Patients Undergoing Postless Hip Arthroscopy Demonstrate Significantly Better Patient-Reported Outcomes and Clinically Significant Outcomes Compared to Conventional Post-Assisted Hip Arthroscopy at Short-Term Follow-Up

Abstract

PurposeTo prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post. MethodsA prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at one center at which the senior author operates, and a perineal post was used at another surgical location. An electronic survey of Patient-Reported Outcome Measures (PROMs) was completed by each patient at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain, University of California Los Angeles (UCLA) Activity Scale, modified Harris Hip Score (mHHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and a Single Assessment Numeric Evaluation (SANE). Postoperative scores and clinically significant outcomes including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) for each PROM were compared between groups. ResultsSixty-nine patients were reached for follow-up (41 post, 28 postless) of 87 patients eligible for the study (79%). No significant differences were found between groups in terms of sex (post: 61% female, postless: 54% female, p = 0.54), age (post: 34 years, postless: 29 years, p = 0.11), body mass index (post: 26 kg/m2, postless: 24 kg/m2, p = 0.23) or follow-up duration (post: 24.4 months, postless: 21.3 months, p = 0.16). There was a significantly higher VAS (3.1 vs 1.4, p = 0.01), significantly lower UCLA Activity Score (7.0 vs 8.4, p = 0.02), and significantly lower mHHS (73.7 vs. 82.2, p = 0.03) in the post-assisted group. A significantly higher proportion of patients in the postless group achieved a PASS for the UCLA (89.3% vs. 68.3%, p = 0.04), mHHS (84.6% vs. 61.0%, p = 0.04), and HOS-SSS (84.0% vs. 61.0%, p = 0.048), and a SCB for HOS-SSS (72.0% vs. 41.5%, p = 0.02). One patient (2.6%) in the post group underwent revision hip arthroscopy and another was indicated for total hip arthroplasty by the time of follow-up. ConclusionPostless hip arthroscopy may result in better clinical outcomes compared to post-assisted hip arthroscopy. Level of EvidenceIII, retrospective cohort study