Revision Hip Arthroscopy Yields Inferior Patient Reported Outcome Measures and Patient Acceptable Symptomatic State Along with Higher Total Hip Arthroplasty Conversion Compared to the Primary Setting at a Minimum 2-Year Follow-Up.

Primary and Revision Hip Arthroscopy in Borderline Hip Dysplasia Shows Comparable Outcomes at a Minimum 5-Year Follow-Up

Purpose: To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship between primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD) at minimum 5-year follow-up. Methods: Patients with BHD, characterized by a lateral center edge angle 18°-25°, who underwent HA for FAIS with capsular repair by a single surgeon between 01/2012 and 06/2018 with minimum 5-year follow-up were identified. Cases of revision HA were propensity-matched 1:2 to cases of primary HA, controlling for age, sex, and body mass index (BMI). Collected PROs included: Hip Outcome Score-Activities of Daily Living and Sport Subscales, International Hip Outcome Score 12, modified Harris Hip Score, and Visual Analog Scale for Pain. Achievement of minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for any measured PRO were compared between groups along with reoperation-free survivorship using Kaplan-Meier survival analysis. Results: Thirty-six revision HA hips (34 patients) were propensity-matched to 72 primary HA hips (70 patients). The groups were similar in age (31.5±10.3 years vs. 30.5±11.2, P=0.669), sex (69.4% female vs. 70.8%, P=0.656), and BMI (25.7±4.0 kg/m2 vs. 25.5±3.7, P=0.849). The revision group showed a greater prevalence of prolonged preoperative pain (50.0% vs. 27.8%, P=0.032) compared to the primary group. A significant improvement in all PROs was observed for both groups with comparable PROs preoperatively and at 5-year follow-up between groups (P≥0.086). The revision and primary groups showed comparable MCID (95.0% vs. 95.7%, P=1.000), PASS (80.0% vs. 83.6%, P=0.757), and SCB (62.5% vs. 70.7%, P=0.603) achievement for any PRO. Comparable reoperation-free survivorship was observed (P=0.151). Conclusion: Propensity-matched patients with BHD undergoing primary and revision hip arthroscopy for FAIS achieved similar minimum 5-year PROs, CSOs, and reoperation-free survivorship. Level of Evidence: Level III, Retrospective Comparative Case Series

Objectives: Previous studies have reported outcomes after revision hip arthroscopy at mid-term follow-up. These studies demonstrate that patients can expect clinical improvement and low rates of reoperation following their revision surgery. However, in comparison to primary hip arthroscopy patients they experience worse outcomes. The purpose of this study was (1) To evaluate long-term outcomes after revision hip arthroscopy and (2) to identify factors that contribute to poorer outcomes. Methods: Patients who underwent revision hip arthroscopy for FAIS between 1/2012-9/2015 were reviewed. Patients were excluded if they underwent revision hip arthroscopy for a reason other than FAIS, underwent staged or prior PAO, had Tönnis grade > 1, had a history of congenital hip disorder (e.g., slipped capital femoral epiphysis), or were missing 8+ year follow-up. Patient-reported outcome (PRO) measures were collected both pre- and post-operatively including Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Scale (HOS-SS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool (iHOT-12). Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated using the distribution and anchor methods, respectively. Rates of MCID and PASS achievement were then evaluated. Rates of reoperation including repeat revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Patients were also divided into clinical successes and failures and compared. A clinical failure was defined as failure to achieve MCID or PASS for any PRO or undergoing a reoperation. Results: A total of 43 patients (72% female; age: 30.1 ± 10.3 years; BMI: 25.8 ± 6.0 kg/m2) met criteria for inclusion. Average follow-up was 9.3 years. At last follow-up there were significant improvements across all PROs (p < 0.001, for all). MCID achievement at final follow-up for each PRO was ≥ 56.5%, with achievement of MCID in any PRO occurring in 73.9% of patients. PASS achievement at final follow-up for each PRO was ≥ 29.6%, with achievement of PASS in any PRO occurring in 63.0% of patients. PASS achievement was 75.7% at two years and 75.8% at five years. Incidence of secondary revision hip arthroscopy was 23.3% and THA was 14.0%, occurring at mean 3.9 ± 2.8 years and 4.2 ± 3.0 years following index revision, respectively. 22 patients were considered clinical successes, and 21 patients were determined to be clinical failures. Both groups demonstrated similar age (28.6 ± 8.5 years vs 31.6 ± 11.9, p = 0.351), sex (77.3% female vs 66.7% female, p = 0.438), and BMI (25.7 ± 7.9 vs 25.9 ± 3.6, p = 0.915). Additionally, clinical successes and failures had similar preoperative PROs (p ≥ 0.133, for all). Presence of preoperative pain for over two years occurred more frequently in clinical failures (45.5% vs 76.2%, p = 0.039). Tönnis grade 1 was also present at a higher rate amongst clinical failures (0% vs 23.8%, p = 0.015). Conclusions: Patients undergoing revision hip arthroscopy can see significant clinical improvement, particularly within the first five years following surgery. However, some patients may see clinical decline beyond eight years post-operatively. Revision hip arthroscopy is associated with relatively high reoperation rate. Those with greater Tönnis grade on preoperative radiographs and increased prevalence of chronic preoperative pain were less likely to achieve a clinical success.

