Editorial Commentary: Older Age, Higher Body Mass Index, and Female Sex May Be Associated With Inferior Long-Term Outcomes in Patients Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement, but With Modification of Risk Factors, Positive Results Can Still Be Achieved.

Abstract

Hip arthroscopy is a successful treatment option for patients with femoroacetabular impingement syndrome, with favorable reported outcomes at >10-year follow-up. Still, a minority of patients experience persistent symptoms postoperatively and potentially require reoperation, such as revision hip arthroscopy or conversion to total hip arthroplasty. There is strong evidence suggesting that patients with pre-existing osteoarthritis (Tönnis grade 2 or greater) at the time of primary surgery are at risk for inferior long-term clinical outcomes after hip arthroscopy. Higher body mass index (BMI), advanced age, and female sex have also been shown to be negatively associated with postoperative outcomes and increase the risk of reoperation in patients undergoing hip arthroscopy surgery. Of concern, nearly 42% of patients with femoroacetabular impingement syndrome undergoing hip arthroscopy in the United States are considered overweight or obese. With that being said, older age, high BMI, and female sex are not contraindications for undergoing primary hip arthroscopy. Older patients without the presence of degenerative changes can still achieve reliable outcomes after hip arthroscopy surgery. High BMI is a modifiable risk factor that can be optimized before proceeding with surgery. Female patients may be more likely to have microinstability, which can be addressed by hip capsulotomy repair. Favorable outcomes may be achieved with appropriate preoperative counseling, optimization of modifiable risk factors, and a patient-specific approach.