For Femoroacetabular Impingement Syndrome Research Articles

Will you get what you want? Treatment goals and expectations of patients with femoroacetabular impingement syndrome regarding physiotherapist-led treatment.

OBJECTIVE: To (i) investigate the goals and expectations of participants enrolled in a clinical trial of physiotherapist-led treatment for femoroacetabular impingement (FAI) syndrome and (ii) explore associations between their expectations and self-reported hip burden and kinesiophobia. METHODS: Data from 150 participants with FAI syndrome who participated in a clinical trial were analysed. Participants described their most important treatment goal and the expectation of achieving this goal throughout physiotherapy treatment. The International Hip Outcome Tool (iHOT-33) subscales were used to assess self-reported hip burden. The Tampa Scale for Kinesiophobia was used to assess kinesiophobia. Participants goals were qualitatively analysed using content analysis. Linear regression was used to explore associations between patient expectations and iHOT and Tampa Scale for Kinesiophobia scores. RESULTS: Participants with FAI syndrome reported goals relating to exercise (52%), improving activities of daily living quality (23%), improving physical function (15%), and reducing pain (10%). Negative expectations regarding physiotherapist-led treatment were reported by 68% of participants. Those with negative expectations reported worse scores for the iHOT-Total score (mean difference = 12 points, 95%CI = [4 to 19]), and iHOT-Symptoms (14 points, [7 to 21]) and iHOT-Social (11 points, [2 to 21]) subscales compared to those with positive expectations. Treatment expectations were not associated with iHOT-Sport, iHOT-Job, and Tampa Scale for Kinesiophobia scores (p > 0.05). CONCLUSION: Patients with FAI syndrome had a generally negative expectation of physiotherapist-led treatment. There was a mismatch between patients' goals and current treatment approaches. Participants with FAI syndrome and negative expectations reported worse quality of life, symptoms, and social concerns than those with positive expectations.

Long-term Survivorship and Outcomes of Patients Without Dysplasia Undergoing Capsular Repair During Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

There is a paucity of literature evaluating long-term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS). To report 10-year survivorship and patient-reported outcomes (PROs) after primary hip arthroscopy with capsular repair for FAIS and evaluate the effect of capsular repair in patients at the highest risk for conversion to arthroplasty. Cohort study; Level of evidence, 3. Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with a minimum 10-year follow-up on the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale for pain (VAS) scores were selected. The preoperative and minimum 10-year follow-up Hip Outcome Score-Sports Specific Subscale (HOS-SSS) scores were also reported, if available. Patients with ipsilateral hip surgery, worker's compensation, Tönnis osteoarthritis grade >1, and hip dysplasia (lateral center-edge angle <25°) were excluded. Survivorship, PROS, and clinical benefit-minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS)-were reported. An additional propensity-matched subanalysis was performed on patients at the highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair to patients with unrepaired capsules. A total of 145 (n = 130 patients) out of 180 eligible hips (n = 165 patients) had a minimum 10-year follow-up (80.6%). Also, 126 hips (86.9%) belonged to women, and 19 hips (13.1%) belonged to men. The mean patient age was 30.3 ± 12.9 years. The survivorship rate was 91% at the 10-year follow-up. The cohort experienced significant improvements (P < .001) in the mHHS, NAHS, HOS-SSS, and VAS for pain scores. Moreover, the cohort achieved high rates of the PASS for the mHHS (89.8%), high rates of the MCID for the mHHS (82.4%), and high rates of the MCID for VAS for pain (80.6%) scores. In the propensity-matched subanalysis performed on patients with the highest risk for arthroplasty, 29 hips with capsular repair were matched to 81 hips with unrepaired capsules. While both groups experienced significant improvements in all PROs (P < .05), the group without capsule repair trended toward a higher conversion to arthroplasty rate when compared with the repair group. In addition, an odds ratio was calculated for the likelihood of converting to arthroplasty after having an unrepaired capsule compared with capsular repair (2.54 [95% CI, 0.873-7.37]; P = .087). Patients undergoing primary hip arthroscopy with capsular repair experienced a high survivorship rate of 91% at a minimum 10-year follow-up. Patients who did not convert to arthroplasty saw favorable improvements in PROs and achieved high clinical benefit rates. In addition, among those patients at the highest risk for conversion to arthroplasty, a trend toward greater survivorship was observed with capsular repair.

