Primary Hip Arthroscopy Research Articles

Decreased volume of rectus femoris and iliocapsularis in patients with femoroacetabular impingement syndrome after primary hip arthroscopy

Purpose(1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes.MethodsData between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs.ResultsA total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P < .05). Both G-med/min and G-max presented decreased volume at postoperative 6 months (all with P < .05). G-med/min presented decreased volume (P = .001) at postoperative 12 months. Changes in RF at postoperative 3 months and 12 months were positively related to improvement of iHOT-12 (Beta = 0.371, P = .012 and Beta = 0.330, P = .026, respectively). Changes in IC at postoperative 6-month was positively related to improvement of mHHS (Beta = 0.367, P = .027) and iHOT-12 (Beta = 0.315, P = .044).ConclusionDuring the initial first year following arthroscopic treatment for FAIS, decreased volume of the RF and gluteal muscles was observed. Early changes in volume of RF and IC were positively correlated to the improvement of minimum 2-year PROs.Level of evidenceLevel IV; case series.

A novel radiographic finding for estimation of the cortical-cancellous boundary: A magnetic resonance imaging case series of patients with femoroacetabular impingement

PurposeTo determine if comparing alpha angle measurements of the outer cortical margin (preoperative alpha angle) and the inner cortical margin (theoretical postoperative alpha angle) on magnetic resonance imaging (MRI) can estimate the amount of sclerotic bone that needs to be resected to restore the alpha angle to normative values (<55⁰) in patients with symptomatic femoroacetabular impingement (FAI). MethodsA retrospective review was conducted on patients with FAI undergoing primary hip arthroscopy and CAM osteoplasty from June 2013 to February 2017. Inclusion criteria were radiologist-measured alpha angles >70° on 3T oblique axial MRI, unilateral primary hip arthroscopy, and age ≥18. Exclusions included previous hip surgery, hip trauma, avascular necrosis, advanced osteoarthritis, dysplasia, poor quality images, or missing MRI images. Alpha angles were measured preoperatively using the outer cortical margin and postoperatively using the inner cortical margin of femur. Surgeries were performed by the senior surgeon. Paired t-tests compared preoperative and postoperative alpha angles, and intraclass correlation coefficients (ICC) were used to assess inter-rater and intra-rater reliability. ResultsOne hundred patients (100 hips) were included with an average age of 40.8 years (range, 18.7–64.9), with 75 % being male (n = 75). The average BMI was 24.7 ± 3.9 (range, 17.1–38.8). The average maximum alpha angle at the outer cortical margin was 77.0 ± 4.2° (range, 70.0–90.8), with an ICC for inter-rater reliability of 0.861, indicating excellent agreement. The average inner cortical alpha angle was 46.4 ± 3.4° (range, 36.5–55.4), significantly less than 55° (p<0.001). The mean difference between the outer and inner cortical alpha angles was −30.6 ± 5.1° (p< 0.001). ConclusionsThe difference between outer and inner cortical alpha angles on MRI can accurately estimate the amount of sclerotic bone resection needed to restore the alpha angle to normative values in patients with FAI. This information may be directly applied clinically marker to assess adequacy of CAM resection.

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Case series; Level of evidence, 4. A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study

PurposeTo investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. MethodsA retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. ResultsFifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). ConclusionPatients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. Level of EvidenceLevel III; retrospective cohort study.

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Labral Repair and Patient-Reported Outcomes: A Systematic Review.

Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality. The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs. Systematic review; Level of evidence, 4. A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I 2 values. Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I 2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I 2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups. Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients.

Revision Hip Arthroscopy: Getting It Right the Second Time

Hip arthroscopy procedures have become increasingly common in the last few decades for treating both intra- and extra-articular hip pathologies. Despite advancements in the field, some patients may not experience improvement and may eventually require revision hip arthroscopy. The multifactorial causes for failure, unknown impacts of the primary procedure and previous iatrogenic considerations can create added complexity for the revision. Given that revision hip arthroscopy has had more variation in patient outcomes and higher rates of subsequent conversion to hip arthroplasty, compared with primary hip arthroscopy, it is imperative to have a good algorithm for patient selection and to understand the various surgical options available to address different pathologies. In this review, we explore the current diagnostic algorithms, etiologies, surgical procedures, outcomes, and provide insights into future directions in the field of revision hip arthroscopy.

