Femoroacetabular impingement : increased waiting times lead to articular destruction in young adults

Hip arthroscopy is the treatment of choice for patients with femoroacetabular impingement (FAI), and it has been shown that outcomes are dependent upon symptom duration. However, the relationship between symptom duration and intra-articular injury pattern at time of arthroscopy has not previously been studied.

A retrospective review was conducted of all patients undergoing hip arthroscopy for FAI between January 2017 and December 2023, who were identified from the institutional database of Queen Elizabeth University Hospital, Glasgow, a tertiary referral, university-affiliated hospital. Times from referral and review to surgery, patient demographics, and intraoperative findings (Beck and University College London Hospitals (UCLH) classifications) were assessed. Multivariate and univariate linear regression analyses were performed to determine if there was a correlation between severity of cartilage injury and waiting time or patient demographics.

A total of 307 patients were eligible for inclusion. The mean age was 34 years (SD 9.2) and mean BMI 26.6 kg/m² (SD 4.5). Time from surgeon review to surgery, patient age, and α angle independently influence the severity of cartilage damage. All cartilage damage scores were significantly correlated to waiting times in males (Beck (r = 0.325; p < 0.001), UCLH (r = 0.248; p = 0.006), UCLH size of lesion (r = 0.197; p = 0.044)). Beck (2.88 vs 2.56; p = 0.027) and UCLH (2.50 vs 2.23; p = 0.038) scores were significantly higher in patients waiting > two years from referral to surgery compared to those who waited < two years. This was more apparent when male patients were analyzed separately (Beck (3.51 vs 2.66; p < 0.001) and UCLH (3.03 vs 2.29; p = 0.001)). Male patients waiting > six months from review to surgery also had significantly worse Beck scores than those waiting < six months (2.98 vs 2.33; p = 0.028).

Increasing waiting times are resulting in increased severity of intra-articular damage in patients undergoing hip arthroscopy for FAI. For the first time, longer waiting times have been correlated with worse cartilage injuries, independent of the size of the cam lesion, particularly in male patients.