Diagnostic Capability of Intra-Articular Injections for Femoroacetabular Impingement Syndrome: A Systematic Review.

To review and critically appraise available literature concerning the diagnostic capability of intra-articular injections for femoroacetabular impingement (FAI) syndrome. Systematic review. N/A. N/A. N/A. Studies assessing pain relief following intra-articular injections for the diagnosis of FAI syndrome, compared with arthroscopy as diagnostic reference standard, were considered eligible. Searches were performed across 8 databases, and the risk of bias was evaluated through the Quality Assessment of Diagnostic Accuracy Studies tool. From 489 articles identified, 4 were included for analysis. Intra-articular injections were composed of anesthetic agents (such as lidocaine, bupivacaine, and ropivacaine), combined or not with corticosteroids (triamcinolone and betamethasone). All studies were judged as "at risk of bias", and a substantial heterogeneity was found considering assessment methods and pain relief thresholds for a positive response to intra-articular injections. Overall, 2 studies reported that intra-articular injections presented a high accuracy in determining the presence of FAI syndrome. However, the remaining 2 studies indicated that intra-articular injections might present restricted diagnostic capability to discriminate FAI syndrome from healthy individuals or those with other hip pathologies. Based on limited evidence, the diagnostic capability of intra-articular injections for FAI syndrome cannot be supported. It remains unclear which pain relief thresholds are related to a higher diagnostic capability. The combination of anesthetics with corticosteroids should also be further explored, including multiple pain assessments for evaluation of prolonged effects.

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

PurposeTo 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 propensity-matched borderline hip dysplasia (BHD) patients at minimum 5-year follow-up. MethodsPatients with BHD, characterized by a lateral center-edge angle 18°-25°, who underwent HA for FAIS with capsular repair by a single surgeon between 01/2012-06/2018 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). A 1:2 ratio was chosen to maximize the number of included patients. 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 analysis. ResultsThirty-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). ConclusionPropensity-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 EvidenceLevel III, Retrospective Comparative Case Series

Hip Arthroscopy Patients With Lower Back Pain Show Delayed Clinical Improvement and Inferior Time-Dependent Survivorship: A Propensity Matched Study at Mid-Term Follow-Up

PurposeTo evaluate patient-reported outcomes (PROs) and survivorship at mid-term follow-up after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with and without preoperative lower back pain (LBP). MethodsPatients with self-endorsed preoperative LBP who underwent HA for FAIS with mid-term follow-up were identified and propensity matched 1:1 to patients without back pain by age, sex, and body mass index. PROs collected preoperatively and at postoperative years 1, 2, and 5 included: Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), International Hip Outcome Score 12 (iHOT-12), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for Pain. Achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared. Survivorship was compared with Kaplan-Meier analysis. Results119 patients with LBP were matched to 119 patients without LBP. Group demographic factors were as follows, age (37.4±11.9 years vs 37.6±12.6, p=0.880), sex (64.4% female vs 67.7%, p=0.796), and BMI (25.3±5.1 kg/m2 vs 25.3±5.4, p=0.930). Average follow-up duration was 6.0 ± 1.9 years. LBP patients showed similar preoperative PROs, yet lower 1-year scores for all PROs (p ≤ 0.044). At final follow-up, similar PROs were shown between groups (p ≥ 0.196). LBP and non-LBP patients had similar MCID achievement for HOS-ADL (59.3%vs.63.1%,p=0.640), HOS-SS (73.9%vs.70.8%,p=0.710), mHHS (66.7%vs.73.4%, p=-.544), iHOT-12 (85.1%vs.79.4%,p=0.500), and VAS-Pain (75.6%vs.69.9%,p=0.490). Groups also had similar PASS achievement for HOS-ADL (63.5%vs.61.3%,p=0.777), HOS-SS (57.0%vs.62.5%,p=0.461), mHHS (81.9%vs.79.1%, p=0.692), iHOT-12 (54.6%vs.61.2%,p=0.570), and VAS-Pain (51.0%vs.55.4%,p=0.570).with similar MCID (p ≥ 0.490) and PASS (p ≥ 0.386) achievement. Conversion to total hip arthroplasty occurred in 3.4% of hips with LBP and 0.8% of hips without LBP (p=0.370), Back pain patients demonstrated inferior time-dependent survivorship compared to patients without back pain on Kaplan-Meier survival analysis (p = 0.023). ConclusionsPatients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with LBP achieve comparable PROs and CSOs to patients without back pain at mid-term, despite lower 1-year PRO scores. LBP patients show inferior reoperation-free time-dependent survivorship compared to those without LBP.

