Summary

Patients with global overcoverage had significantly worse long-term survivorship 6- to 18-years following hip arthroscopy.

Abstract

PURPOSE/HYPOTHESIS: To compare long-term survivorship, joint space width (JSW), intra-operative findings, patient reported outcome measures (PROMs), pain levels, and patient satisfaction in hip arthroscopy patients with coxa profunda and acetabular overcoverage (CO) to a matched-control (MC) cohort. We hypothesized that CO patients achieved significantly worse PROMs and survivorship.

Methods

This retrospective analysis queried patients who underwent hip arthroscopy for labral tears secondary to FAI. Patients with complete PROMs at minimum 8-year follow-up, the presence of coxa profunda as indicated by an acetabular wall projecting medial to the ilioischial line, and a lateral center edge angle greater than 40° were matched 1:1 by sex, age, BMI, Tönnis grade, and labral treatment to a MC cohort that had normal acetabular coverage. Collected outcomes include the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), pain levels, and conversion to total hip arthroplasty (THA).

Results

38 CO patients were 1:1 matched to MC patients. When stratifying by severity of CLJ injury, a significantly greater proportion of CO patients had severe CLJ breakdown (21 [55.3%] vs 13 [31.6]; P = .037) (Table 2). CO patients had a significantly greater mean LCEa than MC patients (44.4 ± 3.9 vs 32.6 ± 3.6 degrees; P <.001). Differences between the CO and MC cohorts in JSW of the femoral head and acetabulum were significant, particularly over the most medial (50º) sourcil location: 10º (4.0 ± 0.8 vs 4.2 ± 1.0 mm; P = .520), 30° (3.9 ± 0.7 vs 4.2 ± 0.9 mm; P = .106), 50º (3.5 ± 0.6 vs 4.0 ± 0.8 mm; P = .002). At 0- to 6-years, there were no differences in mid-term rates of conversion to THA (CO: 6 [15.8%] vs MC: 4 [10.5%]; p = .384). Between 6- to 18-years, however, the CO cohort (5 [13.2%] vs 2 [5.3%]; P = .008) had significantly worse long-term survivorship following hip arthroscopy. There were no differences in mean PROMs between the CO and MC cohorts at final follow-up.

Conclusions

Patients with global overcoverage had significantly worse long-term survivorship 6- to 18-years following hip arthroscopy. Furthermore, CO patients had significantly lower ipsilateral JSW at 50o and greater severity of CLJ breakdown. Together, these findings reveal global overcoverage as a risk factor for progressive hip osteoarthritis and conversion to THA.