Prolonged chronicity of symptoms has been implicated as one cause of suboptimal results after hip arthroscopy in patients with the syndrome of femoroacetabular impingement. The factors implicated are progression of the disease and the development of compensatory mechanisms of movement.
This hypothesis has now been confirmed by a recent study published in the journal “The American Journal of Sports Medicine”. The study set out to explain the effect of a longer duration of preoperative symptoms on patient-reported outcomes, the revision rate and clinical failure after hip arthroscopy for femoroacetabular impingement syndrome.
This retrospective study was carried out in patients who underwent hip arthroscopy between 2012 and 2014, with a minimum follow-up of two years. Demographic data, associated pathological conditions, preoperative scores and symptoms were compared in a group of patients who had had them for less than two years and in a comparison group who had had them for more than two years. The Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific (HOS-SS) and modified Harris Hip Score (mHHS) scales were used and the results were assessed by statistical methods.
624 patients with a mean age of 34 ± 13.5 years were included. 235 patients had had preoperative symptoms for two years or more. The patients whose symptoms had lasted less than two years had statistically significantly higher scores than those with symptoms for two or more years. The patients with a long duration of preoperative symptoms showed less improvement at two years after the operation. The same patients were also less likely to reach an acceptable symptom state on the Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific (HOS-SS) at the two-year reassessment. Finally, the patients with long-standing symptoms showed significantly higher rates of repeat arthroscopy.
The investigators concluded that patients with femoroacetabular impingement-related symptoms lasting two years or more before hip arthroscopy had statistically significantly worse patient-reported outcomes and higher revision rates at two years postoperatively when compared with patients with a shorter duration of preoperative symptoms.
Source: “The American Journal of Sports Medicine”, November 2018