Ten-Year Outcomes in Patients Aged 40 Years and Older After Primary Arthroscopic Treatment of Femoroacetabular Impingement With Labral Repair

Background: Arthroscopic labral repair has been shown to result in favorable short- and midterm outcomes; however, the durability of outcomes specifically in older patients remains underreported. Purpose: To (1) report prospectively collected hip preservation rates and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in patients aged ≥40 years after primary hip arthroscopy with labral repair and (2) perform a matched analysis comparing patients aged ≥40 years with patients aged <40 years. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between February 2008 and December 2011. Patients aged ≥40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up scores were collected for multiple PROMs. Propensity score matching was utilized to compare these patients with a cohort of patients <40 years. Results: Of the 113 hips eligible, 91 hips (80.5%) on 85 patients (6 bilateral) had a minimum 10-year follow-up. There were 58 women (68%) and 27 men (32%) with a mean age and body mass index of 47.8 years and 25.8, respectively. The hip preservation rate for patients aged ≥40 years was 78%, with 20 patients requiring arthroplasty during the study period. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up with high rates of achieving the minimal clinically important difference and Patient Acceptable Symptom State clinical outcome thresholds. In total, 69 patients aged ≥40 years were propensity matched to 107 patients <40 years. Patients ≥40 tended to have a lower hip preservation rate (81.2% vs 91.6%; P = .06), while patients in the younger cohort had significantly higher rates of secondary hip arthroscopy (14% vs 3%; P = .02). Improvement in PROMs was comparable between the groups. Conclusion: Patients ≥40 years who underwent primary hip arthroscopy with labral repair demonstrated a hip preservation rate of 78%, significant and durable improvement in PROMs, and high rates of satisfaction at a minimum 10-year follow-up. Matched analysis with patients <40 years revealed comparable improvement in patient-reported outcomes between the 2 groups, with a tendency to a higher level of arthroplasty in patients ≥40 years.

Two-Year Outcomes of Primary Arthroscopic Surgery in Patients with Femoroacetabular Impingement: A Comparative Study of Labral Repair and Labral Reconstruction.

Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair. Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction. A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044). Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Social Determinants of Health Disparities Increase 5-Year Revision Rates but Not Postoperative Complications After Primary Hip Arthroscopy

To investigate the impact of social determinants of health (SDOH) disparities on 30-day emergency department (ED) visits, 90-day postoperative complications, and five-year secondary surgery rates after primary hip arthroscopy using a large national database. A national administrative claims database was used to identify patients who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2022. Patients were queried for whether they experienced any SDOH disparities, including economic, educational, environmental, or social disparities; those experiencing SDOH within 1 year prior to primary hip arthroscopy were matched 1:1 by age, sex, Elixhauser Comorbidity Index score, diabetes, obesity, and tobacco use to patients not experiencing any lifetime SDOH disparities. Odds of 90-day complications and 30-day ED visits were compared using multivariable logistic regression. Rates of five-year revision hip arthroscopy and of any secondary surgery (revision hip arthroscopy or total hip arthroplasty) were compared by Kaplan-Meier analysis. A total of 3,383 primary hip arthroscopy patients who experienced SDOH disparities were matched 1:1 to a control cohort of 3,383 patients who had not experienced SDOH (age, 41.0 years, 79.6% female, for both cohorts). Odds of adverse events following arthroscopy were low and not different between cohorts (SDOH: 1.51%, vs. No SDOH: 1.57%; P=0.09). Additionally, there was no difference in odds of 30-day ED visits (SDOH: 5.65%, vs. No SDOH: 4.79%; P=0.10). The rate of five-year revision hip arthroscopy was significantly greater among patients experiencing SDOH disparities (5.4% vs. 4.1%; P=0.02); however, there was no difference in rates of any secondary surgery between cohorts (11.8% vs. 10.4%; P=0.10). Patients experiencing SDOH disparities had similar odds of postoperative complications and ED visits after primary hip arthroscopy but greater rates of five-year revision hip arthroscopy compared to a matched-control cohort of patients not experiencing SDOH disparities. 3; retrospective case-control study.

