Faculty Bibliography

PURPOSE/OBJECTIVE:To evaluate whether the duration between staged bilateral hip arthroscopy affects patient-reported outcomes, the rate of arthroscopic revision, or conversion to total hip arthroplasty. METHODS:A retrospective comparative case series was conducted of a single-surgeon prospective database of patients who underwent hip arthroscopy for femoroacetabular impingement syndrome with a minimum of 2-year follow-up. Modified Harris Hip Score and Nonarthritic Hip Score were recorded preoperatively and 2 years postoperatively for each hip. For analysis, patients were allocated into 2 groups: staged procedures <1 year apart and ≥1 year apart. RESULTS:A total of 76 patients (152 hips) underwent staged bilateral primary hip arthroscopies. Overall, the mean age at the first surgery was 36.1 ± 13.1 years and the cohort was 59.2% women. Of these, 43 patients (56.6%) underwent staged procedures <1 year apart, whereas 33 patients (43.4%) were staged 1 year apart. Age (P = .092), sex (P = .828), and body mass index (P = .867) did not significantly differ between groups. At 2-year follow-up, modified Harris Hip Score (first hip: 85.2 ± 17.9 vs 82.5 ± 13.3, P = .588; second hip: 84.7 ± 19.3 vs 79.3 ± 16.0, P = .514) and Nonarthritic Hip Score (first hip: 85.3 ± 19.1 vs 83.2 ± 12.4, P = .660; second hip: 86.5 ± 22.8 vs 84.9 ± 12.2, P = .823) were similar between groups staged <1 year and ≥1 year. There were no significant differences in rates of revision arthroscopy (7.0% vs 12.1%, P = .460) or conversion to total hip arthroplasty (4.7% vs 3.0%, P > .999) between groups staged <1 year and ≥1 year. Based on logistic regression, the duration between hip arthroscopy stages was not associated with the risk of arthroscopic failure (odds ratio: 1.29, P = .227). CONCLUSIONS:There were no significant differences in patient-reported outcomes, rates of revision arthroscopy, and conversion to total hip arthroplasty between patients who underwent staged bilateral hip arthroscopy less than or greater than 1 year apart. Duration of time between staged procedures was not found to affect rates of arthroscopic failure. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative case series.

PURPOSE/OBJECTIVE:To evaluate mid- and long-term outcomes and survivorship after hip arthroscopy for femoroacetabular impingement syndrome in patients aged ≥40 years and, when available, compare these outcomes with younger cohorts. METHODS:The electronic databases PubMed, MEDLINE, and EMBASE were searched for studies assessing the use of primary hip arthroscopy for femoroacetabular impingement syndrome in patients aged ≥40 years with either a younger comparator cohort (≤40 years) or age-stratified analyses permitting comparison. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: = 41.8%). Reported rates of conversion to total hip arthroplasty ranged from 2.9% to 13.2%. Among studies reporting clinically meaningful outcomes, age-based differences were inconsistent. No significant differences were observed between older and younger cohorts in achievement of mHHS minimum clinically important difference across studies reporting comparative data. For mHHS patient acceptable symptom state, 2 studies reported higher rates of achievement in younger patients (P = .04), whereas 2 others found no significant age-based differences; several studies did not report comparative analyses. CONCLUSIONS:Arthroscopic management of femoroacetabular impingement syndrome in patients aged ≥40 years results in significant and durable improvements in pain and function, with preservation of the native hip in most cases, although rates of conversion to total hip arthroplasty range from 2.9% to 13.2% across included studies. LEVEL OF EVIDENCE/METHODS:Level IV, systematic review of Level I to IV studies.

