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

Michael J Vogel; Alexander B Alvero; Richard Danilkowicz; Obianuju Obioha; Kyleen Jan; Shane J Nho

doi:10.1016/j.arthro.2024.06.047

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

Arthroscopy. 2024 Jul 17:S0749-8063(24)00498-5. doi: 10.1016/j.arthro.2024.06.047. Online ahead of print.

Authors

Michael J Vogel¹, Alexander B Alvero², Richard Danilkowicz², Obianuju Obioha², Kyleen Jan², Shane J Nho²

Affiliations

¹ Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: [email protected].
² Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.

PMID: 39029813
DOI: 10.1016/j.arthro.2024.06.047

Abstract

Purpose: To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome.

Methods: 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.

Results: 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).

Conclusions: 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 of evidence: Level III, retrospective comparative series.