Simultaneous Versus Staged Bilateral Hip Arthroscopy in the Treatment of Femoroacetabular Impingement

Purpose: To compare the clinical outcomes and complication rates of patients undergoing simultaneous versus staged bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement (FAI). Methods: Between 2010 and 2013, a total of 1,800 hip arthroscopy cases were retrospectively reviewed for cases of simultaneous bilateral hip arthroscopy. All patients with minimum 1-year follow-up were included. This group was matched 1:2 for age, sex, and alpha angle, to a control group of patients who underwent staged, bilateral procedures. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Scoree-Activity of Daily Living (HOS-ADL), and the Hip Outcome Scoree-Sport-Specific Subscale (HOS-SSS) were obtained preoperatively at 6 months and 1 and 2 years postoperatively. Results: Eighty-one patients (162 hips) were identified who underwent bilateral hip arthroscopy for symptomatic FAI. Twelve patients (24 hips) who underwent simultaneous bilateral arthroscopy with minimum 1-year follow-up were compared with a matched cohort of 24 patients (48 hips) who underwent staged bilateral procedures. Mean preoperative alpha angle was 65.3 degrees +/- 9.6 degrees in the simultaneous group and 65.9 degrees +/- 11.2 degrees in the staged group (P = .6). At a mean follow-up of 17.8 months (range, 12 to 33 months), there were comparable improvements in simultaneous versus staged patient-reported outcome scores (mHHS 90.8 +/- 11 v 88.9 +/- 12.5, P = .662; HOS-ADL 97.3 +/- 3.8 v 92.6 +/- 10.3, P = .057; HOS-SSS 93.3 +/- 10.2 v 86.5 +/- 16.6, P = .203). The mean single anesthetic traction time was 90.8 +/- 21.9 minutes (sum of both hips) in the simultaneous group, compared with a combined 2-anesthetic traction time of 85.7 +/- 27.2 minutes in the staged group (P = .579). There were no traction-related complications in either group. No patients in the simultaneous group required revision surgery, whereas 1 patient in the staged group required lysis of adhesions at 24 months postoperatively. Conclusions: In a small sample, simultaneous bilateral hip arthroscopy is shown to be safe and effective, resulting in similar improvements in patient-reported outcomes at 1-year follow-up compared with staged bilateral procedures.