Poster 215: Time to Achievement of Clinically Significant Outcomes in Elite Athletes and Non-Athletes Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Authors: Kazi Omair , Vogel Michael J. , Wright-Chisem Joshua , Nho Shane J. 
Published: August 2024

Objectives:

Femoroacetabular impingement syndrome (FAIS) is a cause of hip pain that commonly affects an athletic population. As such, there is much interest in the hip preservation and sports medicine communities in exploring outcomes for athletes undergoing hip arthroscopy for FAIS. The purpose of our study was to (1) determine the time to achievement of clinically significant outcomes (CSO) in elite athletes and non-athletes following hip arthroscopy for FAIS and (2) identify what factors contribute to increased time to CSO in both cohorts.

Methods:

Consecutive patients undergoing hip arthroscopy for FAIS with available 6-month and 1-year follow-up were identified. Those who 1) underwent hip arthroscopy for reasons other than FAIS, 2) had prior ipsilateral hip arthroscopy, 3) underwent hip arthroscopy as part of a staged periacetabular osteotomy, 4) had Tonnis grade > 1 on preoperative radiographs, 5) had prior congenital hip disorder (i.e. slipped capital femoral epiphysis, Legg Calve Perthes) were excluded. Amongst those remaining, following the implementation of the inclusion and exclusion criteria, elite athletes were identified as those who competed in a sport at a collegiate, semi-professional, or professional level and non-athletes were identified as those who reported no participation in any sport activity. These two groups were propensity-matched at a 1:1 ratio, controlling for age, sex, and BMI. Previously established minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for Hip Outcome Score-Activities of Daily Living (HOS-ADL) and HOS-Sports Subscale (HOS-SS) were used to quantify CSO achievement. Kaplan-Meier survival analysis was performed to compare time to CSO achievement between groups. The time to 50% MCID and PASS achievement for HOS-ADL and HOS-SS in each group was identified. Stepwise Cox regressions were performed to identify predictors of delayed CSO achievement with the hazard ratios (HR) and confidence intervals (CI) recorded. Included covariates were age, sex, body mass index (BMI), level of sport competition, preoperative pain duration, grade of acetabular chondral defects, and grade of femoral head chondral defects.

Results:

Thirty-three elite athletes were matched to thirty-three non-athletes of similar age (22.2 ± 5.3 years vs. 24.0 ± 5.4, p = 0.174), sex (72.7% female, 78.8% female, p = 0.566), and BMI (24.4 ± 3.5 kg/m2 vs. 24.0 ± 4.2, p = 0.692). Kaplan-Meier survival analysis demonstrated no significant differences in time to CSO achievement between groups (p ≥ 0.218). However, time to 50% achievement of PASS for HOS-ADL and HOS-SS occurred approximately 5 months sooner in elite athletes than non-athletes (PASS HOS-ADL 6.5 months vs. 11.7 months; PASS HOS-SS 6.6 months vs. 11.6 months). No difference in time to 50% MCID achievement was observed (MCID HOS-ADL 5.5 months vs. 5.5 months; MCID HOS-SS 6.0 months vs. 5.3 months). In elite athletes, the presence and severity of acetabular chondral defects predicted delayed achievement of MCID for HOS-ADL (HR: 1.50, CI: 1.02 – 2.22) and PASS for HOS-ADL (HR: 2.22, CI: 1.34 – 3.69). In non-athletes, male sex predicted delayed achievement of PASS for HOS-ADL (HR: 3.50, CI: 1.06 – 11.56).

Conclusions:

Elite athletes and non-athletes who underwent primary hip arthroscopy for FAIS demonstrated similar overall time to CSO achievement, yet elite athletes reached 50% achievement of PASS for HOS-ADL and HOS-SS five months earlier. More severe acetabular chondral defects in elite athletes and male sex in non-athletes delayed CSO achievement.