The 2024 international society for hip preservation physiotherapy agreement on post-operative rehabilitation following hip arthroscopy for femoroacetabular impingement syndrome

IntroductionHip arthroscopy (HA) is a well-accepted, effective treatment intervention for symptomatic femoroacetabular impingement syndrome (FAIS). Post-operative physiotherapy (PT) is crucial for achievement of optimal outcomes; however, no well-accepted post-operative protocol exists for use following HA for symptomatic FAIS.MethodsMembers of the International Society for Hip Preservation (ISHA) with an expertise in rehabilitation following HA participated in this modified-Delphi study. In the first round of the Delphi process, two senior authors presented proposed post-operative phases and goals based upon the guidelines set forth in the 2019 ISHA PT agreement on assessment and treatment of FAIS. The panelists agreed on the proposed post-operative phases and were given the opportunity to present a comprehensive list of interventions for each phase and rehabilitation domain for potential consideration, which were compiled by two senior authors. Utilizing the Grading of Recommendations, Assessment, Development, and evaluation (GRADE) scale, the panelist graded each proposed treatment intervention. Consensus was achieved for 100% of the items included in the guidelines by the second survey round. Following physiotherapist consensus, the identified group of surgeons reviewed and approved the guidelines.ResultsThe panel consisted of 10 physiotherapists and 8 surgeons representing 5 countries. All 10 (100%) physiotherapists who were deemed experts in the rehabilitation of HA for symptomatic FAIS participated in each survey round and provided feedback on each item utilizing the GRADE scale. All 8 (100%) of surgeons specializing in hip preservation approved the guidelines.DiscussionRestoration of pain-free range of motion (ROM), increased strength of the lumbopelvic musculature, and normalization of lower extremity (LE) neuromuscular (NM) control are common rehabilitation goals following HA. The panelists recommend a six-phase rehabilitation progression with time and milestone-based progression to ensure ensure appropriate lumbopelvic and lower extremity neuromuscular control during all recreational and sport specific tasks.ConclusionThis consensus statement presents a six-phase rehabilitation progression for use in individuals following HA for symptomatic FAIS. These expert-driven guidelines will help reduce practice variation and standardize post-operative timelines.

Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Systematic review; Level of evidence, 4. The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.

Background: Prior studies show adolescent patients achieve more favorable outcomes after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared to adult patients at short-term and mid-term follow-up, yet limited studies compare these groups at minimum 10-year follow-up. Purpose: To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship between adolescent and adult patients after HA for FAIS at minimum 10-year follow-up. Study Design: Cohort, Level of Evidence III. Methods: Retrospective evaluation of prospectively collected data was performed on patients who underwent primary contemporary HA for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, between January 2012 and November 2013 with minimum 10-year follow-up. Adolescent patients (age 10-19 years) were propensity matched 1:1 to adult patients (age ≥20 years) controlling for sex, body mass index (BMI), Tönnis grade, pain duration, activity status, and back pain. PROs were collected preoperatively and at 10-year follow-up, including Hip Outcome Score Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), Visual Analog Scale for Pain (VAS Pain) and VAS Satisfaction (VAS Sat). Cohort-specific minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) were calculated and compared between groups. Reoperation-free survivorship was compared. Results: Fifty adolescent patients (age 17.0±1.7 years) were matched to 50 adult patients (33.0±9.3 years) with follow-up duration 10.4±0.4 years. No differences in preoperative PROs were shown. Adolescents achieved greater 10-year HOS-ADL, HOS-SS, mHHS, iHOT-12, VAS Pain, and Satisfaction scores compared to adults (P&amp;lt;0.05 for all). Adolescents showed superior PASS (98% vs. 79%, P=0.015) and SCB (88% vs. 67%, P=0.035) achievement for any PRO. No differences in THA-free survivorship (100% vs. 94%, P=0.083) or revision-free survivorship were shown (90% vs. 94%, P=0.473). Conclusion: Adolescent patients treated with contemporary HA for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, showed superior 10-year PROs and achievement of PASS and SCB compared to a propensity-matched group of adult patients, despite comparable short-term and mid-term PROs. Keywords: Adolescents, Hip Arthroscopy, Long-Term Follow-Up

