Five-Year Follow-up After Hip Arthroscopic Surgery in the Horsens-Aarhus Femoroacetabular Impingement (HAFAI) Cohort

Abstract

Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few.

Purpose: To investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS.

Study design: Case series; Level of evidence, 4.

Methods: A total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperations and conversion to total hip replacement (THR) were recorded. We calculated the proportion of patients who exceeded the minimal important change (MIC), achieved the Patient Acceptable Symptom State (PASS), and were within the 95% reference interval of age- and sex-matched persons with no hip problems. Changes were investigated using paired t tests.

Results: Compared with preoperatively, all HAGOS subscales were improved substantially 5 years after surgery (mean, ≥21 points; P < .001), and 67% to 89% of patients reported improvements exceeding MIC. Between 56% and 80% achieved PASS, but only 7% to 24% reached the 95% reference interval for the HAGOS subscales. A total of 36% had a positive FADIR test and 25% had a positive FABER test, which were improvements compared with preoperatively (P < .001 for both). Patients with a positive FADIR test had significantly worse HAGOS subscales. Six patients (10%) had a THR since their primary hip arthroscopy. In the remaining patients, the mean LJSW was decreased (-0.4 mm; P = .043), and hip OA had worsened in 9 patients (23%; P = .003).

Conclusion: Five years after surgery, the majority of patients experienced HAGOS improvements exceeding MIC while also showing an acceptable PASS. However, clinical tests, participation in physical activities, and quality of life indicated that many patients still experience hip problems.

Registration: NCT04590924 (ClinicalTrials.gov identifier).

Keywords: clinical tests; femoroacetabular impingement; hip arthroscopy; hip osteoarthritis; patient-reported outcomes; total hip replacement.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this study was received from The Health Research Fund in the Middle Region of Denmark and the Augustinus Foundation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2022.

Figures

Figure 1.

Flow of patients from before hip arthroscopic surgery to the 5-year follow-up in the Horsens-Aarhus femoroacetabular impingement (HAFAI) cohort; 7 of 10 patients requiring reoperation and 2 of 6 patients who underwent total hip replacement completed the 5-year patient-reported outcome measures.

Figure 2.

HAGOS subscale values (0 = worst imaginable, 100 = no problems) before, 1 year after, and 5 years after surgery for femoroacetabular impingement syndrome in the Horsens-Aarhus femoroacetabular impingement cohort. *Statistically significant difference from before to 5 years after surgery. ADL, activities of daily living; HAGOS, Copenhagen Hip and Groin Outcome Score; PA, participation in physical activities; QoL, hip-related quality of life.

Figure 3.

HAGOS subscale values (0 = worst imaginable, 100 = no problems) for positive (ie, abnormal test result) and negative (ie, normal test result) ratings of (A) flexion, adduction, internal rotation (FADIR) test, (B) flexion, abduction, external rotation (FABER) test, and (C) psoas test. *Statistically significant difference (P < .05). ADL, activities of daily living; HAGOS, Copenhagen Hip and Groin Outcome Score; PA, participation in physical activities; QoL, hip-related quality of life.