Hip arthroscopy for FAI may reduce function, participation at 1-year postoperatively

Shane J. Nho, MD, MS

Thorborg and colleagues published a case series on hip arthroscopy for labral tears and FAI syndrome to evaluate patient-reported outcomes (PRO) after hip arthroscopy for FAI syndrome and/or labral injury at 3, 6 and 12 months postoperatively. They used the Copenhagen Hip and Groin Outcome Score (HAGOS) scoring system compared to the modified Harris Hip Score (mHHS). The study demonstrated statistically significant improvements only after 3 months for all HAGOS subscale and mHHS scores. Seventy percent of patients achieved minimal important improvements during the first year post-surgery. However, the ability to participate in sport and recreational activities, as well as their quality of life, were still markedly reduced 1 year after surgery.

One of the main points of discussion is patients may not fully reach a high level of function 1 year after hip arthroscopy for FAI syndrome when PROs that do not include a sport subscale are used. Commonly used legacy scores, such as the mHHS, may show significant improvement in activities of daily living, but do not reflect sports or recreational activities. Most previously published studies on hip arthroscopy have a minimum of 2-year follow-up, and it is possible many of these papers reflect the level of function at final follow-up.

Although the authors did an excellent job with the study, there are some limitations that should be discussed. The cohort from a consecutive series from a single surgeon from 2011 to 2014, which is relevant as the surgical technique, included treatment of the labrum with either debridement or repair, surgical correction of FAI syndrome, but capsular closure was not performed. More recent studies in hip arthroscopy for treatment of FAI syndrome and capsular management have shown more predictable outcomes, including return to sport. There were no postoperative radiographs obtained to confirm comprehensive correction of FAI syndrome. Also, the study group was somewhat older than in other published case series with a mean age of 37 years and a similar proportion of men and women. Within the study period, revision surgery was performed in two patients and conversion to total hip replacement in three patients.

The authors underscore the importance of needing both short-, mid- and long-term outcome studies to educate patients as to what improvements they can expect post-surgery. The study raises the question of whether patients are indeed able to return to sport or recreational activities after hip arthroscopy for FAI syndrome. If so, at what time point? Does this occur before 1 year as suggested by prior published series or does this occur much later than 1 year as suggested by the present study? It probably depends on multiple factors that include patient, age, level of activity, degree of degeneration, extent of pathomorphology, chondrolabral injury, surgical technique and rehabilitation.