2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Hip Arthroscopy for Patients with Generalised Joint Laxity and FAI Results in Significant Improvement in Clinical Outcomes, Comparable to Patients without Generalised Joint Laxity

David Filan, PhD, MSc, Waterford, Ireland IRELAND
Patrick Carton, MD FRCS(Orth) FFSEM, Waterford IRELAND

The Hip Preservation Institute, UPMC Whitfield, Waterford, IRELAND

FDA Status Not Applicable

Summary

Patients with a Beighton’s grade higher than 4 are suitable for arthroscopic hip surgery, demonstrating significant improvements in patient-reported outcomes, survivorship and clinically meaningful improvement comparable to those without generalised joint laxity.

Abstract

Introduction

Soft-tissue laxity and hip microinstability are increasingly recognised sources of pain and dysfunction, in addition to femoroacetabular impingement (FAI). The purpose of this study was to assess the pre-operative presentation and 2-year outcomes of arthroscopic treatment of FAI in patients with generalised joint laxity(JL).

Methods

A prospective institutional hip preservation registry was reviewed for cases undergoing primary hip arthroscopy(HA) for FAI, with labral and capsular repair between 2014-2022, with a documented Beighton Score. Two groups were formed: Joint laxity(JL) identified by Beighton>4, and a Control Group identified by Beighton 0. Exclusion criteria consisted of Tonnis>1, AVN, Protrusio. JL cases were matched in a 1:2 ratio with Control cases, based on gender and age±5 years. Patient-reported outcome measures(PROM) consisted of mHHS, UCLA, SF36 and WOMAC, evaluated pre-operatively and 2-years post-op. Cohort-specific minimal clinically important difference(MCID) thresholds were calculated for each PROM using a distribution-based 0.5SD technique, and rates of MCID achievement compared between groups. Range of movement(ROM) and symptom burden(SB, defined by the cumulative reporting of primary and secondary symptoms) was assessed pre- and post-operatively. Survivorship (total hip arthroplasty(THA) conversion and repeat HA) was compared between groups at 2-years. Statistical analysis was performed in SPSS v.26.0, with significance level p<0.05.

Results

74 JL and 760 Control cases met the inclusion criteria. 63 JL cases were matched to 126 Control cases and were included in the analysis; 54% male (p>0.999), 89% Tonnis 0 (p>0.999), mean age 32.1±10.8 (p=0.691).

Both groups had significant improvements in PROMs at 2-years post-op (p<0.001 for all). PROMs were similar between groups pre-operatively: mHHS (p=0.757), UCLA (p=0.308), SF36 (p=0.500), WOMAC (p=0.169); and post-operatively: mHHS (p=0.941), UCLA (p=0.686), SF36 (p=0.065), WOMAC (p=0.120). MCID thresholds were calculated as 8.9, 1.3, 9.3 and 8.2 for mHHS, UCLA, SF36 and WOMAC respectively. No difference in rates of achieving MCID between groups: mHHS (80% vs 84.7%, p=0.512), UCLA (60% vs 66.7%, p=0.511), SF36 (60.5% vs 66.2%, p=0.527), or WOMAC (69.7% vs 76.5%, p=0.456) for JL and Control cases respectively.

SB was not significantly different between groups, pre-operatively (6.8 vs 6.1, p=0.084), post-operatively (3.3 vs 3.0, p=0.665) or change from baseline to post-op (-3.4 vs -3.0, p=0.451) for JL and Controls respectively. For independent symptoms, higher proportion of JL cases reported pain in front of hip (60.7% vs 40.8%, p=0.011) and lower back (54.1% vs 36.0%, p=0.019) pre-operatively. Post-operatively, higher proportion of JL cases reported post-activity stiffness (64.4% vs 32.9%, p<0.001).

ROM was largely unremarkable between groups; adduction higher for Controls pre-operatively (25.0 vs 20.8, p=0.013, Cohen’s d=0.560) and abduction higher in the JL group post-operatively (53.1 vs 47.4, p=0.010, d=0.606).

Survivorship was not significantly different between groups: repeat HA (7.4% vs 10.3%, p=0.552); conversion to THA (3.6% vs 3.4%, p>0.999), for JL and Control group respectively.

Conclusion

Patients presenting with symptomatic hip pain undergoing arthroscopic surgery with generalised joint laxity have excellent 2-year clinical outcome and results are similar to that of patients with no generalised joint laxity. Patients with a Beighton’s grade higher than 4 are suitable for arthroscopic hip surgery.