Age and intraoperative cartilage status as determinants of mid-term functional outcomes after hip arthroscopy

The purpose of this study was to evaluate mid-term functional outcomes after hip arthroscopy for femoroacetabular impingement syndrome and to identify prognostic factors associated with postoperative outcomes at a minimum follow-up of 5 years.

A retrospective analysis was conducted on patients who underwent hip arthroscopy for femoroacetabular impingement syndrome performed by a single surgeon between 2015 and 2020. Patient-reported outcome measures (PROMs), including the Hip Outcome Score, Hip Outcome Score Sports Subscale, Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index, were collected preoperatively and at a minimum follow-up of 5 years. Intraoperative femoral and acetabular cartilage status was graded according to the Outerbridge classification. Univariate linear regression analyses were performed to identify variables associated with postoperative outcomes. Multivariate linear regression analysis was performed only for outcomes showing more than one candidate predictor at univariate analysis.

A total of 87 patients, accounting for 91 hips, were included. All PROMs demonstrated significant improvement from preoperative to postoperative assessment: Hip Outcome Score improved from 68.3 ± 8.5 to 93.5 ± 8.7, Hip Outcome Score Sports Subscale from 68.1 ± 9.0 to 92.4 ± 10.6, Harris Hip Score from 74.1 ± 9.9 to 95.4 ± 7.0 and Western Ontario and McMaster Universities Osteoarthritis Index from 14.5 ± 5.9 to 2.7 ± 5.7 (all p < 0.001). Increasing age was significantly associated with worse postoperative Hip Outcome Score (p < 0.001), Hip Outcome Score Sports Subscale (p = 0.037), and Harris Hip Score (p = 0.004), as well as with higher Western Ontario and McMaster Universities Osteoarthritis Index scores (p = 0.013). No significant associations were found between postoperative outcomes and sex, body mass index, labral pathology, or femoral and acetabular cartilage status. Multivariate analysis identified age as the only independent predictor of postoperative Harris Hip Score (β = -0.22; p = 0.005).

At mid-term follow-up after hip arthroscopy, patient age was identified as an independent predictor of functional outcomes, whereas intraoperative cartilage status was not independently associated with postoperative outcomes. These findings suggest that age should be considered a key prognostic factor in patient selection and preoperative counseling for hip arthroscopy.

Level IV.