Beyond arthroplasty conversion: Rethinking failure after hip arthroscopy for femoroacetabular impingement syndrome

Area of Science:

• Orthopedic Surgery
• Hip Preservation

Background:

• Hip arthroscopy is a common treatment for femoroacetabular impingement syndrome (FAIS).
• Defining treatment failure after hip arthroscopy remains challenging and debated.
• Current definitions may not encompass the full spectrum of unsuccessful hip preservation outcomes.

Purpose of the Study:

• To critically evaluate conversion to total hip arthroplasty (THA) as the primary endpoint for hip arthroscopy failure in FAIS.
• To highlight limitations of conventional radiographic parameters in predicting FAIS treatment failure.
• To advocate for a broader definition of treatment failure encompassing symptomatic persistence and revision without THA.

Main Methods:

• Literature review and critical analysis of existing studies on hip arthroscopy outcomes for FAIS.
• Discussion of the limitations of registry data and specific radiographic variables (e.g., alpha angle, Tönnis grade).
• Emphasis on emerging factors influencing long-term survivorship, such as cartilage status and technique-related factors.

Main Results:

• Conversion to THA represents a late and selective measure of hip arthroscopy failure.
• Symptomatic patients, those with minimal improvement, or undergoing revision without THA are not captured by THA conversion rates alone.
• Conventional radiographic measures may be insufficient to explain the heterogeneity of FAIS treatment failure.

Conclusions:

• The definition of treatment failure in FAIS requires a more comprehensive approach beyond THA conversion.
• Cartilage status, risk stratification, and surgical technique are likely more critical for long-term success.
• Future research should consider multifaceted endpoints and account for treatment-era effects in registry analyses.