Patients With a History of Lumbar Fusion Have a Greater Risk of Revision Arthroscopy and Conversion to Total Hip Arthroplasty After Primary Hip Arthroscopy

PurposeTo characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy. MethodsWe used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York (NY), to identify all patients who underwent hip arthroscopy for FAI between 2010–2020. Patients with prior lumbar fusion were identified using CPT and ICD 9th/10th Revision coding definitions. Patients with and without prior fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: i) no fusion, ii) 1-2 levels, or iii) ≥3 levels. Patients were followed for two years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA. ResultsBetween 2010–2020, there were 23,277 patients that underwent primary hip arthroscopy in NY state. Of these, 348 (1.4%) had a prior lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was higher in patients with prior lumbar fusion compared to patients without (16.5% vs. 8.5%; P < 0.001). This risk increased with the number of levels fused (1-2 levels: 15.1%; aOR, 1.8; 95% CI, 1.3–2.6; vs. ≥3 levels: 26.3%; aOR, 3.4; 95% CI, 1.7–7.0). ConclusionPatients with a history of lumbar fusion had significantly higher rates of revision hip arthroscopy and conversion to THA compared to patients without prior fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1-2 levels fused and 3-fold in patients with 3 or more levels fused. Level of EvidenceLevel III, prognostic retrospective matched comparative case series.

Borderline Developmental Dysplasia of the Hip With Osseous Impingement as Distinct From Femoroacetabular Impingement and Developmental Dysplasia of the Hip.

Borderline developmental dysplasia of the hip (BDDH) accompanied by cam deformity and subspinous impingement has been found to benefit from arthroscopic surgery. However, the research comparing BDDH combined with osseous impingement to femoroacetabular impingement (FAI) without borderline dysplasia remains limited. To compare the clinical symptoms, intraoperative findings, and outcomes of hip arthroscopy in patients with BDDH and osseous impingement versus cam-type FAI. It was hypothesized that BDDH with osseous impingement could be classified as a distinct entity between FAI and developmental dysplasia of the hip (DDH). Cohort study; Level of evidence, 3. Data were collected from patients 18 to 50 years old who underwent primary hip arthroscopy between September 2016 and October 2020. Patients were divided based on preoperative lateral center-edge angle (LCEA) into 2 groups: (1) BDDH group (LCEA 18°-25°; n = 67); and (2) cam-type FAI group without BDDH (FAI group; LCEA 25°-40° and alpha angle >55°; n = 145). Disparities in symptoms, preoperative examination, intraoperative findings and procedures, and patient-reported outcome (PRO) scores were compared. Follow-up was available for 61 (91.0%) patients in the BDDH group and 125 (86.2%) patients in the FAI group. The incidence of cam deformity in BDDH patients was 91.8%. The preoperative characteristics and intraoperative findings were similar between the groups; however, preoperative internal and external hip rotation, Tönnis angle, femoroepiphyseal acetabular roof index, labral size, capsule thickness, and percentage of ligamentum teres tear were significantly higher in the BDDH group than the FAI group, and the percentage of pain aggravating factor, cam deformity, and anterior inferior iliac spine types 2 and 3 were also significantly different between groups (P < .05 for all). The percentage of intraoperative minimal acetabuloplasty, subspinous decompression, labral repair, ligamentum teres debridement, and capsular closure was significantly higher in the BDDH group than the FAI group, while the percentage of femoroplasty was higher in the FAI group (P < .05). Pre- to postoperative improvement on PRO scores was seen in both groups. Given the differences in etiology and surgical procedures between the 2 conditions, it is suggested that BDDH with osseous impingement be classified as an entity distinct from FAI and DDH (and separate from BDDH without impingement) while excluding joint instability.