Six-Month Outcomes Correlate With 10-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To identify whether 6-month outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) correlate with outcomes at minimum 10-year follow-up. Patients who underwent primary hip arthroscopy for FAIS from 2012 to 2013 were reviewed and included if they had 6-month and minimum 10-year follow-up. Patient-reported outcome (PRO) measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) subscale, Hip Outcome Score Sports-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction. We compared 6-month and 10-year outcome scores and analyzed the relations between 6-month and 1-, 2-, 5-, and 10-year outcome scores using Pearson correlation coefficients (r). Six-month scores and clinically significant outcome achievement were then compared with 10-year clinically significant outcome achievement and reoperations, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), using logistic regressions and the Fisher exact test. This study included 60 patients (60.0% female sex; mean age, 36.0 ± 12.2 years). The mHHS, VAS pain score, and VAS satisfaction score significantly improved from 6-month to 10-year follow-up (P ≤ .021), whereas the HOS-ADL and HOS-SS did not (P ≥ .072). There were significant correlations between 6-month and 10-year scores for the HOS-ADL (r= 0.505), HOS-SS (r= 0.592), and mHHS (r= 0.362) (P ≤ .022 for all), as well as significant correlations between 6-month and 1-, 2-, and 5-year scores (P ≤ .014 for all). The 6-month HOS-ADL, HOS-SS, and mHHS were all significantly associated with their respective 10-year achievement of the patient acceptable symptom state (PASS) (P ≤ .044). Furthermore, 6-month HOS-ADL and mHHS were significantly associated with THA conversion (P ≤ .041). Comparable 6-month and 10-year achievement of the minimal clinically important difference (96.5% vs 97.8%, P > .999) and PASS (85.2% vs 87.5%, P > .999) for any PRO was observed. After hip arthroscopy for FAIS, patients' 6-month HOS-ADL and mHHS were significantly associated with their 10-year PROs, PASS achievement, and THA conversion, although correlation strengths decreased with increasing time from surgery. Level IV, case series.

Patients with Borderline Hip Dysplasia Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Demonstrate Lower Outcome Scores but Comparable Survivorship to Non-Dysplastic Controls: A Propensity-Matched Study with Minimum 10-Year Follow-up

Background: Patients with borderline hip dysplasia (BHD) have demonstrated similar outcomes following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared to equivalent patients without dysplasia at short- and mid-term follow-up. However, outcomes in these groups have not yet been compared at long-term follow-up. Objectives: To compare long-term clinical outcomes following primary hip arthroscopy for FAIS between patients with BHD and non-dysplastic matched controls. Methods: A retrospective review was conducted of patients who underwent primary hip arthroscopy for FAIS from January 2012 through February 2013. Patients with BHD, defined as a lateral center edge angle (LCEA) between 18° and 25°, were propensity matched in a 1:3 ratio by sex, age, and body mass index (BMI) to non-dysplastic controls. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes (PROs) were collected preoperatively and 10 years postoperatively, and achievement rates of Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptom State (PASS) were calculated. PRO measures included 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. Gross survivorship was assessed using Kaplan-Meier curves. PROs, MCID and PASS achievement rates, and survivorship were compared between groups. Results: Twenty-eight patients with BHD (71.4% female; age: 30.8 ± 10.8 years, BMI: 24.2 ± 3.9 kg/m2) were matched to 84 controls (66.7% female, age: 34.4 ± 10.5 years, BMI: 24.9 ± 5.1 kg/m2; p ≥ 0.135). Mean follow-up was 10.3 ± 0.3 years. There were no significant differences between groups in any demographic characteristics, radiographic measurements, or intraoperative findings (p ≥ 0.096), except pre- and post-operative LCEA and Tönnis angle, which were lower and higher, respectively, among BHD patients (p &lt; 0.001). Both groups demonstrated significant improvement in all PROs between the preoperative and 10-year postoperative time points (p &lt; 0.001 for all). Preoperative, 10-year postoperative, and magnitude of change (delta) in PRO scores were similar between groups for all measures (p ≥ 0.072), except 10-year postoperative HOS-SS (BHD: 62.9 ± 31.9 vs. Controls: 80.1 ± 26.0, p = 0.030) and change in VAS Pain (BHD: -34.2 ± 27.2 vs. Controls: -48.5 ± 26.1, p = 0.047). Rates of MCID achievement were similar between groups for all PRO measures, but rates of PASS achievement were significantly lower among BHD patients for HOS-ADL (BHD: 39.1% vs. Controls: 77.4%, p = 0.002), HOS-SS (BHD: 45.5% vs. Controls: 84.7%, p = 0.001), and VAS Pain (BHD: 50.0% vs. Controls: 78.5%, p = 0.015). There was no difference in reoperation rate between groups (BHD: 14.3% vs. Controls: 17.9%, p = 0.778). Kaplan-Meier survival analysis demonstrated comparable gross survivorship at long-term follow-up (p = 0.645). Conclusions: Patients with BHD undergoing primary hip arthroscopy for FAIS demonstrated significantly lower sports-specific PRO scores than propensity-matched controls at 10-year follow-up, with a trend toward significantly worse scores for measures assessing activities of daily living, pain, and satisfaction. Rates of MCID achievement were similar between groups, but BHD patients demonstrated lower rates of PASS achievement for the majority of PRO measures. However, patients with BHD had similar long-term hip survivorship compared to controls, with no significant differences in rates of revision hip arthroscopy or conversion to total hip arthroplasty.

Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up

The purpose of the present study was to compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years. A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve. Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P= .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P= .999), orconversion to THA (age ≥40: 13.2%, age <40: 3.8%, P= .161) were identified. On Kaplan-Meier analysis, no significant difference (P=.321) was demonstrated in overall gross survivorship between cohorts. Patients with age≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts. Level III, retrospective comparative prognostic trial.

Hip Arthroscopic Surgery With Chondrolabral Refixation, Osteochondroplasty, and Routine Capsular Closure for Femoroacetabular Impingement Syndrome: Clinical Outcomes at a Minimum 10-Year Follow-up

Background: Hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) has proven to be an effective surgical intervention, with high rates of return to sport and work as well as favorable outcomes at short- and midterm follow-up. However, limited data exist on outcomes at long-term follow-up. Purpose: To evaluate patient-reported outcomes (PROs) at a minimum 10-year follow-up after primary hip arthroscopic surgery including labral repair, femoral osteochondroplasty, acetabular osteochondroplasty, and capsular closure for FAIS. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary hip arthroscopic surgery for FAIS between June 2012 and January 2013 were identified. PROs were collected preoperatively and at a minimum of 10 years postoperatively, including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Unique minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated, and their rates of achievement were analyzed. An alpha level of <.05 was used to determine statistical significance. Results: A total of 94 patients (55 female; mean age, 34.3 ± 12.4 years) were analyzed with a mean follow-up of 10.1 ± 0.3 years (range, 10.0-10.7 years). Patients demonstrated significant 10-year improvement across all PRO measures (P < .001). MCID and PASS thresholds were calculated as follows: HOS-ADL (10.4 and 85.3, respectively), HOS-SS (14.6 and 60.2, respectively), mHHS (8.8 and 76.0, respectively), VAS pain (14.6 and 27.5, respectively), and iHOT-12 (PASS: 71.4). The majority of patients achieved the MCID and PASS for each PRO measure: HOS-ADL (73.4% and 70.9%, respectively), HOS-SS (78.5% and 77.2%, respectively), mHHS (81.0% and 70.9%, respectively), VAS pain (88.6% and 70.9%, respectively), and iHOT-12 (PASS: 73.4%). Overall, 9 patients (9.6%) underwent subsequent revision hip arthroscopic surgery at a mean 4.9 ± 3.7 years (range, 1.1-10.1 years) postoperatively, and 6 patients (6.4%) underwent conversion to total hip arthroplasty at a mean 4.1 ± 3.1 years (range, 0.9-9.3 years) postoperatively. Conclusion: Patients who underwent primary hip arthroscopic surgery for FAIS utilizing contemporary methods of labral repair, acetabular and/or femoral osteochondroplasty, and capsular closure commonly experienced sustained clinical improvement and reported high levels of satisfaction at a minimum 10-year follow-up with low rates of reoperation.

