Evaluating Long-Term Outcomes of Hip Arthroscopy in Adolescents with FAI
Excellent long-term outcomes have been reported in patients over age 18 who underwent hip arthroscopy to treat femoroacetabular impingment. What about in patients under age 18? What are the long-term outcomes in active adolescents diagnosed with FAI?
Jonathan D. Haskel, MD, and Kirk A. Campbell, MD
Menge TJ, Briggs KK, Rahl MD, Philippon MJ. Hip arthroscopy for femoroacetabular impingement in adolescents: 10-year patient-reported outcomes. Am J Sports Med. 2021 Jan;49(1):76-81. doi: 10.1177/0363546520973977. Epub 2020 Dec 1. PMID: 33259224
Femoroacetabular impingement (FAI) is a known cause of hip pain and disability, particularly in young, active populations. With approximately 96% of adolescents with FAI participating in athletics, it is important to appreciate the treatment options available for this condition, as well as their outcomes, so that patients can be appropriately counseled on an optimal treatment plan and realistic expectations.
Hip arthroscopy is an increasingly utilized surgical technique to treat intra-articular hip pathologies, such as labral tear, labral insufficiency, cam and/or pincer impingement, and hip micro-instability, and adult patients (age 18 and older) experience excellent short- and long-term outcomes when it is used to treat FAI. Although studies have investigated short-term outcomes of hip arthroscopy for FAI in adolescent patients, long-term data in this younger population are limited.
With this in mind, Menge et al evaluated 10-year patient-reported outcome scores (PROs) from adolescent patients who underwent hip arthroscopy for symptomatic FAI. They wanted to answer 3 questions:
- What were the PROs preoperatively and at a minimum of 10 years postoperatively?
- What were the operative findings in adolescents who underwent FAI surgery?
- What preoperative findings were associated with the need for revision hip arthroscopy?
The researchers identified 70 hips in 60 patients younger than age 18 at the time of surgery that met the inclusion criteria and had follow-up of 10 years of more. Combined-type FAI was most common in this cohort (76%), followed by cam-type FAI (13%) and pincer-type FAI (11%).
In patients who did not require a revision procedure, clinically significant improvements (P<0.01 for all outcomes scores) were seen in long-term follow-up for:
- Hip Outcome Score-Activities of Daily Living (HOS-ADL), from 64 postoperatively to 92 at follow-up
- Hip Outcome Score-Sports, from 40 to 86
- Modified Harris Hip Score (mHHS), from 56 to 88
- 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), from 41 to 54
Seven hips (10%) required revision hip arthroscopy at an average of 4 months from the initial procedure. All patients who underwent revision surgery were female and had lower HOS-ADL (P=0.02), mHHS (P=0.049), and SF-12 PCS (P=0.008) scores preoperatively. Revision was also associated with global laxity (P=0.045) as assessed using Beighton scoring, as well as longer duration of preoperative symptoms.
Femoroacetabular impingement is increasingly recognized as a cause of hip pain and disability in active patients, particularly among adolescents. Although most adolescent patients with FAI can be adequately managed non-operatively, certain patients may benefit from arthroscopic surgery, particularly those with cam-pincer combined FAI who fail a dedicated trial of conservative care.
Significant short- and mid-term functional improvements have been seen in adolescents who underwent hip arthroscopy for FAI. The study by Menge et al offers a long-term perspective on the procedure, with excellent patient-reported outcomes that are maintained for a minimum of 10 years postoperatively.
At 10%, the revision rate in this study was higher than in other studies investigating outcomes of FAI surgery among adolescents. The authors attributed this finding, in part, to the fact that most of the revisions took place early in the data collection period, potentially representing the learning curve associated with hip arthroscopy. In addition, the implants used during that time period are no longer utilized, and improved rehabilitation protocols have since been instituted. In fact, the revision rate was 0% following the institution of the new rehabilitation protocols after 2006.
The findings of this study suggest that in general, surgeons can expect excellent patient-reported outcomes in adolescents with FAI who undergo hip arthroscopy. The study also identified patients who are at higher risk of requiring revision surgery:
- Female patients with lower patient-reported outcome scores
- Patients with ligamentous laxity
- Patients with longer duration of preoperative symptoms
Female patients and patients with ligamentous laxity are often able to perform supra-physiologic range of motion at the hip; therefore, a stable labral repair with capsular closure is paramount to prevent micro-instability of the hip following surgery. Future studies that investigate the role of labral repair versus augmentation in patients with ligamentous laxity may guide treatment for this particular patient population, which could potentially minimize the risk for revision hip arthroscopy.
Jonathan D. Haskel, MD, is a resident physician at NYU Langone Orthopedic Hospital, New York, New York. Kirk A. Campbell, MD, is an Assistant Professor of Orthopedic Surgery, Division of Sports Medicine, at NYU Langone Orthopedic Hospital, New York, New York.
Disclosures: The authors have no disclosures relevant to this article.