Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome

Abstract

Background: A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group. Purpose: To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: The study was a retrospective analysis of all consecutive patients who identified as either a competitive athlete or a nonathlete and had undergone hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and April 2017. Patients in the 2 groups were matched 1:2 by age, sex, and body mass index. Baseline and clinical outcomes, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score, and international Hip Outcome Tool-12, were collected preoperatively and at 2 years postoperatively and compared between the groups. The MCID and substantial clinical benefit were calculated for each group separately and compared using chi-square analysis. Results: A total of 59 competitive athletes and 118 nonathletes were included in the final analysis. Most of the competitive athletes were soccer players (23.7%), followed by softball players (10.2%) and runners (10.2%). Postoperative score comparison between competitive athletes and nonathletes demonstrated a statistically significant difference in the HOS-SS (mean ± SD, 84.5 ± 19.0 vs 76.1 ± 23.8; P = .02). Meaningful outcome analysis demonstrated that competitive athletes had a higher rate of achieving the HOS-SS threshold for the MCID (97.4% vs 82.5%; P = .021). There was no other difference in frequency of achieving the threshold for any other meaningful clinical outcome between the groups. Conclusion: Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. However, competitive athletes achieved the MCID on the HOS-SS at higher rates than nonathletes and had significantly higher scores at 2 years postoperatively on the HOS-SS.

Threshold Values for Success After Hip Arthroscopy Using the Patient-Reported Outcomes Measurement Information System Assessment: Determining the Minimum Clinically Important Difference and Patient Acceptable Symptomatic State

“…20,21,24 Furthermore, a study of 330 female patients undergoing hip arthroscopy for femoroacetabular impingement reported that female athletes have significantly greater rates of achieving the PASS and MCID when compared with those of nonathletes. 14 This is supported by a recent age-, sex-, and body mass index-matched study by Clapp et al, 6 who applied separate MCIDs to competitive athletes versus nonathletes and found that competitive athletes had higher rates of attaining the MCID as compared with those of nonathletes. While it is not practical to calculate a separate PASS or MCID threshold for every descriptive characteristic, we found that athletes in general require higher postoperative scores to ''feel good'' than nonathletes.…”

Improvements After Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in High-Level Ice Hockey Players: 2-Year Outcomes by Player Position

“…The improvements in PROMs in this study are in accordance with previous literature on athletes undergoing hip arthroscopy, although most studies include athletes in general and not only ice hockey players. 6,15,28,29 However, a previous study of 28 professional ice hockey players reported improved outcomes in the modified Harris Hip Score and high patient satisfaction postoperatively after arthroscopic treatment for FAIS. 25 Furthermore, Schallmo et al 31 noted high rates of return to the NHL and significantly higher return to sport (91%) as compared with professional basketball, baseball, and American football players.…”

Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes

“…29 Although several studies have reported positive results in elite athletes treated with arthroscopic surgery, most use return to sports (RTS) or performance outcome. 3,6,38 However, only a few studies have used patient-reported outcome measures (PROMs) to present the results, 10,36,37,39 and the reports on the long-or midterm outcome in this patient category are limited. 9,33 Nevertheless, arthroscopic treatment in athletes presenting with FAIS is increasing, and studies suggest that high-level athletes will improve their hip function and have a high rate of return to preinjury activity levels.…”