Score (MHHS) and Non-arthritic Hip Score (NAHS) were investigated.ResultsThe mean follow-up period was 32.2 (range 24–60) months. THA was required in 3 patients in their 50s and 60s, which was a significantly higher rate compared to that in patients Younger than 50 years old (17% vs 0%, p = 0.036). Progression to osteoarthritis was also significantly more frequent in patients in their 50s and 60s than in patients in their 70s (50s and 60s: 33%; 70s: 0%, p = 0.030). In all age groups, the preoperative MHHS and NAHS improved at last follow-up (p < 0.001). The 50s and 60s age group [hazard ratio (HR) 6.62], preoperative mild osteoarthritic change (Tönnis grade 1, HR: 3.29) and severe cartilage damage on the acetabulum (HR: 2.63) were risk factors for progressive osteoarthritis and THA conversion.ConclusionsArthroscopic FAI correction and labral preservation surgery provide favourable clinical outcomes for patients over 70 years old in the absence of significant osteoarthritis and severe acetabular chondral damage. Patients in their 50s and 60s have a higher risk of both THA conversion and progressive osteoarthritis, while patients aged over 70 years show no evidence of progressive osteoarthritis. Chronologic age in isolation is not an absolute contra-indication to hip arthroscopy.Level of evidenceIII.
Highlights
Femoroacetabular impingement (FAI) is a condition resulting from the pathologic abutment between the acetabular rim and proximal femur [10]
Clinical inclusion criteria were groin pain refractory to a minimum of 3 months of Patients were divided into three groups by age: the Advanced age group consisted of 9 patients (6 males and 3 females) over 70 years of age at the time of surgery, the Middle age group consisted of 18 patients (6 males and 12 females) aged from 50 to 69 years, and the Younger age group consisted of 57 patients (31 males and 26 females) less than 50 years of age
There were no significant differences of the distribution of FAI type among three groups
Summary
Femoroacetabular impingement (FAI) is a condition resulting from the pathologic abutment between the acetabular rim and proximal femur [10]. Arthroscopic surgery for FAI in the younger population is a safe and effective procedure, especially in patients younger than 50 years old [4, 39]. Several studies have shown less favorable clinical outcomes following arthroscopic surgeries for treating FAI patients in the older population. In a series of 40 patients over 60 years old, that. Domb et al reported in a series of 52 patients over 50 years old that 17.3% underwent subsequent THA [9]. Philippon et al showed that 20–32% of patients 50 years old or older required conversion to THA [28, 30]
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