Summary

This study investigated the 24-month quality-of-life outcomes after arthroscopic hip surgery for femoroacetabular impingement syndrome (FASI), finding that while all patients showed improvements, those with moderate-to-severe hip osteoarthritis experienced less favorable long-term trajectories compared to those with mild or no osteoarthritis.

Abstract

Purpose. Arthroscopic hip surgery is a recommended treatment for femoroacetabular impingement syndrome (FASI) that is intended to decrease symptoms, restore joint mechanics and disrupt articular cartilage damage, yet inconsistent evidence exists, and little is known about postoperative quality of life trajectories and its relationship with osteoarthritis severity. The purpose of this study was to investigate the 24-month post-arthroscopy quality-of-life trajectories in patients with and without hip osteoarthritis.

Methods. Patients were prospectively recruited from an orthopaedic clinic specializing in hip arthroscopic surgery. Signs and symptoms of FAIS included pain induced with flexion/abduction/external rotation, groin pain with hip flexion, and sharp pain with flexion/internal rotation, and an alpha angle >55 degrees. All participants underwent weight-bearing anterior-posterior and frog-leg radiographs of the pelvis prior to surgery and were used to quantify the degree of correction. The Kellgren and Lawrence (KLG) grade was used to categorize participants according to osteoarthritis severity including no radiographic evidence of hip osteoarthritis (KLG=0), mild hip osteoarthritis (KLG=1) and moderate-to-severe hip osteoarthritis (KLG≥2). All surgeries were performed by one experienced surgeon. Demographic data were collected preoperatively. Prior to surgery, at 2 and 6 weeks postoperatively, and at 3, 6, 12, and 24 months postoperatively patients were asked to complete the 33-item International Hip Outcome Tool (iHOT33). The change in iHOT33 score was calculated for each follow-up time point minus baseline. Linear regression analysis was performed to investigate the quality-of-life trajectories over time, using the group mean iHOT33 score for each time point as the dependent variable and time as the independent variable. Regression models were repeated for each group of osteoarthritis severity.

Results. Two hundred and sixty patients were recruited to participate. The mean age was 39±12 years, with 117 males (45%) and 143 females (55%), and BMI of 26.7±8.2kg/m2. The mean duration of symptoms prior to surgery was 47±97 months. Combined CAM-type and pincer-type deformities comprised 66% of the operative hips, with 14% as CAM-type and 20% as pincer-type only. Mean joint space narrowing of the hip prior to surgery was 4.5±0.9mm. Preoperatively, 147 participants were classified as KLG=0, 77 participants were classified KLG=1, and 36 participants were classified as KLG≥2. Across all participants, the iHOT33 reported at each postoperative time point was significantly greater than the preoperative score (p<0.001). In participants without radiographic evidence of hip osteoarthritis, quality-of-life significantly increased 4.0 points (95%CI: 2.8, 5.3; p=0.001) per postoperative visit., and in participants with mild hip osteoarthritis, quality-of-life significantly increased 3.4 points (95%CI: 2.7, 4.1; p<0.001) per postoperative visit. However, in individuals with moderate-to-severe hip osteoarthritis, quality-of-life non-significantly increased 0.8 points (95%CI: -0.81, 2.5; p=0.227) per postoperative visit.

Conclusions. Increases in quality-of-life trajectories were observed over time for all participants. Although short-term trajectories were similar between groups up to 12-weeks postoperative, long-term trajectories were less favourable for individuals with moderate-to-severe hip osteoarthritis. These findings may support clinicians in the management of patient expectations after surgery and help identify individuals requiring additional supports postoperatively.