Workers’ Compensation Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome Experience Worse Mid-Term Outcomes but Similar Return-to-Work: A Propensity-Matched Analysis at 5-Year Follow-Up

Abstract

To investigate mid-term patient-reported outcomes (PROs) and return-to-work for workers' compensation (WC) patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) versus propensity-matched, non-WC controls and to determine whether achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) differ between these populations. A retrospective cohort study was conducted on WC patients who underwent primary HA for FAIS from 2012 to 2017. WC and non-WC patients were propensity matched on a 1:4 basis by sex, age, and body mass index (BMI). PROs were compared preoperatively and at 5 years postoperatively, employing the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. MCID and PASS were calculated using published thresholds for these measures. Preoperative and postoperative radiographs and the presence and timing of return to unrestricted work were evaluated. Forty-three WC patients were successfully matched to 172 non-WC controls and followed for 64.2 ± 7.7 months. WC patients demonstrated lower preoperative scores for all measures (P≤.031) and worse HOS-ADL, HOS-SS, and VAS pain scores at 5-year follow-up (P ≤ .021). There were no differences in MCID achievement rates or magnitude of change between preoperative and 5-year postoperative PROs (P ≥ .093); however, WC patients achieved PASS at lower rates for HOS-ADL and HOS-SS (P ≤ .009). 76.7% of WC and 84.3% of non-WC patients returned to work without restrictions (P= .302) at 7.4 ± 4.4 versus 5.0 ± 3.8 months, respectively (P<.001). WC patients undergoing HA for FAIS report worse preoperative pain and function than non-WC patients and experience worse pain, function, and PASS achievement at 5-year follow-up. However, they demonstrate similar MCID achievement and magnitude improvement between preoperative and 5-year postoperative PROs, and return to work without restrictions at a similar rate to non-WC patients, although they may take longer to do so. Level III, retrospective cohort study.