Do Female Athletes Return to Sports After Hip Preservation Surgery for Femoroacetabular Impingement Syndrome?: A Comparative Analysis

Abstract

Background:Female patients undergoing surgery for femoroacetabular impingement syndrome (FAIS) often experience inferior clinical outcomes and higher failure rates when compared with male patients. The influence of athletic status on hip arthroscopic outcomes in female patients, however, is unclear.Purpose:To compare patient-reported outcomes (PROs) of athletic and nonathletic female patients undergoing hip arthroscopic surgery for FAIS, and to determine the return-to-sports rate in the athlete group.Study Design:Cohort study; Level of evidence, 3.Methods:Two-year PROs were assessed in female patients who had undergone hip arthroscopic surgery for FAIS by a single surgeon. Patients who self-identified as athletes were compared with nonathletes. Preoperative and postoperative PRO scores including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport-Specific (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction were analyzed and compared between athletes and nonathletes. Subanalysis was performed based on patient age and body mass index (BMI).Results:A total of 330 female patients undergoing hip arthroscopic surgery for FAIS were identified. Of these, 221 patients identified as athletes (mean age, 29.1 ± 11.1 years; mean BMI, 23.0 ± 3.5 kg/m2) and 109 as nonathletes (mean age, 39.3 ± 11.4 years; mean BMI, 27.8 ± 5.8 kg/m2). Both groups demonstrated improvements in HOS-ADL, HOS-SS, mHHS, VAS for pain, and VAS for satisfaction scores (P < .001 for all). Athletes had significantly higher postoperative PRO scores compared with nonathletes (P < .001 for all). A 1:1 matched-pair subanalysis of 97 athletes and 97 nonathletes controlling for age and BMI indicated that these relationships held independently of potential demographic confounders (P < .001 for all). The number of patients meeting the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the HOS-ADL, HOS-SS, and mHHS was significantly higher in athletes aged ≤25 years versus those aged >25 years and for athletes versus nonathletes (P < .05 for all). Further, 189 of 194 athletes returned to sports at a mean of 6.0 ± 3.9 months postoperatively, with 93.7% reporting returning to the same or higher level of competition.Conclusion:Among female patients undergoing hip arthroscopic surgery for FAIS, patients considered athletes achieved superior clinical outcomes compared with patients considered nonathletes. In addition, younger female athletes had higher rates of achieving the MCID and PASS for all PRO measures.

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

“…In the present study, competitive athletes achieved the MCID for the HOS-SS (97.4% vs 82.5%) at significantly higher rates than nonathletes. This finding disagrees with Frank et al, 12 who exhibited that female athletes achieved the MCID at higher rates than female nonathletes not only in the HOS-SS but the HOS-ADL and mHHS as well. It is important to note that Frank et al used the MCID for each PRO that had already been established in the literature, which could allow for these thresholds to be more easily reached.…”

“…When female athletes versus female nonathletes were examined, the athletic population had superior clinical outcomes with significantly greater HOS-ADL, HOS-SS, and mHHS scores 2 years postoperatively. 12 With regard to the current study, competitive athletes had superior outcomes with significantly greater HOS-ADL and HOS-SS scores than nonathletes at a minimum of 2 years after surgery. Although their scores were not statistically significant, competitive athletes also had higher overall scores 2 years postoperatively in all other PROs when compared with nonathletes.…”

“…27 The number of studies comparing athletes and nonathletes after hip arthroscopy is lacking, with only a handful comparing these patient groups 12,27,34,43 and none of them examining competitive athletes (collegiate, semiprofessional, and professional) versus nonathletes. Three of these studies found that athletes had significantly better patient-reported outcomes (PROs) than nonathletes, 12,34,43 while the fourth demonstrated that athletes and nonathletes did not have statistically different outcomes. 27 When professional athletes were compared with recreational athletes, professional athletes displayed a quicker return to sports, but functional outcomes and rate of return to sports were similar between the groups.…”

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

“…The surgical technique used by the senior author for primary arthroscopic treatment of femoroacetabular impingement has been described. 11 Briefly, patients who were clinically and radiographically diagnosed with femoroacetabular impingement were selected for surgery after a trial of nonoperative management. Arthroscopy was performed with the patient in the supine position using the anterior, modified anterior, and distal anterolateral portals.…”

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

“…Large effect sizes for patient-reported physical activity (where able to be calculated) were seen in all studies at latest follow-up for the HOS, HOOS, HAGOS and iHOT33 subscales, with the exception of ten study groups for the HOS [44, 80,85,97,98,138,142,144,146,147]; and one for HAGOS [17] in which effect sizes were moderate pre-to post-arthroscopy. In assessing progress between two post-arthroscopy time points, Kemp et al [89] determined a small effect size for the HOOS-SR.…”