DOI: 10.1177/23259671261484236 ISSN: 2325-9671

Has Surgical Evolution in Hip Arthroscopic Techniques Improved Patient-Reported Outcome After Treatment of Symptomatic Femoroacetabular Impingement (FAI)

Karen Mullins, David Filan, Patrick Carton
Show PDF Cite

Background:

Hip arthroscopy for femoroacetabular impingement (FAI) has undergone substantial technical advancements. Whether these combined improvements have led to measurable clinical benefit is unknown.

Purpose:

To compare 2-year outcomes between 2 surgical eras separated by 10 years and determine whether contemporary surgical approaches yielded greater treatment benefit.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Prospectively collected single-surgeon registry data on primary hip arthroscopies for FAI were reviewed, comparing patients treated between 2010 and 2012 (early group) with those treated between 2020 and 2022 (contemporary group). Outcomes comprised of survivorship, repeat arthroscopy, patient-reported outcomes (PROMs) (eg, modified Harris Hip Score, University of California, Los Angeles, 36-Item Short Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index), range of motion (ROM), and satisfaction at 2 years. Survivorship was compared using a Kaplan-Meier Curve. Between-group comparisons for continuous data were performed using Mann-Whitney U tests, and Wilcoxon signed-rank tests for within-group comparisons. Reoperation rates and satisfaction rates were compared using the chi-square test.

Results:

A total of 658 cases met the inclusion criteria (early group: n = 347; contemporary group: n = 311). The contemporary group underwent significantly greater bony correction for both the lateral center-edge angle (–6° vs 0° change, P < .001) and the alpha angle (−10° vs −6°; P < .001). All patients in the contemporary group underwent capsular repair. The contemporary group had higher rates of labral cuff repair. Despite these technical advances, survivorship (97% vs 98%; P = .379) and rates of repeat arthroscopy (8.4% vs 6.4%; P = .242) were similar. Both groups demonstrated significant improvements across all PROMs (all P < .001). The early group demonstrated greater improvements in ROM, with medium-to-large gains in all directions ( P < .001 for all). In contrast, the contemporary group showed more limited ROM gains despite more extensive bony correction, with statistically significant increases in adduction and internal rotation only ( P < .001), both of which were medium to large in magnitude. Finally, satisfaction was high in both groups (85% vs 80%; P = .108).

Conclusion:

Despite substantial technical evolution in arthroscopy, including the introduction of capsular repair, anatomical labral preservation, and more refined bony correction, surgical advancements in FAI treatment did not lead to superior outcomes at 2 years. Both surgical eras provided improvements in pain and function, high survivorship, and high satisfaction. The findings reinforce that, in the appropriate patient, hip arthroscopy is a consistently effective treatment option for symptomatic FAI, and that the clinical benefits of treatment have remained stable despite technical advances.

More from our Archive