Primary Hip Arthroscopy Is Associated With Earlier Achievement of Substantial Clinical Benefit Compared With Revision Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome. Patients undergoing primary and revision HA for femoroacetabular impingement syndrome with complete 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport Subscale (HOS-SSS) were identified. Revision patients were propensity matched 1:4 to primary patients with HA, controlling for age, sex, and body mass index (BMI). Time to achievement of minimal clinically important difference and substantial clinical benefit (SCB) were compared alongside cumulative CSO achievement at 6, 12, and 24 months. Hazard ratios (HRs) for predictors of earlier CSO achievement were identified with multivariate Cox regressions. Fifty patients with revision HA were propensity-matched to 200 patients with primary HA of similar age, sex, and BMI. Patients with primary HA demonstrated a greater prevalence of regular preoperative physical activity (87% vs 59%, P < .001). Patients with primary HA showed significantly greater SCB achievement for HOS-ADL at 6, 12, and 24 months (P < .001) and significantly greater SCB achievement for HOS-SSS at 12 and 24 months (P ≤ .001) compared with patients with revision HA. Patients with primary HA achieved SCB for HOS-ADL (P < .001) and HOS-SSS (P= .015) quicker than patients with revision HA. Predictors of earlier CSO achievement included preoperative PRO score (HR 0.98-1.02, P ≤ 0.007), lower BMI (HR 0.97, P= .038), presence of physical activity (HR 1.51, P= .038), and absence of revision status (HR 0.52-0.56, P ≤ .019). Patients with primary HA showed a quicker time to SCB achievement for HOS-ADL and HOS-SSS compared with patients with revision HA. Preoperative PRO score, lower BMI, regular physical activity, and primary HA status predicted earlier CSO achievement. Level III, retrospective comparative series.

Paper 16: Long-term Outcomes of Primary Hip Arthroscopy: Multicenter Analysis at Minimum 10-Year Follow-Up with Attention to Labral and Capsular Management

Objectives: Hip arthroscopy is rapidly advancing, with literature increasingly reporting positive outcomes at short- and mid-term follow-up; however, available long-term data remains limited. The purpose of this study is to evaluate long-term outcomes of primary hip arthroscopy at minimum 10-year follow-up at two academic centers by describing patient-reported outcomes (PROs) and determining reoperation, revision, and total hip arthroplasty (THA) rates. Methods: Primary hip arthroscopies performed between January 1988 and April 2013 at 2 academic centers were evaluated for postoperative PROs including Visual Analogue Scale (VAS), Tegner Activity Scale score, Hip Outcome Score Activities of Daily Living and Sport Scale (HOS-ADL/HOS-SS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), 12-item International Hip Outcome Tool (iHOT-12), surgery satisfaction, function, and reoperations. Results: Two-hundred ninety-four primary hip arthroscopies with a mean age of 40±14 years; 66% female; and a mean body mass index (BMI) of 27±6 kg/m2 were followed for mean 12±3 years (range: 10-24). Labral debridement and repair were performed in 41% and 59% of patients, respectively. All patients underwent interportal capsulotomy and 2% underwent T-capsulotomy. Eleven percent of patients underwent capsular repair. At final follow-up, patients reported mean VAS at rest of 2±2, with use of 3±3, iHOT-12 of 68±27, NAHS of 81±18, mHHS of 79±17, HOS-ADL of 82±19, and HOS-SS of 74±25. Mean surgical satisfaction was 8.4±2.4 (Table 1). Sixty-five hips (23%) underwent THA and 33 (11%) underwent revision arthroscopy (Table 2). Risk factors for THA included older age (p&lt;0.001), higher BMI (p&lt;0.001), lower lateral center-edge angle (p=0.039), larger alpha angle (p=0.001), higher Tönnis grade (p=0.011), labral debridement (p=0.004), and capsular nonrepair (p=0.030). Patients undergoing combined labral and capsular repair demonstrated a THA conversion rate of 3% compared to 31% for patients undergoing combined labral debridement and capsular nonrepair (p=0.006) (Table 3). Labral repair trended towards increased 10-year THA-free survival (84% vs. 77%, p=0.085) while capsular repair demonstrated significantly increased 10-year THA-free survival (97% vs 79%, p=0.032) (Figure 1). Conclusions: At minimum 10-year follow-up, patients undergoing primary hip arthroscopy demonstrated high rates of satisfaction and acceptable outcome scores. In total, 11% of patients underwent revision hip arthroscopic surgery with a THA conversion rate of 23%. Conversion to THA was associated with patient factors including older age and higher Tönnis grade as well as potentially modifiable surgical factors including labral debridement and capsular nonrepair.