Background: Outcomes of revision hip arthroscopy in the athletic population have not been well established. Purpose: (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. Results: A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group (P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). Conclusion: Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.

Purpose(1) To determine the clinical outcomes following revision arthroscopy for patients with hip synovial chondromatosis (SC), and (2) to compare the clinical outcomes between patients undergoing revision hip arthroscopy and primary hip arthroscopy. Methods Patients undergoing hip arthroscopy between December 2014 and January 2021 was reviewed. Patients treated for SC and confirmed by postoperative pathology were included. Exclusion criteria were age less than 18 years old, hip osteoarthritis (Tönnis grade > 1), history of autoimmune disease, avascular necrosis, and Legg–Calve–Perthes disease. Patients undergoing revision surgery were included in the revision group, while those undergoing primary surgery were matched in a 1:4 ratio and included in the primary group. Preoperative and postoperative patient reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. The PROs and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS, iHOT-12, and NAHS were compared between the two groups.ResultsA total of 12 patients were included in the revision group, while 48 patients were included in the primary group. No significant difference was found in baseline characteristics (all with P > .05). No significant difference was found in the arthroscopic findings and procedures (all with P > .05). Both groups presented significant improvement of postoperative PROs compared to the preoperative PROs (all with P < .001). No significant difference was found in preoperative PROs between the two groups (all with P > .05). Postoperatively, the revision group presented inferior VAS (P = .007), mHHS (P = .007), iHOT-12 (P = .004), and NAHS (P = .028), as well as lower rate of achieving MCID of NAHS (P = .038), and PASS of mHHS (P = .003) compared to the primary group.ConclusionPatients undergoing revision arthroscopy for hip SC presented favorable clinical outcomes at minimum of 2-year follow-up, although the postoperative PROs, rate of achieving MCID, and PASS were lower compared to patients undergoing primary arthroscopy.

Repeat Revision Hip Arthroscopy Outcomes Match That of Initial Revision But Not That of Primary Surgery for Femoroacetabular Impingement Syndrome

Purpose(1) To determine the clinical outcomes following revision arthroscopy for patients with hip synovial chondromatosis (SC), and (2) to compare the clinical outcomes between patients undergoing revision hip arthroscopy and primary hip arthroscopy.MethodsPatients undergoing hip arthroscopy between December 2014 and January 2021 was reviewed. Patients treated for SC and confirmed by postoperative pathology were included. Exclusion criteria were age less than 18 years old, hip osteoarthritis (Tönnis grade > 1), history of autoimmune disease, avascular necrosis, and Legg–Calve–Perthes disease. Patients undergoing revision surgery were included in the revision group, while those undergoing primary surgery were matched in a 1:4 ratio and included in the primary group. Preoperative and postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. The PROs and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS, iHOT-12, and NAHS were compared between the two groups.ResultsA total of 12 patients were included in the revision group, while 48 patients were included in the primary group. No significant difference was found in baseline characteristics (all with P > .05). No significant difference was found in the arthroscopic findings and procedures (all with P > .05). Both groups presented significant improvement of postoperative PROs compared to the preoperative PROs (all with P < .001). No significant difference was found in preoperative PROs between the two groups (all with P > .05). Postoperatively, the revision group presented inferior VAS (P = .007), mHHS (P = .007), iHOT-12 (P = .004), and NAHS (P = .028), as well as lower rate of achieving MCID of NAHS (P = .038), and PASS of mHHS (P = .003) compared to the primary group.ConclusionPatients undergoing revision arthroscopy for hip SC presented favorable clinical outcomes at minimum of 2-year follow-up, although the postoperative PROs, rate of achieving MCID, and PASS were lower compared to patients undergoing primary arthroscopy.Level of Evidence: III.

