Poster 110: Primary Hip Arthroscopy for Femoroacetabular Impingement in Patients Over 50 Years of Age Demonstrates Improvement in Patient Reported Outcomes: A Cohort Study with Minimum 10-Year Follow Up

Objectives: Hip arthroscopy has seen a drastic increase in utilization over the last two decades for the treatment of femoroacetabular impingement (FAI). In young patients, the efficacy of hip arthroscopy is well established. However, the use of hip arthroscopy in older patients is controversial as total hip arthroplasty (THA) has consistently demonstrated excellent results in this population. Currently, little is known regarding the efficacy of hip arthroscopy for the treatment of FAI in patients over the age of 50. More specifically, long term data assessing patient risk factors in older patients is sparse. As a result, the aim of the present study is to assess patient reported outcomes (PROs) and risk factors associated with subsequent surgery in patients over the age of 50 who underwent hip arthroscopy for treatment of FAI. Methods: A retrospective review of all primary hip arthroscopies performed before 2013 by the senior author in patients over the age of 50 was conducted. Patients were included if they were over the age of 50 at the time of surgery and at least 10 years out from revision hip arthroscopy for the treatment of FAI related pathology. Patients were excluded if they had acetabular dysplasia (LCEA<20), had a history of Legg-Calve Perthes Disease, Slipped Capital Femoral Epiphysis, or a prior surgery or fracture on the ipsilateral hip. Patient demographics, radiographic parameters, subsequent surgery information, and patient reported outcomes (PROs)—including 12-Item Short Form Survey Physical Component Score (SF-12 PCS), 12-Item Short Form Survey Mental Component Score (SF-12 MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), Vail Hip Score (VHS), Hip Outcome Score – Activities of Daily Living (HOS-ADL), and Hip Outcome Score – Sport (HOS-Sport)—were collected pre- and minimum 10 years postoperatively. Results: A total of 346 patients over the age of 50 who underwent primary hip arthroscopy were identified, and 190 (55%) patients provided follow up at a mean of 11.1 ± 1.4 years. The mean age at the time of surgery was 56.8 ± 5.7 years. Additionally, 26 patients (14%) underwent a microfracture procedure, and 94 (50%) had an Outerbridge grade 3 or 4 cartilage defect (Table 1). Of those with completed follow up, 95 patients had a subsequent surgery including 80 (42%) who had a THA and 15 (8%) who had a revision hip scope (Table 1). Notably, patients demonstrated a survival rate of 74%, 69%, and 61% at 5, 10, and 15 years respectively (Table 2). The remaining 95 patients with completed follow up reported improvement in mHHS, HOS-ADL, HOS-Sport, SF-12 MCS, SF-12 PCS, and WOMAC Total at a minimum 10-year follow up (Table 3). Additionally, most patients achieved HOS-ADL, HOS-Sport, and mHHS MCID and PASS (Table 4). Conclusions: To our knowledge, the present study is the first to report long-term outcomes in this population. The findings of the present study suggest hip arthroscopy is an effective procedure for the treatment of FAI in patients over the age of 50, with over 60% of patients exceeding the long-term follow up of the present study and not requiring a subsequent surgery 15-years post-operatively. Next steps are to bolster patient follow-up, as we are unable to comment on the outcomes of the patients lost to follow-up, thus our reported THA conversion rate may be more liberal than reality. Additionally, we aim to identify patient risk factors associated with successful patient outcomes as well as factors that may influence the need for a subsequent surgery.

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