Preoperative Symptom Severity Predicts 5-Year Hip Arthroscopy Outcomes

Purpose: This study sought to assess the prognostic effect of preoperative symptom severity on hip arthroscopy outcomes for femoroacetabular impingement syndrome (FAI). Methods: Patients undergoing hip arthroscopy between September 2012 and July 2014 for FAI with a minimum of 5-year clinical outcomes were compiled. Patient reported outcomes (PROs) including modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were collected. High and low preoperative function (PF) subgroups were created using baseline population median mHHS (43.3) as a threshold with PROs below the median score indicating low preoperative function and vice versa for scores above the median. Kaplan-Meier analysis, Cox proportional modeling, analysis of variance (ANOVA), and linear regressions were used for analysis. Results: One hundred five of 131 eligible patients (80.2% inclusion; age: 42.6 [+ or -] 1.4 years; body mass index: 25.3 [+ or -] 0.4 kg/[m.sup.2]) met the study criteria. The 5-year survival-to-revision rate (85% versus 61%, p = 0.013) and survival-to-arthroplasty rate (95% vs. 82%, p = 0.022) were greater in the high versus low PF group. ANOVA demonstrated the high versus low PF group had higher baseline (mHHS: 52.7 [+ or -] 1.4 vs. 36.1 [+ or -] 1.1, p < 0.001; NAHS: 57.4 [+ or -] 1.6 vs. 39.3 [+ or -] 1.2, p < 0.001) and 1-year (mHHS: 91.9 [+ or -] 1.8 vs. 79.5 [+ or -] 2.7, p< 0.001; NAHS: 91.7 [+ or -] 1.6 vs. 80.8 [+ or -] 2.5, p < 0.001) outcomes. High versus low PF achieved higher Minimal Clinically Important Difference (77% vs. 57%, p = 0.026) at 5-years. High versus low PF achieved higher Patient Acceptable Symptomatic State rates at 1 year (79% vs. 47%, p< 0.001) and 5 years (66% vs. 45%, p = 0.032). Linear regression demonstrated body mass index (mHHS: p = 0.002; NAHS: p = 0.005), pincer resection (mHHS: p = 0.046), and preoperative symptom severity (mHHS: p = 0.001; NAHS: p = 0.002) to be predictors of 5-year change in PROs. Conclusion: Preoperative symptom severity is a reliable prognostic indicator of clinical survival rates and PROs after hip arthroscopy for FAI. Subjects with high PF are likely to have increased longevity of the index procedure while maintaining excellent PASS and MCID rates mid-term as opposed to those with low PF.