Patients Undergoing Revision Hip Arthroscopy Demonstrate Comparable Survivability and Improvement but Worse Postoperative Outcomes Compared to Patients Undergoing Primary Hip Arthroscopy: A Propensity Matched Study at Five-Year Follow-Up

BackgroundHip arthroscopy for femoroacetabular impingement syndrome (FAIS) has proven to be an effective surgical intervention with high rates of return to sport and work, and favorable outcomes at short and mid-term follow-up. However, limited data exists on outcomes at long-term follow-up utilizing modern techniques such as labral repair and capsular closure. Thus, we aim to evaluate patient-reported outcomes (PROs) at minimum ten-year follow-up following primary hip arthroscopy including labral repair, osteochondroplasty, and capsular repair for FAIS.MethodsPatients who underwent primary hip arthroscopy for FAIS between January 2012 and October 2014were identified. PROs were collected preoperatively and at 10-years, including Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and Visual Analog Scale (VAS) for Pain and Satisfaction. Unique Minimal Clinically Important difference (MCID) and Patient Acceptable Symptomatic State (PASS) thresholds were calculated, and rates of achievement were analyzed. An alpha level of <0.05 was used to determine statistical significance.ResultsA total of 500 patients (314 females; age: 33.8±12.3 years) were analyzed with follow-up of 10.4±0.4 years (range, 10.0–13.0 years). Patients demonstrated significant 10-year improvement across all PRO measures (p<0.001). MCID and PASS thresholds were calculated as follows: HOS-ADL (MCID: 9.8; PASS: 85.7), HOS-SS (14.9; 64.6), mHHS (8.9; 74.1), VAS Pain (-14.4; 28.2), and iHOT-12 (PASS: 77.9). The majority of patients achieved MCID and PASS for each PRO measure: HOS-ADL (MCID: 74.2%; PASS: 71.5%), HOS-SS (75.9%; 74.2%), mHHS (75.8%; 70.1%), VAS Pain (87.3%; 70.8%), iHOT-12 (PASS: 67.9%). 31 patients (6.2%) underwent subsequent revision hip arthroscopy and 35 (7.0%) underwent conversion to THA. Upon logistic regression, BMI, psychiatric history, and preoperative HOS-ADL were negatively predictive of MCID achievement for HOS-ADL. Psychiatric history was also negatively predictive of PASS achievement for HOS-ADL.ConclusionPatients undergoing primary hip arthroscopy for FAIS utilizing contemporary methods of labral repair, acetabular and/or femoral osteochondroplasty, and capsular closure commonly experience sustained clinical improvement and low rates of reoperation at 10-year follow-up.

Background: Prior studies have reported outcomes following revision hip arthroscopy (HA) at short-/mid-term time-points; there remains a paucity of literature comparing clinical outcomes and reoperation rates between patients undergoing primary and revision HA at 10 years postoperatively. Purpose: To compare patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, and reoperation rates after HA in both the primary and revision settings at long-term follow-up. Methods: Patients undergoing HA were identified and revision hips were propensity-matched 1:4 to primary hips by age, sex, and body mass index (BMI). Collected PROs included Hip Outcome Score Activities of Daily Living/Sports Subscale (HOS-ADL/SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool-12 item questionnaire (iHOT-12), Visual Analog Scale for Pain/Satisfaction (VAS-Pain/Satisfaction). Cohort-specific thresholds for minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated, and CSO achievement was determined. PROs, CSOs, and rates of reoperation including total hip arthroplasty (THA) and revision HA were compared. Results: Thirty-two revision hips were propensity matched to 128 primary hips with similar follow-up time (10.9±0.52 vs. 10.9±0.48, p≥0.350). Both groups saw statistically significant improvement in PROs pre- to post-operatively (p&amp;lt;0.001, for all) with no noted differences across groups at 10-years postoperatively (p≥0.123, for all). Revision hips had lower MCID achievement for VAS-Pain (63.2vs.85.7%, p=0.044) and PASS achievement for HOS-SS (36.8%vs.62.1%, p=0.047); otherwise, no statistical differences in MCID or PASS achievement were observed (p≥0.263). Rates of subsequent arthroscopy were similar between groups (12.5%vs.9.4%, p=0.529). Revision hips underwent THA conversion more frequently than in primary hips (18.8%vs.4.7%, p=0.015), with 83.3% (5/6) of the THA conversions in the revision cohort occurring &amp;gt;4.5 years after revision HA. Conclusions: Revision and primary HA cohorts demonstrated significant improvement in all PROs, however revisions may have lower achievement of CSOs. Re-revision rates were in line with primary revisions at long-term follow-up; conversion to THA occurred more frequently after revision HA with subsequent THA occurring most frequently at time points beyond 4.5 years.