Paper 46: Modern Hip Arthroscopy for FAIS Delays the Natural History of Osteoarthritis in a Fourth of Patients: A 12-Year Follow-Up Analysis

Objectives: Little is known about the impact of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. The purpose of this investigation was to (1) characterize the natural history of FAIS and (2) understand the impact of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of ten years. Methods: Between 2010-2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary unilateral hip arthroscopy (labral repair, femoroplasty, capsular closure), and minimum ten-year follow-up. The preoperative and minimum ten-year postoperative radiographs of patients were evaluated at each timepoint. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by two independent reviewers. Subgroup analyses were performed. Results: A total of 200 hips from 100 patients were available with 74% follow-up at a mean of 12.0 years were evaluated. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared to 28% (28/100) among operative hips (Table 1). At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time (Table 2). Modern hip arthroscopy conferred a relative risk reduction of 42% in osteoarthritis progression. Borderline dysplasia, age, preoperative Tönnis grade, and alpha angle &gt; 65° were key risk factors in the radiographic progression of osteoarthritis. Conclusions: While the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history was favorably altered in a quarter of patients after arthroscopic correction (Figure 1). Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Mixed patterns of impingement and instability that underwent arthroscopy were the fastest to degenerate.

Poster 222: Long-term Survivorship in Patients with Coxa Profunda and Acetabular Overcoverage: An Average 11-Year Follow-up After Hip Arthroscopy

Objectives: A prior study investigating 2-year patient-reported outcomes (PROs) following hip arthroscopy found that patients with coxa profunda and acetabular overcoverage report worse improvements yet similar overall outcomes scores. Regarding conversion to total hip arthroplasty (THA), however, patients with coxa profunda and overcoverage experienced significantly lower rates of survivorship (88.9% vs 100%; p = 0.04). When considering long-term outcomes, a recent study by Domb et al. found an 85.7% 10-year survivorship in patients after hip arthroscopy. Currently, there remains a paucity of literature on the effects of a deep acetabular socket and pincer-type femoroacetabular impingement on patient outcomes beyond 2-years follow-up. The objective of the present study was to report the long-term survivorship, revision surgery rate, patient satisfaction, pain level, and functional outcome scores in patients with coxa profunda and acetabular overcoverage following hip arthroscopy. Methods: This was an institutional review board-approved retrospective cohort study of patients with coxa profunda and a LCE angle &gt; 40° who underwent hip arthroscopy for labral tears or FAI between November 2002 and May 2013. After failing conservative management, all patients were treated by a single surgeon and received the same capsulotomy technique and postoperative protocol. Patients with a minimum 8-years follow-up, complete PROs, the presence of coxa profunda as indicated by the acetabular wall projecting medial to the ilioischial line, and a LCE angle &gt; 40° were included (Figure 1). Patients with severe osteoarthritis (Tönnis osteoarthritis grade &gt; 2) or any previous hip surgeries were excluded. Patients meeting inclusion and exclusion criteria represented the overcoverage cohort (OC) and were matched 1:1 by sex, age within 8 years, body mass index (BMI) within 5 kg/m2, Tönnis grade, and labral treatment (repair vs debridement) to a matched control (MC) cohort that had a LCE angle between 25° and 40°. Collected postoperative outcomes include conversion to THA, revision hip arthroscopy, patient satisfaction, pain level (0-100), number of corticosteroid injections, and 6 PROs (modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific subscale (HOS-SSS), and 33-item International Hip Outcome Tool (iHOT-33). Pearson χ2 test and Fisher exact test were used to compare categorical variables; two-sample t-tests were used to compare continuous variables. The threshold for statistical significance was set to 0.05. A survival analysis was performed using Kaplan-Meier curves. All statistical analyses were performed using Stata software (version 18.0; StataCorp). Results: A total of 38 patients in the OC cohort were 1:1 matched with 38 patients in the MC cohort. There were no differences in patient demographics including age, BMI, sex, Tönnis grade, labral treatment, follow-up duration, and Beck classification of labral damage or transition zone (chondrolabral junction) cartilage damage (Table 1). At an average of 11.3 years postoperatively (minimum 8-years follow-up), patients in the OC and MC cohort experienced similar rates of conversion to THA (OC: 11 [28.9%] vs MC: 6 [15.8%]; p = .169) and revision hip arthroscopy (OC: 4 [10.5%] vs MC: 1 [2.6%]; p = .165). The average time from primary hip arthroscopy to conversion to THA was 8.0 ± 6.5 years for OC and 3.7 ± 3.0 years for MC (p = .144) with the OC cohort converting to THA between 6.5 months to 17.14 years while the MC cohort ranged from 4.8 months to 7.8 years. Age at conversion to THA was 54.3 ± 8.0 years for the OC cohort and 59.0 ± 4.0 years for the MC cohort (p = .195). By Kaplan-Meier survival analysis, patients showed similar rates of survivorship (84.2%) at 12 years after hip arthroscopy; however, OC patients showed a 13.1% decrease in long-term survivorship (71.1%) between years 12 and 18 (Figure 2). Additionally, OC and MC patients showed similar levels of patient satisfaction, pain level, postoperative corticosteroid injections, and scores for all 6 PROs (Table 2). Conclusions: Patients with coxa profunda and overcoverage (LCE angle &gt; 40°) showed similar levels of survivorship, revision arthroscopy, patient satisfaction, pain level, number of corticosteroid injections, and PROs to a 1:1 matched cohort of patients with normal acetabular coverage (LCE angle between 25° and 40°) at a minimum 8-years after primary hip arthroscopy. When analyzing long-term survivorship after 12 years, however, patients with overcoverage showed a 13.1% decrease in long-term survivorship (71.1%) compared to a matched control cohort. Overall, a greater focus on extended follow-up care after hip arthroscopy is needed to improve long-term survivorship in patients with a deep acetabular socket and pincer-type femoroacetabular impingement.