BACKGROUND:Psychiatric comorbidity has been linked to inferior orthopaedic outcomes, but studies evaluating its impact on survivorship after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in the long term remain limited. PURPOSE/OBJECTIVE:To evaluate the association between preoperative psychiatric comorbidity, particularly among those who are using psychotropic medications, and failure, patient-reported outcome measure (PROM) scores, and failure-free survivorship after hip arthroscopy for FAIS at a minimum 10-year follow-up. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:< .05. RESULTS:≤ .002). Although both the psychiatric comorbidity and no psychiatric comorbidity groups improved significantly, patients with psychiatric comorbidity achieved smaller improvements and lower postoperative PROM scores. CONCLUSION/CONCLUSIONS:Psychiatric comorbidity was associated with increased failure rates, reduced long-term survivorship, and lower PROM scores after hip arthroscopy for FAIS.

PURPOSE/OBJECTIVE:The purpose of this study was to report minimum 10-year survivorship, patient-reported outcomes (PROs), clinically significant outcome achievement and predictors of outcomes and failure in patients with structurally stable femoroacetabular impingement syndrome (FAIS) who underwent primary hip arthroscopy with interportal capsulotomy without capsular repair. METHODS:A retrospective review was conducted of patients undergoing primary hip arthroscopy for FAIS from 2010 to 2013 with a minimum 10-year follow-up. Exclusion criteria included hip dysplasia, Tönnis Grade >1, prior ipsilateral hip surgery and unavailable preoperative radiographs. All patients underwent interportal capsulotomy without capsular repair. Outcomes included modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), minimal clinically important difference (MCID) achievement, survivorship and predictors of PROs and failure. RESULTS:A total of 150 patients were included (62.7% female), with mean follow-up of 11.7 ± 1.1 years and mean age of 38.3 ± 12.1 years. Ten-year survivorship was 90.7%; 7 patients (4.7%) underwent total hip arthroplasty and 7 (4.7%) underwent revision arthroscopy. mHHS improved from 52.0 ± 11.7 to 87.9 ± 16.7 (p < 0.001), and NAHS improved from 49.5 ± 11.4 to 86.2 ± 18.0 (p < 0.001). Patient Acceptable Symptom State (PASS) was achieved by 76.0% of patients for mHHS and 65.3% for NAHS. Female sex and higher body mass index (BMI) were associated with worse 10-year PROs, whereas Tönnis Grade 1 (p = 0.003) and lower preoperative NAHS (p = 0.034) were associated with failure. CONCLUSION/CONCLUSIONS:Primary hip arthroscopy for structurally stable FAIS performed with interportal capsulotomy and without capsular repair demonstrated favourable 10-year outcomes, high PASS achievement and 90.7% survivorship. Clinically, these findings provide long-term benchmarking data for counselling appropriately selected patients with structurally stable hips. Higher BMI and female sex were associated with worse 10-year PROs, while Tönnis Grade 1 and lower preoperative NAHS were associated with increased failure risk, supporting their use in preoperative risk stratification and shared decision-making. LEVEL OF EVIDENCE/METHODS:Level IV, retrospective case series (single-surgeon, without comparison group).

PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and patient-reported outcomes, achievement of clinically significant thresholds, and reoperation rates in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at minimum 10-year follow-up. METHODS:A retrospective review of a prospectively gathered database of hip arthroscopy patients from August 2012 to June 2014 was conducted. Inclusion criteria were patients ≥18 years with clinically and radiographically confirmed FAIS and labral tearing who underwent primary hip arthroscopy with labral repair or debridement and had ≥10 years of follow-up. MRI labral width measurements were performed by 2 blinded musculoskeletal radiologists at standardized clockface locations using a validated technique. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were classified as hypoplastic if they had a labral width below the mean on 2 or more views. Outcomes and reoperation rates were compared between groups using independent samples t-tests for continuous variables and chi-square tests for categorical variables. RESULTS:were included, with a mean follow-up of 11.30 ± 0.47 years. Patients were categorized into hypoplastic (n = 42) and nonhypoplastic (n = 41) groups. There was no significant difference between hypoplastic and nonhypoplastic groups with respect to age, sex, smoking status, or intraoperative procedures. Additionally, there were no significant intergroup differences in mHHS or NAHS improvement at 5 or 10 years postoperatively. Both groups showed high achievement of the mHHS minimal clinically important difference threshold at 10-year follow-up with no significant difference (nonhypoplastic: 90.3% vs hypoplastic: 85.2%, P = .549). There was also no difference achievement of the patient acceptable symptom state (nonhypoplastic: 64.5% vs. hypoplastic: 70.4%, P = .636). However, the hypoplastic group had a significantly higher rate of revision arthroscopy (28.6% vs 9.8%, P = .030) and conversion to total hip arthroplasty (21.4% vs 4.9%, P = .026) when compared with the nonhypoplastic group. CONCLUSIONS:Hypoplastic labral width on preoperative MRI was associated with an increased risk of revision hip arthroscopy and conversion to total hip arthroplasty at 10 year follow-up in patients with FAIS. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative case series.