Association of Postless Distraction in Hip Arthroscopy With Decreased Postoperative Groin Numbness

Background: Patients undergoing hip arthroscopy performed with perineal post distraction may experience postoperative nerve and soft tissue complications related to the perineal post. Purpose: To compare rates of postoperative numbness in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with postless distraction and perineal post distraction methods. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was performed on patients who underwent hip arthroscopy for FAIS, with postless distraction and perineal post distraction methods. Medical records were reviewed for patient characteristics, radiographic data, and operative data. Traction force data were collected on all patients prospectively using a previously validated method. Data on postoperative numbness (presence/absence and regionality) were collected prospectively at routine postoperative follow-ups (6-week and 3-month postoperative clinic visits). Results: Overall, 195 patients were included, with 94 patients (mean age, 30.4 years) in the postless distraction cohort and 101 patients (mean age, 31.9 years) in the post distraction cohort. The overall numbness rates were 29 of 94 (30.9%) in the postless distraction group and 45 of 101 (44.6%) in the post distraction group (P = .068). Rates of postoperative groin numbness were 1 of 94 (1.1%) in the postless distraction group and 19 of 101 (18.8%) in the post distraction group (P < .001). Multivariate analysis for postoperative groin numbness demonstrated post distraction (odds ratio [OR], 16.5; P = .022) and traction time (OR, 1.7; P = .020) to be statistically significant variables. In subgroup analysis of the post distraction group, traction time (P = .015), but not holding (P = .508) or maximum traction force (P = .665), reached statistical significance in patients who developed postoperative groin numbness. Conclusion: Postless distraction hip arthroscopy demonstrated a statistically significantly lower rate of groin numbness rates in comparison with a traditional perineal post distraction method. In the post distraction group, traction time was significantly higher in patients who developed postoperative groin numbness than in those who did not.

Borderline Hip Dysplasia Is Not Associated With Significant Differences in Hip Survivorship or Patient-Reported Outcomes Following Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Cohort Study

To compare hip survivorship and patient-reported outcomes after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with versus without comorbid borderline hip dysplasia (BHD) at 2-year follow-up. A retrospective matched-cohort study was conducted involving patients who underwent primary hip arthroscopy for FAIS with a single surgeon from 2010 to 2019. BHD was defined as lateral center edge angle (LCEA) of 20 to 25°. Subjects with BHD were matched 1:2 to controls without BHD on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Alpha angle, LCEA, Tönnis angle, and acetabular retroversion signs were measured on preoperative and/or postoperative hip radiographs. Patient-reported outcomes were assessed using the mHHS and the Non-Arthritic Hip Score. Hip survivorship, outcome scores, and achievement of the minimum clinically important difference were compared between groups using the Mann-Whitney U test or Fisher exact test, as appropriate. P values <.05 were considered significant. Thirty-one BHD subjects (mean age 36.8 years, 71.0% female) and 62controls (mean age 38.0 years, 71.0% female) were included. There were no significant intergroup differences in demographics or preoperative radiographic measurements besides LCEA and Tönnis angle (all P > .05). Intraoperatively, subjects with BHD were found to have significantly shorter labral tears (mean 2.6 vs 2.8 clock-face hours, P= .048), but there were no significant intergroup differences in acetabular or femoral cartilage status (all P > .05). Postoperatively, there were no significant intergroup differences in rates of revision arthroscopy (BHD 6.5% vs control 11.3%) or conversion to total hip arthroplasty (BHD 9.7% vs control 1.6%), in 2-year improvement of the mHHS and Non-Arthritic Hip Score, or in minimum clinically important difference achievement rates (all P > .05). BHD is notassociated with a significant difference in hip survivorship or patient-reported outcomes following primary hip arthroscopy for FAIS. Level III, retrospective comparative study.

