Summary

The aims of this study were to determine (1) how pregnancy planning ad affected patients’ decisions to pursue hip arthroscopy, (2) whether undergoing hip arthroscopy affected hip pain before anfter pregnancy, and (3) whether hip arthroscopy was associated with any pregnancy-related complications.

Abstract

Purpose

Women of reproductive age are among the most frequent recipients of hip arthroscopic procedures. Anatomical changes during pregnancy may exacerbate existing hip pathologies such as femoroacetabular impingement (FAI) and labral tears, potentially leading to greater pain and risk of pregnancy complications. However, the impact of hip pain and arthroscopy on pregnancy-related decision-making and outcomes is poorly understood. The aims of this study were to determine (1) how pregnancy planning affected patients’ decisions to pursue hip arthroscopy, (2) whether undergoing hip arthroscopy affected hip pain before and after pregnancy, and (3) whether hip arthroscopy was associated with any pregnancy-related complications.

Methods

We retrospectively studied female patients aged 18-45 years who underwent hip arthroscopy for the treatment of FAI and/or labral tears at our center from 2010-2021. Eligible subjects were administered an electronic survey that assessed obstetrical history, concerns about how their hip pain and/or the process of undergoing hip arthroscopy could affect future pregnancies, location and intensity of hip pain at various time points, and pregnancy complications. Hip pain intensity was reported on a Visual Analog Scale (VAS). Subjects also completed the modified Harris Hip Score (mHHS). Continuous variables were compared within groups with Wilcoxon signed rank test and between groups with Kruskal-Wallis test. Fisher’s exact test was used to compare categorical variables between groups.

Results

A total of 86 patients completed the survey. Mean age at surgery was 32.3 ± 6.4 years, mean BMI was 24.5 ± 4.7, and mean follow-up time was 52.0 ± 34.3 months. Half of the cohort reported moderate or high concern that hip pain would worsen during future pregnancy, while a slight majority felt that hip surgery would not raise their risk of pregnancy complications (56.0%) or impair hip function after pregnancy (51.2%). 27 patients (31.4%) had become pregnant after hip surgery at an average of 6.3 ± 1.4 months postoperative, of whom 13 (48.2%) cited hip pain as a factor in getting surgery before pregnancy and 9 (33.3%) reported delaying a planned pregnancy to undergo surgery. Patients who became pregnant after surgery experienced a significant increase in VAS pain during pregnancy (p=0.02), though pain resolved after pregnancy in most (19 of 27, 70.4%). Of the 39 nulligravid patients, 28 (71.2%) were considering future pregnancy and 32 (84.2%) did not consider hip pain to be a factor in their nulligravid status. No significant difference in mHHS was found at latest follow-up between nulligravid patients, patients who had not been pregnant since hip surgery, and patients who got pregnant after hip surgery (mean 79.6 vs 80.0 vs 79.6, p=0.94).

Conclusions

Most female hip arthroscopy patients were not concerned that their surgery would have a negative impact on their pregnancy outcomes or hip function after pregnancy. Although hip pain was exacerbated during pregnancy, most patients experienced a resolution of pain following delivery. Pregnancy-related complications did not occur more frequently in the hip arthroscopy cohort compared to the wider U.S. population. Outcomes were comparable between nulligravid women and those who had only been pregnant prior to surgery.