Along with irreparable labrum from failed prior surgery, diminutive or calcified labrum in cases of primary surgery have become an indication for labral reconstruction of the hip. Radiologists can reliably and accurately measure the labral width or height and volume on magnetic resonance imaging (MRI). For preoperative purposes, an MRI that confirms a diminutive labrum can lead the surgeon to indicate primary labral reconstruction as the native labrum may not be providing an adequate suction seal to the femoral head. For postoperative purposes, MRI measurements of the volume of the labral graft can provide the surgeon and patient with important information about the healing progress and ultimate success of the reconstruction. Future routine postoperative MRI measurements of labral volume will help the hip arthroscopist determine the ideal volume of the labral reconstruction graft.

INTRODUCTION/BACKGROUND:The purpose of this study was to conduct an analysis of the cross-sectional area (CSA) of hip musculature before and after hip arthroscopy (HA) for femoroacetabular impingement (FAI). The hypothesis was that there will be a significant increase in the CSA of analysed hip muscles that will correlate with increases in PROs following surgery. METHODS:-test. RESULTS: = 0.037) significantly predicted an increase in mHHS at 1 year when controlling for time between surgery and post-op MRI. CONCLUSIONS:Gluteus maximus and minimus muscles demonstrated significantly increased CSA after HA for FAI patients. Change in CSA was positively correlated with PROs for the gluteus maximus at 1-year follow-up. These findings underscore the clinical significance of muscle adaptations following hip arthroscopy for FAI.

PURPOSE/UNASSIGNED:To assess correlation of pre-operative symptoms, labral damage and chondrolabral junction pathology on MRI with intra-operative findings in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS/UNASSIGNED:Consecutive patients with FAI treated surgically were included. Data were collected on patient demographics and preoperative clinical outcome measures. Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips. The presence of cartilage fraying, chondrolabral separation, labral tear pattern (intrasubstance, linear, complex), chondral flap, cartilage delamination, and ligamentum teres (LT) pathology (degeneration/partial or complete tear) were recorded on preoperative MRI and intraoperatively during arthroscopy. Inter-reader and inter-method agreement were measured using weighted-Cohen's or Fleiss'-kappa, or Kendall's coefficient. Associations between MRI and arthroscopic findings and preoperative modified-Harris-Hip-Score (mHHS) and Non-Arthritic-Hip-Score (NAHS) were assessed using Mann-Whitney-U or Kruskal-Wallis test. RESULTS/UNASSIGNED:All readers detected lower rates of chondrolabral separation, cartilage delamination, and chondral flap, and higher rates of LT tear on MRI compared to arthroscopy. Linear tears were the most common tear pattern detected by readers on MRI (29%-50%) and arthroscopy (71%). The inter-reader agreement was moderate for LT findings and fair for remaining MRI variables. Between MRI and arthroscopy, there was moderate agreement for labral fraying for one reader (k = 0.303, 95% CI[0.106-0.501], p = 0.004) and fair agreement for labral tear pattern for one reader (k = 0.187, 95% CI[0.037-0.337], p = 0.006). There was poor-to-no agreement between MRI and arthroscopy for the remaining MRI variables for all readers (p = 0.05). Preoperative mHHS and NAHS scores demonstrated no significant association with preoperative MR or intraoperative findings (p > 0.05). CONCLUSION/UNASSIGNED:MRI labral and chondrolabral findings in patients with FAI underestimated the intraoperative pathology identified during hip arthroscopy and were not associated with preoperative patient reported outcome measures. LEVEL OF EVIDENCE/UNASSIGNED:III (retrospective case series).