Poster 192: The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post

Objectives: Pudendal nerve palsy (PNP) is a poorly characterized but common postoperative complication of hip arthroscopy (HA) with a perineal post that can result in external genital numbness and sexual dysfunction in both men and women. Previous attempts to quantify the incidence of these symptoms have relied on patient-initiated reports, chart review, unvalidated questionnaires or have neglected the female experience altogether – failures which likely underestimate the incidence of this complication. We aimed to describe the incidence of postoperative PNP, the breadth of symptoms patient experience and their duration, as well as establish the relationship between PNP and table traction. Methods: We utilized a multisurgeon prospective cohort of HA patients a single academic center. All patients underwent primary unilateral hip arthroscopy, osteochondroplasty and labral repair in a supine position with a perineal post. Patients with preexisting PNP symptoms, including sexual dysfunction, and those who were not sexually active were excluded. Intraoperative traction duration and force were recorded using a Tekscan sensor applied to the perineal post. A PNP screening questionnaire and standardized, validated sexual function questionnaires were administered confidentially to patients at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Patient-reported hip function scores (iHOT-33) were completed preoperatively and at 6 months postoperatively. Results: A total of 100 patients were enrolled. The mean age was 36.2 ± 9.4 years old, 56 patients (56%) were male. The mean traction duration was 80 ± 19 minutes. In the acute postoperative period, 77 patients (77%) experienced symptoms consistent with PNP. The most common sensory symptom described was perineal numbness (n = 77, 77%), followed by paresthesias (n=26, 26%). Seventeen men (17%) and 13 women (13%) reported symptoms of sexual dysfunction postoperatively, in the form of erectile dysfunction (men) or reduced sexual lubrication/dyspareunia/anorgasmia (women). Of patients who experienced PNP symptoms (n = 77), 21% had symptoms resolve by 6 weeks, 71% by 3 months, 90% by 6 months. Two male patients (3.6%) had persistent erectile dysfunction beyond 6 months postoperatively. Persistence of PNP symptoms beyond 6 weeks was associated with lower 33-item International Hip Outcome Tool (iHOT-33) scores at 6 months (mean difference: 18.4 [95% CI: 6.5-30.4], p = 0.003). Analysis of the calibrated sensor data to establish the relationship between traction force, pressure, and duration with PNP is pending. Conclusions: In this preliminary analysis of a planned 100-patient cohort, patients experienced a high rate of PNP and sexual dysfunction symptoms following HA with perineal post, far higher than previous reports. Most symptoms resolved within the first 3 months postoperatively. Anticipated results from the sensor data within this ongoing study are likely to provide insight into the relationship between traction force and/or duration and PNP incidence. A postless HA setup could be considered as an alternative given the described morbidity.

Paper 17: Does Higher Quality CAM Resection Correlate with Better Patient-Reported Outcomes?