A Smartphone App Shows Patients Return to Preoperative Gait Metrics 6 Weeks After Hip Arthroscopy, and Gait Metrics Have Low to Moderate Correlations With a Hip-Specific Patient-Reported Outcome Measure

The purpose of this study was to use a smartphone app to collect gait metrics in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and determine when gait metrics return to preoperative levels and if gait metrics correlate with postoperative hip-specific patient-reported outcomes. Patients undergoing primary hip arthroscopy for FAIS from August 2021 to December 2022 were prospectively enrolled. Patients downloaded the iPhone app, rHip, at ∼6 months postoperatively, enabling retroactive access to Apple Health data. Gait metrics included step count, step length, and walking speed. Each patient's preoperative baseline was compared to that individual's successive postoperative week metrics. All patients underwent a standard 4-stage rehabilitation protocol. We compared metrics from beginning to end of each phase (i.e., week 1 to 6 for phase 1) and evaluated correlations with patient outcomes. Fifty patients (40 women; age: 31.9 ± 14.5 years) were included. Patients had significantly reduced step count from postoperative weeks 1 to 5 and improved upon baseline at weeks 13 and 16 to 26. Patients had significantly reduced step length from postoperative weeks 1 to 4 and improved upon baseline at weeks 16 and 20. Patients had significantly lower walking speed from postoperative weeks 1 to 6 and improved upon baseline at week 20 (P < .05). Step count significantly improved over phase 1 rehabilitation (P < .05). Step length and walking speed significantly improved over each of phases 1 to 3 (P < .05 for all). Preoperatively, weak correlations were noted between step length and Patient-Reported Outcomes Measurement Information System (PROMIS) for Physical Function (PF)/Pain, as well as walking speed and Hip Outcome Score-Activities of Daily Living (HOS-ADL)/PROMIS-Pain. At 3 months, moderate correlations were noted between step count and HOS-ADL/12-item international Hip Outcome Tool (iHOT-12), step length and HOS-ADL/PROMIS-PF, and walking speed and HOS-ADL/iHOT-12/PROMIS-PF/PROMIS-Pain. At 6 months, weak to moderate correlations were noted between all 3 gait metrics and HOS-ADL. A smartphone app was capable of capturing health data gait metrics. Patients undergoing hip arthroscopy for FAIS returned to baseline levels in step count, step length, and walking speed after phase 1 (6 weeks) of rehabilitation. The most consistent correlations between gait metrics and step count were seen at 3 months, although only weakto moderate. Gait metrics similarly had weak to moderate correlations with HOS-ADL at 6 months. Level IV, case series.

Medicaid Insurance Is Associated With More Complications and Emergency Department Visits but Equivalent 5-Year Secondary Surgery Rate After Primary Hip Arthroscopy

To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year rate of secondary surgeries for patients with Medicaid vs commercial insurance undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and/or labral tears using a large national database. The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases, Tenth Revision diagnosis codes for FAIS and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Patients with Medicaid were matched 1:4 to a control group of commercially insured patients based on age, sex, body mass index, and Elixhauser Comorbidity Index. Rates of 90-day complications and 30-day ED visits were compared using multivariate regression models. Five-year rates of secondary surgeries-revision arthroscopy or total hip arthroplasty-were compared between cohorts by Kaplan-Meier analysis. A total of 2,033 Medicaid patients were matched with 8,056 commercially insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially insured patients to experience any 90-day complication (2.12% vs 1.43%; odds ratio [OR], 1.2; P= .02). Medicaid patients also experienced more 30-day ED visits than commercially insured patients (8.61% vs 4.28%), and on multivariate logistic regression, insurance status was the strongest determinant of 30-day ED visits (relative to commercial, Medicaid OR, 2.02; P < .001). Despite these differences, 5-year rates of secondary surgeries were comparable between groups (6.1% vs 6.0%; P= .6). In this large national database study, Medicaid patients undergoing primary hip arthroscopy showed significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to commercially insured patients. Nevertheless, both groups had similar survivorship rates at 5-year follow-up, similar to prior estimates irrespective of insurance. These results document encouraging secondary surgery rates in Medicaid patients.

