Poster 213: Outcomes of High-Level Competitive Athletes Undergoing Hip Arthroscopy as Compared to Non-Competitive Athletes at 5-Year Follow-Up: A Propensity Matched Analysis

Abstract

Objectives: Hip arthroscopy has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes and non-competitive athletes, with favorable patient reported outcomes (PROs), and low rates of complications. Previous data demonstrates a high return to sport (RTS) rate, reported up to 88% to 92%. Although PROs and RTS have previously been evaluated, many studies are limited to short-term follow-up and do not differentiate between competitive and non-competitive athletes. The objectives of this study were to (1) determine differences in mid-term clinical outcomes at 5-years follow-up between patients who are high-level competitive athletes (CA) versus propensity matched, non-competitive athletes (NCA) undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), (2) determine whether achievement rates of minimal clinically important differences (MCID) and patient acceptable symptomatic states (PASS) differ between the two groups, and (3) determine return to sport (RTS) rate in CA. Methods: Patients who were collegiate, semi-professional, or professional athletes and underwent primary hip arthroscopy for FAIS from January 2012 to April 2017 were identified. Patients were propensity matched on a 1:4 basis to NCA controls by age, sex, and body mass index (BMI). Preoperative and postoperative radiographs were assessed. Patient reported outcomes (PROs) collected preoperatively and at 5-years included international Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), and Visual Analog Scale (VAS) for Pain and Satisfaction. MCID and PASS rates were determined using previously-published thresholds for iHOT-12, mHHS, HOS-ADL, HOS-SS, and VAS Pain. RTS rate and duration was collected retrospectively. Results: A total of 57 high-level CA who underwent primary hip arthroscopy for FAIS (33 female, age: 21.7 ± 4.2 years, BMI: 23.1 ± 2.8kg/m2) were propensity matched to 228 NCA controls (132 female, p > 0.999; age: 23.3 ± 5.8 years, p = 0.022; BMI: 23.8 ± 4.3 kg/m2, p = 0.239). There were no statistically significant differences between any radiographic parameters in any of the pre- or postoperative radiographic parameters between groups. Of note, competitive athletes had higher outcome scores prior to surgery in HOS-ADL (CA: 74.9 ± 13.7 vs NCA: 66.4 ± 18.4, p = 0.001) and mHHS (CA: 64.7 ± 12.9 vs NCA: 59.7 ± 14.3, p = 0.040). Both groups demonstrated significant postoperative improvements in all outcome scores measured (p ≤ 0.001). At 5-years postoperatively, CA had lower VAS pain than NCA (CA: 17.3 ± 17.6 vs NCA: 24.7 ± 25.9, p=0.017). There were no significant differences in achieving MCID or PASS for HOS-ADL, HOS-SS, mHHS, or iHOT-12 at final follow-up. CA returned to sport (RTS) at a median of 25.2 weeks (Q1 22.4 – Q3 30.7) with an overall RTS rate of 90%. The CA participated in a multitude of sports (Figure 1) however, there was no significant differences in comparing RTS between individual sports (p = 0.163) (Figure 2). Conclusions: CA patients demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates following primary hip arthroscopy, which were comparable to non- competitive controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than controls and achieve lower average self-reported pain at 5-years postoperatively. CA patients demonstrate high rate of RTS (˜90%) at a median of ˜25 weeks post- operatively.