The aim of this study was to compare outcomes between anteverting proximal femoral osteotomy (APFO) and anteverting periacetabular osteotomy (APAO) for femoroacetabular impingement syndrome (FAIS) due to combined acetabular retroversion (ARV) and femoral retrotorsion (FRT). We also compared these outcomes with hip arthroscopy (HA) for FAIS without ARV or FRT. Twelve patients with ARV and FRT underwent either APAO (six) or APFO (six) at two centres. A control group of 24 patients underwent HA for FAIS without version abnormality. Outcome measures included various hip scores, time to radiological bony union, complications, and conversion to hip arthroplasty. At the 2-year follow-up, no AFPO or APAO hips required arthroplasty. Patient-reported outcome scores showed no significant difference between the APAO and APFO groups: Non-Arthritic Hips Scores (NAHS) (APAO: median 72, range 52–78; APFO: 76, 52–80, P = .76), International Hip Outcome Tool 12 (iHOT-12) (APAO: 64, 48–70 vs. APFO: 55, 46–72, P = .57), EuroQol 5 Dimension Visual Analogue Scale (APAO: 72, 57–78 vs. APFO: 75, 49–80 P = .78), and University of California Los Angeles Score (APAO: 7, 4–8 vs. APFO: 6, 4–9 P = .43). APAO patients achieved radiological union faster (10.2 weeks: 6.6–19.3 vs. 19.2 weeks: 12–23, P = .05). Aside from metalwork removal, one AFPO patient required revision intramedullary nail to induce union. Compared to AFPO or APAO, HA patients (NAHS: 86.7, 72.1–94.1; iHOT-12: 73.1, 63.2–88.1) had better outcome scores (P < .05). Both APFO and APAO can achieve good outcomes and short-term survivorship for combined ARV and FRT, although function may be inferior to HA in patients without rotational abnormalities.

Background: Previous studies have identified predictors of total hip arthroplasty (THA) conversion after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) at short- to midterm follow-up, yet no studies to the authors’ knowledge have established a scoring system for predicting THA conversion at a minimum 10-year follow-up. Purpose: To create a scoring system to predict 10-year THA conversion after contemporary HA for FAIS. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected from patients undergoing primary contemporary HA for FAIS, including labral repair, osteoplasty of FAIS deformity, and capsular repair, between January 2012 and October 2013, with a minimum 10-year follow-up. Patients who underwent THA conversion were compared with patients who achieved 10-year THA-free survivorship. Significant predictors of THA conversion were identified, and predictor weights were assigned to create the THA-10 score. The score was applied to the cohort, and its clinical utility was evaluated. The threshold score with the greatest sensitivity and specificity for predicting 10-year THA conversion was identified. Results: In total, 280 patients were included; 21 (7.5%) underwent THA conversion by the 10-year follow-up. Patients who underwent THA conversion were of older age (45.4 ± 11.3 vs 33.2 ± 12.1 years; P < .001), had a greater body mass index (28.0 ± 5.2 vs 24.8 ± 4.7 kg/m2; P = .011), and had a greater prevalence of Tönnis grade 1 osteoarthritis (42.9% vs 14.3%; P = .003) and high-grade acetabular (61.9% vs 12.7%; P < .001) and femoral head (33.3% vs 7.3%; P < .001) chondral defects compared with THA-free survivors. After variable weighting, the THA-10 score was established as 1 point for body mass index ≥25 kg/m2, 1 point for Tönnis grade 1, 2 points for age ≥47 years, and 3 points for high-grade defects of the acetabulum or femoral head. The THA-10 score was found to have clinically significant diagnostic value with an area under the receiver operating characteristic curve of 0.823. Patients scoring ≥4 points were 13.2 times more likely to undergo THA conversion (95% CI, 5.0-35.1; P < .001). Conclusion: This study created the THA-10 score and showed it to have clinically significant diagnostic utility in predicting 10-year THA conversion after HA for FAIS. Patients scoring ≥4 points were 13.2 times more likely to undergo THA conversion.

