Joint preservation after hip arthroscopy in patients with FAI. Prospective analysis with a minimum follow-up of seven years

Background: The purpose of this study is to evaluate the clinical outcomes, radiological degenerative progression and the joint preservation rate in a series of patients with Femoroacetabular Impingement (FAI) treated with hip arthroscopy at a minimum follow-up of 7 years. The predictive factors for total hip arthroplasty (THA) requirement were analyzed. Materials and methods: Between February 2008 and February 2009, 42 consecutive patients treated with hip arthroscopy due to FAI syndrome were included. There were 15 women and 27 men with an average age of 38 years (range 23 to 56 years). The surgery involved joint damage stabilization (labral tears and/or chondrolabral injuries) and correction of associated bony deformities (cam and/or pincer lesions). A prospective clinical follow-up was made with no patient lost. We specifically addressed the need for THA. Predictive factors for THA were also analyzed. Results: At final follow up, joint preservation rate was 83.33% (CI 95% 68,64%-93,03%). Probability of evolving to a THA in patients with radiographic preoperative Tonnis grades 0 and I was of 0% (CI 95%: 0-12.77). Probability of evolving to a THA in patients with preoperative Tonnis grades II and III was 46,67% (CI 95% 21.27%-73,41%). A statistically significant difference was present between both groups (p= 0.002). Patients older than 45 years at the time of hip arthroscopy were at significant risk of evolving to a THA (p=0.0012). Excluding those patients who undergone a THA: modified HHS was 88.25 points (80-96) and radiographic analysis addressed a 14,29% (IC95% 4,81%-30,26%) of progressive degenerative changes without affecting clinical results. Conclusions: Hip arthroscopy for the treatment of patients with FAI syndrome showed favorable results regarding joint preservation. Patients with preoperative radiographic evidence of advanced-stage osteoarthritis and those older than 45 years at the time of surgery have higher risk of requiring THA.