Background: The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. Purpose: To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. Results: A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P = .027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. Conclusion: After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4.

Background: There has been increasing interest in defining clinically meaningful outcomes in patient reported outcomes following orthopaedic surgery. Little is known about the factors associated with clinically meaningful outcomes after hip arthroscopy for femoroacetabular impingement. Study Design: Case-control study; Level of evidence, 3. Purpose: To report on a large, prospectively collected consecutive series of patients who underwent comprehensive arthroscopic treatment of femoroacetabular impingement (FAI) and capsular management with greater than 2-year follow-up. The objectives were to determine (1) what percentage of patients achieve clinically significant outcomes after hip arthroscopic surgery for FAI as determined by the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) and (2) what factors are associated with achieving the MCID and PASS. Methods: Data from an institutional repository of consecutive patients undergoing primary hip arthroscopic surgery with routine capsular closure for FAI that had failed nonsurgical management between January 2012 and January 2014 were prospectively collected and analyzed. Of 474 patients during the enrollment period, 386 (81.4%) patients were available for a minimum 2-year follow-up. Demographics, radiographic measurements, intraoperative characteristics, and patient-reported outcome scores were collected. The primary outcome measure was achieving published thresholds for the MCID and PASS for the Hip Outcome Score (HOS)–Activities of Daily Living (ADL) in patients with FAI. The HOS–Sport-Specific Subscale (SSS), complications, and reoperations were secondary outcome measures. Multivariate regression analyses were conducted to identify factors associated with achieving the MCID and PASS. Results: At a minimum of 2-year follow-up, the patients had statistically significant improvements in all patient-reported outcomes (HOS-ADL, HOS-SSS, and modified Harris Hip Score [mHHS]; P < .001 for all), with a 1.2% rate of revision hip arthroscopic surgery and 1.7% rate of conversion to total hip arthroplasty. The MCID was achieved by 78.8% of patients for the HOS-ADL, and the PASS was achieved by 62.5% for the HOS-ADL. Younger age (P = .008), Tönnis grade 0 (P = .022), and lower preoperative HOS-ADL score (P < .001) were associated with successfully achieving the MCID for the HOS-ADL. Younger age (P < .001), larger medial joint space width (P = .028), and higher preoperative HOS-ADL score (P < .001) were associated with achieving the PASS for the HOS-ADL. Younger age (P < .001), lower body mass index (P = .006), non–workers’ compensation status (P = .020), and lower preoperative HOS-SSS score (P < .001) were associated with achieving the MCID for the HOS-SSS. Younger age (P = .001), Tönnis grade 0 (P = .014), running (P = .008), and higher preoperative HOS-SSS score (P < .001) were associated with achieving the PASS for the HOS-SSS. Overall, 49.4% of patients achieved all 4 clinically significant outcomes: both the MCID and PASS for the HOS-ADL and HOS-SSS. Conclusion: The majority of patients undergoing hip arthroscopic surgery with routine capsular closure for FAI experienced clinically significant outcomes that met the MCID or PASS criteria, with low rates of revision and conversion to total hip arthroplasty. Factors associated with these successful outcomes on multivariate analyses included younger age with a normal joint space. Patients with lower preoperative HOS scores were more likely to achieve the MCID, whereas patients with higher preoperative HOS scores were more likely to achieve the PASS.

Background: There is a paucity of literature evaluating patient outcomes in patients undergoing revision labral repair and labral reconstruction. Purpose: To compare outcomes in patients undergoing revision hip arthroscopy for treatment of labral tears by labral repair or labral reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. An a priori power analysis determined that a total of 62 patients were required. Patients undergoing revision hip arthroscopy for labral tears with completed 2-year outcome scores were included. Patients undergoing primary hip arthroscopy, labral debridement, concomitant gluteal repair, and patients with hip dysplasia (lateral center-edge angle <20°) were excluded. Patients were grouped into revision labral repair and labral reconstruction groups. Patient demographics and patient-reported outcomes (PROs) including Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, visual analog scale for pain and satisfaction, and achievement of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were analyzed. Results: A total of 40 patients underwent revision labral repair and 55 patients underwent labral reconstruction. Patients undergoing revision labral repair were younger (mean age, 30.0 ± 10.7 years vs 34.4 ± 9.7 years; P = .048), had lower rates of labral degeneration (25.0% vs 62.7%; P = .004), and had lower rates of severe complexity of tears (21.1% vs 66.0%; P = .003). However, the labral repair group had higher rates of articular cartilage damage (62.5% vs 33.3%; P = .009). There were no differences in any preoperative or 2-year postoperative PROs. Furthermore, no differences were seen in achievement of MCID or PASS in any PRO. Conclusion: In this multicenter study on revision hip arthroscopy, patients undergoing revision labral repair were younger and had better labral characteristics but greater cartilage damage compared with patients undergoing labral reconstructions. Despite these differences, patients who underwent labral repair reported similar outcomes to those undergoing labral reconstruction.

