Summary

Accelerated (within 7 days) staged bilateral hip arthroscopic surgery in athletes symptomatic for femoroacetabular impingement results in comparable clinical outcomes to delayed staged procedures and matched unilateral arthroscopy.

Abstract

Introduction

Athletes are at increased risk of presenting with symptomatic femoroacetabular impingement (FAI) bilaterally. Staged hip arthroscopy (HA), where conservative management has been unsuccessful, is an option however the optimal timing of the second procedure is unknown. Previous literature reports the timeframe for staged procedures to range from 2-4 weeks to 6-16 weeks. Delaying contralateral surgery in cases of bilateral symptoms may result in increased progression of chondrolabral pathology.

Purpose

To compare minimum 2-year outcomes for patients undergoing accelerated staged arthroscopy against 1) those undergoing delayed staged arthroscopy, and 2) those undergoing unilateral arthroscopy.

Methods

Our prospective institutional HA registry was retrospectively reviewed for patients undergoing bilateral primary HA for FAI between 2009-2022. Inclusion criteria were competitive athletes with concurrent bilateral symptoms at initial presentation and minimum 2-year post-operative patient-reported outcomes (including mHHS, UCLA, SF36, WOMAC), rates of achieving minimal clinically important difference (MCID), return to sport (RTS) and satisfaction. Exclusion criteria were Tonnis >1 on either operated hip, dysplasia (LCEA <25o), Perthes, Protrusio, AVN. Two groups were extracted based on the duration between procedures: within 7 days (Accelerated group) and within 4-6 weeks (Delayed group). Bilateral patients from the Accelerated group were matched in a 1:2 ratio with comparable unilateral patients based on age (±2 years), gender and athletic status. Data was analysed using SPSS, p-value <0.05 considered significant.

Results

131 bilateral patients (262 hips) were included: 91 in Accelerated group, 40 in Delayed group. Mean time between surgeries was 0.99±0.02 weeks (Accelerated) and 6.35±2.18 weeks (Delayed). All 91 athletes from Accelerated group were successfully matched to 182 Unilateral athletes. All three groups demonstrated significant improvement from baseline across all PROs (p<0.001 for all). Acquired change in outcomes was similar and not statistically significantly different between groups (p>0.05). Satisfaction with relief from pain was achieved by 85.9% Accelerated group, compared to 83.1% Delayed group (p=0.053) and 87.3% Unilateral group (0.933). MCID for mHHS was achieved by 85% Accelerated group, compared to 91.5% Delayed group (p=0.212) and 87.6% Unilateral group (p=0.456). At 2 years post-op 73.2% Accelerated group returned to their main sport compared to 78.8% Delayed group (p=0.631) and 72.9% Unilateral group (p=0.948).

Conclusion

Staged bilateral hip arthroscopy separated by 1 week apart is a safe and effective treatment option for bilateral symptomatic athletes. Improvement in PROs and RTS rates are comparable with a delayed duration between procedures and with those case-control matched athletes undergoing unilateral arthroscopy