Outcomes of Staged Bilateral Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome: A Nested Matched-Pair Control Study Focusing on the Effect of Time Between Procedures

Abstract

Background: Bilateral hip symptoms from femoroacetabular impingement syndrome (FAIS) are a common finding in patients regardless of athletic involvement. Oftentimes, patients and surgeons choose to stage bilateral hip arthroscopic surgery. Purpose/Hypothesis: The purpose of this study was (1) to compare minimum 2-year outcomes between patients who underwent staged bilateral hip arthroscopic surgery for FAIS to a propensity score–matched control group that underwent unilateral hip arthroscopic surgery and (2) to investigate the effect of time between bilateral procedures on patient-reported outcomes (PROs). We hypothesized that, after bilateral hip arthroscopic surgery, the improvement in outcomes would be similar to that after unilateral hip arthroscopic surgery and the time duration between bilateral procedures would not affect the final outcome. Study Design: Cohort study; Level of evidence, 3. Methods: Data were retrospectively reviewed on a consecutive series of patients who underwent primary hip arthroscopic surgery at our institution between June 2008 and November 2017. Patients who underwent bilateral hip arthroscopic surgery with minimum 2-year PROs for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sports Specific Subscale (HOS-SSS), patient satisfaction, and a visual analog scale (VAS) for pain were included. The study group was matched 1:1 based on age, sex, and body mass index to a control group that only required unilateral hip arthroscopic surgery. Additionally, a subanalysis was performed on the study group to determine the effect of time between arthroscopic procedures. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the mHHS and HOS-SSS were determined. The P value was set at <.05. Results: A total of 205 patients (410 hips) were included. The mean age and body mass index of the study group were 32.3 ± 13.2 years and 25.0 ± 5.1, respectively. All 410 hips that met the inclusion criteria were matched. There were no significant differences in patient, radiographic, or procedural data. A significant and comparable improvement was reported for all PRO measures and the VAS ( P < .0001) in both groups. Similarly, rates of achieving the MCID and PASS were comparable. After dividing the study group based on whether the contralateral procedure was performed <3 months or >3 months after the first procedure, it was determined that patients had a significant improvement and favorable outcomes regardless of time between bilateral procedures. Conclusion: Patients who underwent unilateral and bilateral hip arthroscopic surgery for FAIS had a significant and comparable improvement in PROs at a minimum 2-year follow-up. A time interval of <3 months or >3 months between bilateral procedures did not affect PROs.

Accelerated Bilateral Hip Arthroscopy (1 Week Apart): Outcomes Compared With Delayed Bilateral Procedure (4-12 Weeks) and Case-Control Matched Unilateral Arthroscopy

“…When the contralateral side is operated on >3 months after the first side, this may more closely resemble the experience of patients who undergo unilateral surgery. 2…”

“…It appears, therefore, that the time interval between procedures does not influence outcomes, a finding that has been previously demonstrated. 2,14 A key point of consideration, however, is that both staged groups in the current study underwent their procedures within the generally accepted literature-based time frame for management of bilaterally symptomatic FAI. 11,19 What this study adds to the literature is that an accelerated time between procedures (1 week) is a safe and effective strategy to improve symptoms and functional ability in athletes presenting with bilateral FAI symptoms and describes a novel time period for bilateral management.…”

“…When the contralateral side is operated on .3 months after the first side, this may more closely resemble the experience of patients who undergo unilateral surgery. 2 Kuhns et al 17 compared bilateral versus unilateral outcomes after HA. In their study, the bilateral group comprised a mix of patients who had bilateral symptoms (65%, undergoing staged bilateral surgery) and those who had symptoms unilaterally but developed symptoms on the contralateral side at a later date (35%).…”

“…MCID, minimal clinically important difference; mHHS, modified Harris Hip Score; SF-36, 36-Item Short Form Health Survey; UCLA, University of California Los Angeles activity scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index. the timing of surgery to the contralateral hip ranging from between 7.8 and 9.3 months (range, 1.0-69.7 months) 2,33,35 to 15 months. 11 Although none of these studies indicate whether symptoms were present bilaterally at the time of initial presentation or whether symptoms to the contralateral limb developed at a later date, it is likely there is a mix of patients grouped as ''bilateral,'' owing to the extended time frame between procedures.…”

“…In their bilateral symptomatic group, the contralateral, less symptomatic side was operated on within 3 months of the first side. More recent studies reporting outcomes for patients undergoing staged bilateral HA continue to vary, with the timing of surgery to the contralateral hip ranging from between 7.8 and 9.3 months (range, 1.0-69.7 months) 2,33,35 to 15 months. 11 Although none of these studies indicate whether symptoms were present bilaterally at the time of initial presentation or whether symptoms to the contralateral limb developed at a later date, it is likely there is a mix of patients grouped as “bilateral,” owing to the extended time frame between procedures.…”