Summary

Both patients with Tönnis grade 1 and Tönnis grade 0 demonstrated favorable outcomes. However, patients with Tönnis grade 1 had larger improvements in modified Harris Hip Score and visual analog scale score.

Abstract

Background

Research on the outcomes of arthroscopic treatment for femoroacetabular impingement (FAI) and labral tears in patients with mild osteoarthritis (OA) is limited, especially in the long term.

Purpose

The goal of this study is to evaluate the 10-year outcomes of arthroscopic treatment for FAI and labral tears in patients with mild preoperative osteoarthritis (Tönnis grade 1). Additionally, we compared these results to a control group without OA (Tönnis grade 0) to assess the impact of mild OA on long-term surgical success.

Methods

Data were collected retrospectively from patients who underwent hip arthroscopy between February 2008 and April 2014. We matched patients with Tönnis grade 1 in a 1 to 1 ratio with a control group of Tönnis grade 0 patients according to age, sex, BMI, labral treatment, capsular treatment, acetabular Outerbridge, and follow-up time. Included patients received treatment for labral pathology and had 10-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores, iHOT12 and satisfaction. We excluded patients with prior ipsilateral hip surgery, previous ipsilateral hip condition including hip fractures, slipped capital femoral epiphysis, avascular necrosis, and hip dysplasia (lateral center edge angle [LCEA] <18°), or were Worker’s compensation.

Results

Of 219 eligible hips, 174 had a minimum 10-year follow-up (80%) and were matched to 174 hips in the control group. Patients in both groups showed significant improvements in all PROs (P <0.01). The Tönnis 1 group showed greater improvement in mHHS (P = 0.03 comparing the delta pre-op to 10yr of the groups) and in VAS (P <0.01 comparing the delta pre-op to 10yr of the groups). The Tönnis 1 group showed lower but not significant improvement in HOS-SSS and had higher but not significant conversions to THA (30.4% vs. 24.1%). The requirement for a second arthroscopy was similar in both groups. Patient Satisfaction was 7.85 ± 2.45.

Conclusion

Patients in both groups demonstrated favorable outcomes for all PROs. Although both groups showed similar preoperative PRO scores, patients with Tönnis grade 1 had larger improvements in mHHS and VAS. Revision and conversion to arthroplasty rates were similar in both groups, but the Tönnis 1 patients converted sooner. Hip arthroscopy is a durable option for treating FAI and labral pathology in patients with Tönnis grade 1 or less.