Objectives: The relationships between CAM resection quality and patient-reported outcomes (PROs) are unknown in the literature. This study aimed to investigate the correlation of CAM resection quality with patient’s self-reported International Hip Outcome Tool (iHOT) scores collected annually post-surgery. Methods: A retrospective analysis was conducted including patients who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) between 2012 and 2019. Inclusion criteria were pre-operative radiographic signs of CAM-type impingement (alpha angle &gt; 55 °) and post-operative plain radiographs. Exclusion criteria were radiographic signs of a pincer or mixed impingement, history of femoral neck or proximal femur fracture, and treatment of concomitant hip pathologies. The following data were collected: demographic information, radiographic findings, and iHOT scores. CAM resection quality data were categorized based on findings from three plain radiographs (anteroposterior (AP) pelvis, frog leg lateral, and 45° Dunn views). High quality resections were defined as those post-operative alpha angle &lt;55°. Results: This study included 148 participants who underwent CAM resection. From Frog leg views, 88% of patients had high-quality resections and presented superior post-operative iHOT scores compared to the 12% of patients with poor resection quality during the 1-year to 5-year follow-up period. Likewise, from Dunn views 82% of patients with a high-quality CAM resection displayed a similar trend in post-operative iHOT scores compared to 18% of patients with poor resection quality on Dunn views. However, this positive association between resection quality and post-operative iHOT scores was not evident in AP imaging. With AP views, 82% of patients with high-quality resections did not show a significant difference in iHOT scores compared to 18% of patients with poor resection quality. Conclusions: This study found that high quality CAM resection from arthroscopic surgery correlated with better iHOTs up to 5-years post-surgery from the Dunn and frog leg radiographic imaging views.

Poster 199: High Prevalence of Elevated Beighton Scores in Females Undergoing FAI Surgery

Objectives: Femoroacetabular impingement (FAI) is classically described as restricted internal rotation in flexion resulting in labral and cartilage pathology. Despite 20 years of FAI research, there is still limited understanding of the drivers of symptomatology in the subset of patients with underlying FAI morphology. While the prevalence of FAI morphologies is substantially higher in men, numerous studies have shown more women being treated for FAI compared to men. Soft-tissue laxity and hip instability are increasingly recognized as a potential contributor to symptoms in addition to FAI. The Beighton score is a well-accepted means to quantify soft-tissue laxity and has been validated for self-scoring. The purpose of the current study was to (1) investigate the prevalence of soft-tissue laxity in male and female patients presenting with symptomatic FAI in a multicenter prospective cohort study, and (2) correlate soft-tissue laxity with patient primary complaints of either mobility, stability, or pain. Methods: A prospective multicenter cohort study of 696 FAI patients undergoing primary hip arthroscopy surgery was performed and utilized for the current study. Inclusion criteria are patients aged 14 to 45 years old with idiopathic FAI not caused by childhood disease. Exclusion criteria are previous ipsilateral hip procedures or disease processes such as neuromuscular disease or Tonnis 2 or greater osteoarthritis. The Beighton score was assessed by electronic patient self-scoring. Beighton scores &gt;4 were considered a marker of soft-tissue laxity. The MSP index was utilized to have patients rank from most to least the biggest problems with their hip: Mobility (M), Stability (S), or Pain (P). The chi-square or Fisher exact test were utilized to compare groups. Results: The prevalence of Beighton scores &gt;4 was 57.2% in female patients, compared to 29.3% in male patients (p &lt; 0.001). In female patients, 44.4%, 22.6%, and 7.7% had Beighton scores of 5+, 7+, and 9 respectively, compared to 16.7%, 5.8%, and 1.8% in male patients (all p &lt; 0.005). In the overall FAI cohort, pain was the primary complaint in 72.1% of patients, compared to 24.2% complaining primarily of mobility and 3.7% complaining primarily of stability. Among female patients, the presence of soft-tissue laxity (relative to thresholds of Beighton 4, 5, 7, and 9) did not significantly influence the patient primary complaints (with pain being the predominant complaint). Overall, 85 female patients had a Beighton score of 7 or greater and only 2.4% reported stability of the hip as a primary complaint, compared to 2.4% of female patients with a Beighton &lt;7. Stability was more commonly indicated as a second most important factor in the setting of soft-tissue laxity, compared to mobility. Among female patients with a Beighton &gt;7, 29.5% reported stability as a primary or secondary complaint, compared to 15.2% of female patients with a Beighton score &lt;7. Conclusions: Over half of female patients undergoing FAI surgery have underlying soft-tissue laxity as measured by the Beighton score. In the setting of soft-tissue laxity, patient primary symptomatic complaint remains pain, but a secondary complaint is significant more likely to be stability rather than mobility (compared to FAI patients without soft tissue laxity complain of mobility secondarily over stability). Further research is needed to better understand the role of soft-tissue laxity in the pathophysiology of FAI and the outcomes of surgical treatment.

