High survivorship and excellent 5-year outcomes in patients older than 40 years undergoing arthroscopy for femoroacetabular impingement.

PURPOSE: To assess 5-year clinical outcome, in adults > 40 years of age, following hip arthroscopy for femoroacetabular impingement compared to a younger, matched, control group.

METHODS: All primary arthroscopies for FAI between 2009 and 2016 were considered (n = 1762). Hips presenting with Tönnis > 1, lateral centre edge angle < 25°, or prior hip surgery were excluded. Younger (< 40 years) and older hips (> 40 years) were matched for gender, Tönnis grade, capsular repair and radiological parameters. Survival (avoidance of total hip replacement {THR}) was compared between the groups. Patient reported outcome measures (PROMs) were also completed at baseline and 5 years to assess changes in functional capacity. Additionally, hip range of motion (ROM) was assessed at baseline and review. The minimal clinically important difference (MCID) was determined and compared between groups.

RESULTS: Ninety-seven older hips were matched to 97 younger controls (78% male in both groups). The average age of the older group at the time of surgery was 48.0 ± 5.7 years, compared to 26.7 ± 6.0. Six (6.2%) of the older hips and 1 (1%) of younger hips converted to THR (p = 0.043, effect size = 0.74, large). There were statistically significant improvements in all PROMs. At follow-up, there were no differences in PROMs between groups; significant improvements in hip ROM were also observed with no difference in ROM between groups at either time point. Similar achievement of MCIDs was observed in both groups.

CONCLUSIONS: Older patients experience a high survivorship rate at 5 years, although this may be lower than younger patients. Where THR is avoided, large clinically significant improvements in pain and function are observed.

LEVEL OF EVIDENCE: Level IV.