Background: Single-leg squat lower extremity kinematics improve after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and these changes are associated with patient reported outcomes at 6-months and 1-year after surgery. However, little is known about how joint moments change after surgery for FAIS. The purpose of this study was to report lower extremity joint moment changes during a single-leg squat within the 1st year after hip arthroscopy for FAIS. Methods: Fifteen people diagnosed with FAIS scheduled for hip arthroscopy underwent three-dimensional motion capture testing before and 6-months to 1-year after hip arthroscopy. All participants performed three-trials of a single-leg squat (SLS) task using an established motion capture testing workflow. The sagittal plane internal ankle, knee, and hip, and frontal and transverse plane hip moments were extracted at peak knee flexion during the SLS. All joint moments were normalized to body mass in kilograms (Nm·kg-1). Paired samples t-tests were used to evaluate changes in lower extremity joint moments before and after surgery. An alpha level of 0.05 was applied to indicate statistical significance and all statistical analysis was performed using SPSS version 29. Results: After hip arthroscopy, sagittal plane internal knee (Pre: -0.39 ± 0.19 vs. Post: -0.43 ± 0.25, p = 0.01) and ankle joint moments (Pre: -0.67 ± 0.28 vs. Post: -0.79 ± 0.27, p = 0.04) significantly increase during a SLS task. No changes in hip moments were found when comparing the preoperative to postoperative time point in these patients. Discussion: Knee extension and ankle plantarflexion moments during a SLS task increase within 6-months to 1-year after hip arthroscopy for FAIS, despite no changes in hip moments being found. Following hip arthroscopy for FAIS, SLS squat depth increases, as do hip and knee kinematics. This may indicate that squat depth increases by using a more knee dominant strategy.

BackgroundMasters athletes (MAs), defined as those aged 35 and older actively participating in sports, have demonstrated superior short-term outcomes and reoperation-free survivorship after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared to non-athletic counterparts; however, their mid- and long-term outcomes remain unclear.Hypothesis/PurposeTo evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship at long-term follow-up following primary HA for FAIS in MAs in comparison to a propensity-matched non-masters athletes (NMAs) control group, defined as those aged 35 and older who denied weekly sports activity. We hypothesized MAs would demonstrate superior PROs, CSO achievement, and reoperation-free survivorship compared to NMAs.Study DesignCohort, Level of Evidence III.MethodsPatients with minimum weekly preoperative sports participation over the age of 35 who underwent HA for FAIS between 1/2012-10/2014 with long-term follow-up were propensity-matched 1:1 to patients who denied weekly preoperative sports participation over the age of 35 controlling for age, sex, and body mass index (BMI). PROs collected preoperatively and at 2-, 5-, and 10-year follow-up timepoints included Hip Outcome Score-Activities of Daily Living and Sports Subscale (HOS-ADL/HOS-SS), 12-item International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and Visual Analog Scale (VAS) for Pain and Satisfaction. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were compared. Survivorship was compared with Kaplan-Meier analysis.ResultsIn total, 70 MAs were matched to 70 NMAs. Demographics were similar between MAs and NMAs, including age (44.89±7.7 vs. 45.77±6.9 years, P=0.473), sex (60.0% vs. 58.6% female, P=0.496), and BMI (26.19±4.9 vs. 26.79±4.4 kg/m2, P=0.444). Average follow-up duration was 10.32±0.3 years. Preoperative PROs were similar between groups (P≥0.114). MAs demonstrated superior 2-year HOS-ADL and iHOT-12 scores (P≤0.049). By 5-year follow-up with durability to 10-year follow-up, PROs were similar between groups (P≥0.065). Both groups demonstrated similar MCID and PASS achievement for all PROs (P≥0.111). Both groups demonstrated similar time-dependent reoperation-free survivorship (P=0.6).ConclusionsMAs undergoing primary HA for FAIS achieve comparable PROs, CSOs, and reoperation-free time-dependent survivorship to NMAs at long-term follow-up.Key TermsMasters Athletes, Hip Arthroscopy, Femoroacetabular Impingement Syndrome, Long-term Outcomes

Background: No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. Study Design: Systematic review and meta-analysis. Methods: Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. Results: Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. Conclusion: The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.