Poster 205: Long-Term Outcomes for Patients Undergoing Revision Hip Arthroscopy

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 &gt; 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 &lt; 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.

Poster 180: TXA Administration After Hip Arthroscopy: Preliminary Data of a Randomized Controlled Trial

Objectives: Previous studies in shoulder and knee arthroscopy have reported that tranexamic acid (TXA) may improve early functional recovery, prevent postoperative intra-articular bleeding, reduce subjective pain, and improve intra-operative visual field clarity. However, there is a paucity of literature describing the use of TXA in hip arthroscopy. Previous studies have reported statistically significant improvements in VAS pain and Modified Hip Harris scores. However, they used a limited subset of Patient Reported Outcome Measures (PROMs) and did not characterize the effects of TXA on visibility during arthroscopy. The primary objective of this study is to determine the role of TXA in hip arthroscopy based on assessment of postoperative pain and function. A second objective of this study is to determine whether TXA influences intra-operative visual clarity and pump pressures. Methods: This double blinded randomized controlled trial is enrolling 70 patients undergoing primary hip arthroscopy. Subjects are randomized to receive TXA (n=35) or not receive TXA (n=35). The TXA group receives 1g of TXA intravenously at the time of incision and another 1g of TXA during closure. For the duration of the surgery, arthroscopic visual field clarity is rated by the surgeon every 15 minutes as poor, fair, or good and assigned a score of 1, 2, and 3, respectively. Each time the visual clarity is rated, pump pressure is also recorded. Range of motion, VAS Pain, iHOT-12, HOS Sport and activities of daily living, PROMIS Physical Function (PF), and PROMIS Pain Interference (PI) scores are collected preoperatively and postoperatively at days 14 and 42. Additionally, VAS pain is assessed at postoperative day 1. At the completion of all study activities, patient charts are reviewed to determine whether they have requested any additional analgesic medication during the study. Results: The preliminary data for this study includes completed data from 16 (9 female, 7male) patients with a mean age of 44 years. The TXA and control groups had 9 and 7 patients, respectively. No significant difference in VAS pain scores were observed preoperatively, at 1 day postoperatively, or at 42 days postoperatively. There was a significant difference (p=0.01) in VAS pain scores between the two groups at 14 days postoperatively, with the TXA and control groups having mean scores of 2.22 ± 1.48 and 4.33 ± 1.21, respectively. Both groups have shown improvements in PROMs between preoperative scores and postoperative day 42, with larger improvements being seen in the TXA group (although failing to meet statistical significance). Complete preliminary data for PROMs can be seen in Table 1. The average visual score in the TXA group (2.85 ± 0.25) was better than that of the control group (2.67 ± 0.2) but failed to meet statistical significance (p=0.132). The frequency that each rating was assigned was calculated for each group and can be seen in Table 2. A chi-squared test of independence was conducted to examine the relationship between the distribution of grades (Good, Fair, Poor) and the treatment groups (TXA and Control). The test indicated no association between the two variables (Pearson’s χ² = 5.6, df = 2, p = 0.06). Although the p-value did not reach significance level (α&lt;0.05), the preliminary data favored the TXA group in terms of visibility. Pump pressures did not show any significant difference between the TXA group and the control group at any of the time points. No patients have requested additional pain medications during their involvement in this study at this time. Conclusions: The use of TXA in hip arthroscopy descriptively demonstrated improvements in post-operative pain and function, but not intraoperative visual clarity. The trends in the preliminary data, particularly for visual clarity and the measures of pain such as VAS Pain (Figure 1) and PROMIS-PI (Figure 2), suggest a clinical benefit to intraoperative TXA use. Larger sample sizes are needed to establish the significance of these findings and further explore the relationship between TXA and postoperative outcomes, visual clarity, and pump pressures in hip arthroscopy.