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

To compare mid-term clinical outcomes between patients undergoing primary hip arthroscopy (HA) versus revision hip arthroscopy (RHA) for femoroacetabular impingement syndrome (FAIS). A retrospective cohort study was conducted on 1,862 patients who underwent hip arthroscopy for FAIS from January 2012 to April 2017. Patients who underwent RHA were propensity matched in a 1:4 ratio by age, sex, body mass index (BMI), and exercise status to patients who underwent primary HA. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes before and at 5 years after surgery, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction, were compared between groups. Minimally clinically important difference and patient-acceptable symptomatic state (PASS) achievement rates were compared using previously published thresholds. Fifty-one patients who underwent RHA (35 female, 16 male; age 36.2 ± 10.2 years; BMI 26.5 ± 5.9) were followed up for 63.9 ± 9.2 months and then propensity matched in a 1:4 ratio by sex, age, and BMI to 204 control patients who underwent primary HA. At midterm follow-up, patients in the RHA cohort had significantly lower scores for HOS-SS (RHA 64.9 ± 32.5 vs HA 75.3 ± 26.2, P= .044), mHHS (RHA 72.2 ± 22.4 vs HA 80.1 ± 18.1, P= .039), and iHOT-12 (RHA 61.4 ± 29.3 vs HA 71 ± 27.6, P= .043) compared to primary HA patients. Rates of achieving PASS were significantly decreased for HOS-SS (RHA 38.3% vs HA 55.4%, P= .039) and iHOT-12 (RHA 41.9% vs HA 59.9%, P= .035) in the RHA cohort. There were no significant differences in rates of conversion to THA or subsequent reoperation on the index hip between groups. Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients. Level III; retrospective comparative study.

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis.

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.

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

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 &gt; 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.

Five-Year Outcomes of Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Among Female Patients: Higher Body Mass Index Is Associated With Reduced Clinically Significant Outcomes

To evaluate the impact of age, body mass index (BMI), and symptom duration on 5-year clinical outcomes among females following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We conducted a retrospective review of a prospectively collected database of hip arthroscopy patients with a minimum 5-year follow-up. Patients were stratified by age (<30, 30-45, ≥45 years), BMI (<25.0, 25.0-29.9, ≥30.0), and preoperative symptom duration (<1 vs ≥1 year). Patient-reported outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Pre- to postoperative improvement in mHHS and NAHS was compared between groups using the Mann-Whitney U test or Kruskal-Wallis test. Hip survivorship rates and minimum clinically important difference (MCID) achievement rates were compared with Fisher exact test. Predictors of outcomes were identified using multivariable linear and logistic regression. P values <.05 were considered significant. In total, 103 patients were included in the analysis with a mean age of 42.0 ± 12.6 years (range, 16-75) and mean BMI of 24.9 ± 4.8 (range, 17.2-38.9). Most patients had symptoms of duration ≥1 year (60.2%). Six patients (5.8%) had arthroscopic revisions, and 2 patients (1.9%) converted to total hip arthroplasty by 5-year follow-up. Patients with BMI ≥30.0 had significantly lower postoperative mHHS (P= .03) and NAHS (P= .04) than those with BMI <25.0. Higher BMI was associated with reduced improvement in mHHS (β= -1.14, P= .02) and NAHS (β= -1.34, P < .001) and lower odds of achieving the mHHS MCID (odds ratio [OR]= 0.82, P= .02) and NAHS MCID (OR= 0.88, P= .04). Older age was predictive of reduced improvement in NAHS (β= -0.31, P= .046). Symptom duration ≥1 year was predictive of higher odds of achieving the NAHS MCID (OR= 3.98, P= .02). Female patients across a wide range of ages, BMIs, and symptom durations experience satisfactory 5-year outcomes following primary hip arthroscopy, but higher BMI is associated with reduced improvement in patient-reported outcomes. Level III, retrospective comparative prognostic trial.

Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers’ compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively (P < .01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs (P≥ .515) and PRO values at 5-year follow-up (P≥ .098). There were no significant differences in the achievement of the minimal clinically important difference (P≥ .422) or Patient Acceptable Symptom State (P≥ .161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study’s cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up.

High-Level Competitive Athletes Who Undergo Hip Arthroscopy Demonstrate Durable 5-Year Outcomes and Lower Subjective Pain: A Propensity-Matched Analysis.