Introduction: Hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has been demonstrated to improve outcomes but carries inherent risks of complications and the need for revision arthroscopy or conversion to total hip arthroplasty (THA). The objective of this study is to evaluate preoperative radiographs, patient outcomes, and risk factors for reoperation in patients undergoing HA for FAIS. Methods: A retrospective review of 351 consecutive patients undergoing HA for FAIS from July 2015 to June 2018 was conducted. The primary endpoints were revision hip arthroscopy (RHA) and THA. Univariate and multivariate analysis was performed to evaluate the risk factors for these endpoints. Results: By the end of the study period, 21 (6.0%) patients had undergone an RHA and 27 (7.7%) patients had undergone a THA. When comparing patients who had an RHA to those that did not, there were significant differences in preoperative radiographic characteristics, including smaller sourcil angle (P = 0.012) and lower Tönnis grade (P = 0.038) between groups. These patients were also more likely to have had a postoperative injection in the 1st year (P &lt; 0.001). No factor was independently predictive of revision HA in multivariate analysis. Patients who underwent a subsequent THA were significantly older (P &lt; 0.001) and required more suture anchors for repair (P &lt; 0.001) than those that did not. On preoperative radiographs, Tönnis grade (P = 0.43) skewed higher. The multivariate regression models generated area under the curve of 0.740 and 0.864 for RHA and THA, respectively, indicating acceptable to strong predictive performance. Conclusion: Individual preoperative patient characteristics and radiographic findings are of limited value in assessing risk for RHA or THA after HA for FAIS. However, predictive models incorporating demographic and radiographic findings hold promise for identifying patients at risk for these outcomes. Further study is needed to refine models and assess their value in preoperative patient selection and counseling.

Background: The purpose of this study was to explore the impact of social deprivation on preoperative characteristics and postoperative outcomes following hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary HA for FAIS were identified and their social deprivation index (SDI) score was assigned based on provided zip code. Quartiles (Q1-Q4) were established using national percentiles, with Q4 representing areas of greatest deprivation. Patient-reported outcomes (PROs) were collected preoperatively and at minimum 2-year follow-up. Clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB), were determined. Incidence of revision HA and conversion to total hip arthroplasty (THA) were recorded. SDI quartiles were compared for preoperative characteristics, PROs, CSO achievement, and reoperations. Predictors of achievement for MCID, PASS, SCB, THA conversion, and revision HA were identified with multivariable logistic regressions. Results: In total, 2060 hips were included with the following SDI distribution: Q1=955, Q2=580, Q3=281, Q4=244. More socially deprived patients presented at later ages, with higher BMIs, a longer preoperative pain duration, and greater joint degeneration (p≤0.035). The most socially deprived groups were comprised of more African American and Hispanic individuals, with less participation in physical activity, and a greater prevalence of smoking, lower back pain, and Workers’ Compensation (WC) status (p≤0.018). PRO scores and achievement of PASS and SCB were worse in those from areas of greater social deprivation (p≤0.017). Age, BMI, activity status, race/ethnicity, SDI quartile, WC, back pain, preoperative pain duration, and Tönnis grade were independent predictors of CSO achievement, revision arthroscopy, and/or THA conversion (p≤0.049). Conclusions: In patients undergoing HA for FAIS, social deprivation is associated with worse overall health, greater duration of preoperative hip pain, increased joint degeneration, and inferior clinical outcomes; however, patients may see clinical improvement regardless of social deprivation. Study Design: Cohort study; Level of evidence, III

Background: Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly growing field in sports surgery; however, factors associated with poor outcomes and identification of predictor models of inferior clinical outcomes is unclear. Purpose: To analyze predictors of clinical failure and inferior clinical outcomes among patients undergoing hip arthroscopy for treatment of FAIS. Study Design: Case-control study; Level of evidence, 3. Methods: Data were collected and analyzed from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS from a single fellowship-trained surgeon between January 2012 and November 2015. Baseline data, postoperative patient-reported outcomes, and rates of clinical failure and inferior clinical outcomes were recorded at 2 years postoperatively. Clinical failure was defined by revision hip arthroscopy or conversion to total hip arthroplasty. Inferior clinical outcome was defined as not reaching the minimal clinically important difference (MCID) or patient acceptable symptomatic state for Hip Outcome Score–Activities of Daily Living. A multivariate logistic regression analysis was used to identify significant predictors of clinical failure and inferior clinical outcome. Results: Out of 1161 eligible patients, 935 (80.5%) completed 2-year postoperative patient-reported outcomes. The mean ± SD age and body mass index were 33.3 ± 12.3 years and 25.4 ± 8.2 kg/m2, respectively. The overall clinical failure rate was 3.6% (n = 34), including 23 cases (2.5%) of revision hip arthroscopy and 11 cases (1.2%) of conversion to total hip arthroplasty. Predictors of clinical failure were lower preoperative International Hip Outcome Tool score (P = .016), chronic preoperative pain (P = .001), and chondromalacia in the affected hip (P = .04). The inferior clinical outcome group, consisting of those who failed to reach the MCID for Hip Outcome Score–Activities of Daily Living, included 256 patients (27.4%). Predictors of inferior clinical outcomes were Tönnis grade >1 (P = .01), workers’ compensation (P < .001), and increased body mass index (P = .02). Conclusion: This study demonstrates that 73% of all patients treated for symptomatic FAIS with primary hip arthroscopy and routine capsular closure achieved the MCID. Clinical failure is predicted by a number of modifiable and nonmodifiable factors, including chronic preoperative pain and presence of chondromalacia. The current study updates the midterm failure rates and outcomes achievable with hip arthroscopy for FAIS.