Background: Labral augmentation has emerged as an essential procedure to address a deficient or irreparable labrum while preserving native labral tissue and restoring the hip suction seal mechanism. Purpose: To evaluate midterm outcomes of arthroscopic hip labral augmentation for labral insufficiency after previous hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Patients were identified from a prospectively collected database who underwent arthroscopic hip labral augmentation between January 2011 and January 2017 with a minimum 3-year follow-up. Pre- and postoperative patient-reported outcome scores were compared and included the 12-Item Short Form Health Survey physical and mental component summaries, Western Ontario and McMaster Universities Osteoarthritis Index, modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport). Postoperative Tegner Activity Scale and patient satisfaction (1-10) scores were also evaluated. The minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) between the preoperative and minimum 3-year follow-up scores were calculated. Results: A total of 88 patients (39 men, 49 women) underwent revision hip arthroscopy with labral augmentation. The average age was 32.8 ± 11 years. Of these, 77 patients (88%) were available for the minimum 3-year follow-up. The survivorship (absence of conversion to total hip arthroplasty) at 3 years and 5 years was 93% at both time points, with a mean survival time of 8.5 years (95% CI, 8.0-8.9). Eleven patients (14%) required revision arthroscopic surgery for continued pain. Revisions occurred at a mean of 2.6 ± 1.4 years after augmentation. The mean follow-up was 5.2 ± 1.2 years (range, 3-9 years). For patients not requiring subsequent surgery (n = 61), all patient-reported outcome measures significantly improved, which included a 20-point increase in HOS-ADL (MCID, 82%; PASS, 72%) and mHHS (MCID, 78%; PASS, 70%). The median postoperative Tegner score was 4 (range, 1-10). The median postoperative patient satisfaction score was 9 out of 10 (range, 1-10). Conclusion: Arthroscopic hip labral augmentation is a successful treatment option for patients with labral insufficiency after previous hip arthroscopy, demonstrating improved patient-reported outcomes and survivorship of 93% at 3 years and 5 years. This technique provides a valuable labral preservation option when addressing hip labral pathology when viable native labral tissue remains.

Background: Data on mid-term outcomes in patients with borderline hip dysplasia (BHD) based on sex differences following hip arthroscopy are scarce. Purpose: To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. Study Design: Case-Control study; Level of evidence, 2. Methods: Data were prospectively collected and retrospectively reviewed for all BHD patients, lateral center-edge angle (LCEA) between 18°-25°, who underwent primary hip arthroscopy between October 2008 and July 2018. BHD patients baseline and minimum 5-year follow-up PROMs scores were included. Exclusion criteria were: LCEA &amp;lt; 18º or &amp;gt;25º, previous ipsilateral hip surgery or conditions, or Tönnis grade &amp;gt;1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as non-conversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1:1 ratio based on age, body mass index (BMI), and Tönnis grade. Results: Propensity-score matching created a cohort of 152 hips (76 males and 76 females). Males and females were similar for age (years), 33.63 ± 13.49 vs. 32.01 ± 13.39 (P = 0.491); BMI 26.62 ± 4.56 vs. 26.02 ± 5.01 (P = 0.346); and LCEA 22.61º ± 1.91 vs. 22.16º ± 2, (P = 0.387). Significant and comparable improvement in all PROMs at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI; however, it was significantly higher for females for the MCID for the mHHS (86.8% vs. 69.7%, P = 0.0105), MCID for the NAHS (88.2% vs. 61.8%, P = 0.0002), MCID for the VAS for pain (84.2%vs. 64.5%, P = 0.005), PASS for the mHHS (90.8% vs. 78.9%, P = 0.041), and MOI for the NAHS (77.6% vs. 55.3%, P = 0.0057). Survivorship for males (94.74%) and females (89.47%) was similar (P = 0.229). Conclusion: At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent hip arthroscopy demonstrated significant and comparable PROMs and survivorship. Clinical benefit was significantly higher in females, demonstrated by higher achievement rates for the MCID, PASS, and MOI.