Hip arthroscopy (HA) has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes (CA) and non-CA at short-term follow-up. However, there is a paucity of literature investigating midterm outcomes comparing athletes with Controls. Athletes would have significant improvements at 5 years, with favorable outcomes compared with their control counterparts, and high return-to-sport (RTS) rate. Propensity-matched retrospective comparative cohort study. Level 3. CAs who underwent primary HA for FAIS from January 1, 2012 to April 30, 2017 were identified and propensity matched on a 1:4 basis to Controls by age, sex, and body mass index (BMI). Patient-reported outcomes (PROs) were collected preoperatively and at 5 years. Minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) rates were calculated using previously published thresholds. Rate and duration of RTS were collected retrospectively. A total of 57 high-level CA (33 female, 24 male; age, 21.7 ± 4.2 years; BMI, 23.1 ± 2.8 kg/m2) were propensity matched to 228 Controls (132 female, 96 male; P > 0.99; age, 23.3 ± 5.8 years; P = 0.02; BMI, 23.8 ± 4.3 kg/m2, P = 0.24). Significant differences were observed in preoperative Hip Outcome Score Sports Specific and Activities of Daily Living (HOS-ADL) subscales (CA, 74.9 ± 13.7 vs Controls, 66.4 ± 18.4; P = 0.01) and modified Harris Hip Score (mHHS) (CA, 64.7 ± 12.9 vs Controls, 59.7 ± 14.3; P = 0.04). Both groups demonstrated significant postoperative improvements in all outcome scores measured (P ≤ 0.01). At 5 years postoperatively, there were significant differences between groups in Visual Analog Scale (VAS) Pain (CA, 17.3 ± 17.6 vs Controls, 24.7 ± 25.9; P = 0.02). There were no significant differences in achieving MCID or PASS. Athletes RTS at a median of 25.2 weeks (Q1 22.4-Q3 30.7) with an overall RTS rate of 90%. Similar rates of revision were seen between CA patients (n = 3; 5.3%) and Control patients (n = 9; 3.9%) (P = 0.66). CAs demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates after primary HA, which were comparable with those of 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. In addition, CA patients demonstrate high rates of RTS at a median of 25 weeks postoperatively. This study provides insight into CA versus Control PROs and rates of achieving MCID and PASS at a midterm follow-up of 5 years. Furthermore, this study offers perception into RTS rate, both in general as well as specified to individualized sports.

Pericapsular Nerve Group Block Leads to Small but Consistent Reductions in Pain Between 18 and 24 Hours’ Postoperatively in Hip Arthroscopy for Femoroacetabular Impingement Surgery: A Prospective, Randomized Controlled Clinical Trial

To investigate whether the use of a pericapsular nerve group (PENG) block would reduce perioperative pain after arthroscopic therapy for femoroacetabular impingement syndrome (FAIS) and to examine opioid requirements and occurrence of postoperative nausea and vomiting (PONV). Between May 2022 and October 2022, patients (N= 68) undergoing arthroscopic surgery for FAIS were randomly allocated into 2 groups. The first group received an ultrasound-guided PENG preoperatively with 20 mL of 0.375% ropivacaine and standardized postoperative oral medication. The second group received a sham block preoperatively with 20 mL of 0.9% saline and standardized postoperative oral medication. The primary end point was pain scores (visual analog score [VAS], 0-10) during the first 24 hours postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the minimal clinically important difference (MCID) was calculated using the half standard deviation method. The incidence of PONV as well as opioid usage (converted to morphine equivalent) within the first 24 hours were secondary outcomes. Randomization and permission were successfully obtained from 68 participants. From the fifteenth postoperative hour, the PENG group reported significantly less postoperative pain than the control group (24th postoperative hour: VAS pain PENG group 1.3 ± 0.9 [0-3]; 95% confidence interval {CI} 0.4-1.2 vs the VAS pain control group 2.4 ± 1.6 [0-5]; 95% CI 1.4-4.7; P= .009). The VAS pain score threshold for achieving the MCID at 24 hours postoperative was defined as a decrease of 1.1. 27 patients (79%) in the PENG group and 22 patients (65%) in the control group were able to achieve MCID (P= .009). Opioid dosage and postoperative nausea did not differ significantly between groups (P=.987 and P= .655, respectively). Concomitant complications such as falls, hematomas, or weakened muscles did not occur in either group. According to this study, a PENG block minimally reduced pain after arthroscopic treatment for FAIS between the 18th and 24th postoperative hours. The PENG group achieved significantly more often the pain VAS MCID. However, there was no proof that the PENG group consumed fewer opioids than the control group. Overall, PONV was found at a low and comparable rate. Level I, randomized controlled trial.