BackgroundHip-spine syndrome (HSS), characterized by lumbosacral pathology contributing to hip symptoms, is increasingly recognized, but outcomes after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in these patients remain limited. This study compared 10-year outcomes following HA between patients with and without HSS.MethodsA retrospective analysis of a prospective database was conducted for patients who underwent HA for FAIS with minimum 10-year follow-up. HSS was defined as preoperative lumbar spinal disease confirmed by imaging or prior surgery. Patients with HSS were propensity-matched 1:2 to controls based on age, sex, BMI, and preoperative modified Harris Hip Score (mHHS). Patient-reported outcomes (PROs), including mHHS and Non-Arthritic Hip Score (NAHS), were collected. Ten-year PROs and rates of achieving minimal clinically important difference (MCID) were compared.ResultsTwenty-eight patients with HSS (mean age 44.4) were matched to 56 controls (mean age 41.6). Baseline characteristics were similar between groups (all p>0.05). Both groups showed significant improvement in mHHS and NAHS at 10 years. However, the HSS group had significantly lower final mHHS (75.4 vs 89.9, p=0.006) and NAHS (72.0 vs 88.1, p=0.009) scores. Improvement in mHHS was significantly lower in the HSS group (24.5 vs 36.7, p=0.036), while change in NAHS was similar (p=0.104). A smaller proportion of HSS patients achieved MCID for mHHS (76% vs 96.1%, p=0.012) and NAHS (76% vs 94.2%, p=0.051). The HSS group had a higher, but not statistically significant, conversion rate to total hip arthroplasty (THA) (10.3% vs 3.4%, p=0.327). Revision arthroscopy rates were similar (p=1.0).ConclusionAt 10-year follow-up, patients with HSS demonstrated significant functional improvements after HA for FAIS, though outcomes were inferior to controls in terms of PRO scores and MCID achievement. HSS was associated with a higher, but non-significant, risk of THA conversion. Presence of lumbar spine pathology should not be considered a contraindication to HA, but patients should be counseled appropriately regarding expected outcomes.

(1) To compare the pre- and postoperative driving performance in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); (2) to examine the differences in driving performance between patients with versus without capsular repair. Patients who underwent arthroscopic hip surgery for FAIS were included. Driving performance of participating patients was collected using a driving simulator preoperatively and at 2 weeks, 4-6 weeks and 8-12 weeks postoperatively. Data collected included demographics, surgery laterality, intraoperative procedures, left and right turn reaction time, total turn reaction time, gas off time (GOF), and break reaction time (BRT). Repeated measures analysis of variance (ANOVA) was used for statistical analysis. 21 subjects (9 males, 12 females) with a mean age of 30 ± 9 years were included and 57.1% of the subjects had right-sided surgery. There was no difference between the mean preoperative and the 2-week postoperative left (0.72 seconds and 0.75 seconds, respectively) right (0.77 seconds and 0.75 seconds, respectively), and total (0.74 seconds and 0.75 seconds, respectively) turn reaction times as well as GOF (0.62 seconds and 0.60 seconds, respectively) and BRT (0.92 seconds and 0.93 seconds, respectively), indicating that the patients' driving performance returned to the preoperative level as early as 2 weeks following hip arthroscopy for FAIS. There was no significant difference amongst any of the driving variables between patients who underwent capsular repair (50%) and those who did not. There was no significant difference amongst any of the driving variable s between patients who underwent left versus right hip arthroscopy. Patients' driving performance returns to the preoperative level as early as 2 weeks after hip arthroscopy for FAIS. Surgery laterality nor capsular repair make any significant difference in the time for driving abilities to return to baseline. The impact of intraoperative procedures performed, and the analgesic medications used postoperatively on the driving ability of patients undergoing hip arthroscopy warrants further investigation in larger patient populations.