Hip arthroscopy has grown exponentially over the past decade, with a parallel rise in revisions, underscoring the importance of refined patient selection and diagnostic accuracy. This review outlines the most common causes of failure after primary hip arthroscopy and provides a framework for evaluation, imaging, and management. Notably, differentiating between impingement and instability is crucial, as misclassification can worsen outcomes. Revision procedures may provide clinically meaningful improvement in patient-reported outcomes and delay total hip arthroplasty in well-selected patients. However, recognizing when to shift from preservation to replacement is key to optimizing outcomes.

PURPOSE/OBJECTIVE:To compare 10-year outcomes of hip arthroscopy in patients with Tönnis grade 1 versus grade 0 osteoarthritis, with specific focus on patient-reported outcomes, rates of minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and arthroscopic revision and total hip arthroplasty (THA) conversion rates. METHODS:Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were prospectively enrolled. A 1:1 propensity score match based on age, sex, body mass index, smoking status, labral treatment, capsular management, lateral center edge angle, and preoperative alpha angle matched Tönnis grade 1 patients to Tönnis grade 0 patients. Inclusion criteria were symptomatic FAIS with radiographic deformity, failure of nonoperative treatment, and ≥10-year follow-up. Patients were excluded for prior ipsilateral hip arthroscopy, Tönnis grade >1, incomplete data, dysplasia (lateral center edge angle < 18°), developmental hip disorders, or concomitant procedures. Modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and failure (revision arthroscopy or THA conversion) rates at 10 years were assessed. RESULTS:Out of a total database of 152 patients, the study matched 32 Tönnis grade 1 patients (mean age 40.79 ± 10.1 years; body mass index 25.13 ± 3.73; follow-up 12.16 ± .96 years [range, 10.08-13.59]) to 32 Tönnis grade 0 patients (mean age 41.82 ± 11.66; body mass index 25.63 ± 3.53; follow-up 11.42 ± 1.23 years [range: 10.02-13.58]) for a total of 64 included patients within this study. Baseline characteristics were well matched with the only significantly different variable being follow-up time (P = .009), though all patients reached a minimum follow-up of 10-years. Both cohorts showed significant improvements in mHHS and NAHS at 10 years (P < .0001), with no significant differences between groups at 10-years (mHHS P = .509; NAHS P = .339) or any other time point. MCID achievement rates were high for both mHHS (Tönnis 0: 87.5%; Tönnis 1: 90.6%; P = .689) and NAHS (Tönnis 0: 87.5%; Tönnis 1: 93.8%; P = .391). Tönnis grade 1 patients showed higher failure (THA/revision) rates compared to Tönnis grade 0 patients (31.25% vs 3.13%; P = .006). Analyzed separately, Tönnis grade 1 patients had 5 cases (15.63%) of THA conversion compared to 0 cases in the Tönnis grade 0 cohort (P = .05), while revision rates were similarly elevated in the Tönnis grade 1 group (5/32; 15.63%) compared to Tönnis grade 0 patients (1/32; 3.13%) (P = .196). CONCLUSIONS:Hip arthroscopy yields significant long-term improvements for FAIS patients with Tönnis grade 1 and 0 osteoarthritis. However, increased failure rates in Tönnis grade 1 patients suggests that preoperative osteoarthritis may predispose patients to greater rates of subsequent THA conversion or revision. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative matched case series.