Purpose: To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary and revision HA for FAIS with complete 6-month, 1-year, and 2-year Hip Outcome Score - Activities of Daily Living (HOS-ADL) and Sport Subscale (HOS-SS) were identified. Revision patients were propensity matched 1:4 to primary HA patients, controlling for age, sex, and body mass index (BMI). Time to achievement of Minimal Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB) were compared alongside cumulative CSO achievement at 6, 12, and 24 months. Predictors of earlier CSO achievement were identified with multivariate Cox regressions. Results: Fifty revision HA patients were matched to 200 primary HA patients. There were no differences in age (30.1±11.6 years vs. 29.7±11.4, p=0.816), sex (86% female vs. 84%, p=0.830), or BMI (25.4±3.7 kg/m2 vs. 25.9±4.1, p=0.806) between groups. Primary HA demonstrated a greater prevalence of regular, preoperative physical activity (87% vs. 59%, p&amp;lt;0.001). Significantly more primary HA patients achieved MCID for HOS-ADL by 6 months (80.7% vs. 60.0%, p=0.005) and by 12 months (87.3% vs. 76.0%, p=0.047). Primary HA patients achieved SCB for HOS-SS quicker than revision HA (p=0.036). Preoperative PRO score predicted delayed achievement of CSOs (p ≤ 0.002), alongside age, BMI, activity level, and revision status (p ≤ 0.047). Conclusions: Primary HA patients showed greater achievement of MCID for HOS-ADL at 6 and 12 months and quicker achievement of SCB for HOS-SS compared to revision HA patients. Preoperative PRO score, increased age, greater BMI, infrequent physical activity, and revision HA predicted delayed achievement of CSOs. Level of Evidence: Level III, Cohort Study Keywords: Time to Outcomes, Hip Arthroscopy, Revisions

Background: Prior studies have compared clinical outcomes in sport-participators and non-participators. The time to achieve clinically significant outcomes (CSOs) after hip arthroscopy (HA) across these groups remains unappreciated. Additionally, the relationship between early-term patient-reported outcome scores (PROs) and return to sport (RTS) remains misunderstood. Purpose: To compare the time to achievement of CSOs in sport participators and non-participators following HA for femoroacetabular impingement syndrome (FAIS), to identify predictors of earlier CSO achievement, and to assess the relation between PROs and RTS. Methods: Patients undergoing HA for FAIS between 01/2012 to 12/2018 with 6-month, 1-year, and minimum 2-year completion of Hip Outcome Score-Activities of Daily Living/Sports Subscale (HOS-ADL/SS) were identified. Those that endorsed routine sport participation were propensity-matched to those who denied sport participation by age, sex, and body mass index (BMI). Achievement of CSOs, including minimal clinically important difference, patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) was determined. Time to achievement of CSOs was compared between groups using Kaplan-Meier survival analysis. Cumulative CSO achievement at various time points were determined and compared. Cox hazard regressions were performed to identify predictors of early CSO achievement. RTS within 2-years of surgery was recorded, and the PROs of those that returned were compared to those that did not. Results: One-hundred and nineteen sport participators were matched to 119 non-participators. Sport participators had higher SCB achievement for HOS-ADL at 6 months (47.3% vs. 30.6%, p=0.008), with otherwise comparable cumulative CSO achievement (p≥0.069, for all). Kaplan-Meier analysis demonstrated earlier PASS (p=0.023) and SCB (p=0.011) achievement for HOS-ADL in sport participators. Increased BMI, no prior sport participation, and higher pre-operative HOS-ADL score were significant predictors for delayed PASS and SCB achievement for HOS-ADL SCB (p≤0.030, for all). 82.2% of patients successfully RTS at 8.2±3.1 months post-operatively. Those that RTS had higher HOS-ADL scores at 6-months and 1-year (p≤0.004) and higher HOS-SS scores at 6-months, 1-year, and 2-years (p≤0.008). Conclusions: Sport participators who underwent HA for FAIS demonstrated quicker time to achievement of PASS and SCB for HOS-ADL compared to non-participators. RTS was 82.2%, which was associated with higher postoperative PROs. Level of Evidence: Cohort, Level III