No Difference in Responders and Nonresponders to Preoperative Intra-articular Corticosteroid Injection Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome at 10 Years: A Matched Analysis.

Abstract

To compare 10-year patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship between patients who responded to intra-articular corticosteroid (IACS) injections and those who had no response to IACS injections after contemporary hip arthroscopy for femoroacetabular impingement syndrome. Retrospective review of patients undergoing primary hip arthroscopy between January 2012 and August 2014. Patients who received a preoperative IACS injection were divided based on whether they had symptomatic relief (responder group) or no relief (nonresponder group). Groups were propensity matched in a 1:1 ratio based on age, sex, body mass index (BMI), acetabular cartilage grade, and Tönnis grade. Demographics, radiographics, CSOs, and survivorship were compared. PROs were measured preoperatively and up to the 10-year follow-up, which included Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, and visual analog scale for pain and satisfaction. Survivorship was also compared. Overall, 116 responder patients (age: 36.4 ± 11.4 years, 67.2% female, BMI: 25.4 ± 4.7) were matched to 116 nonresponder patients (age: 36.6 ± 12.8 years; 62.1% female; BMI: 25.4 ± 4.6) (70.4% follow-up). No differences between groups were seen between any demographic or radiographic findings. Preoperatively, the responder group had significantly lower visual analog scale for pain scores compared to the nonresponder group (68.4 ± 17.5 vs 74.4 ± 17.2, P = .006). Otherwise, both groups saw similar outcomes scores for all other PROs preoperatively and at the 2-, 5-, and 10-year follow-up. CSO achievement was also similar between groups, with ≥97.6% of all patients achieving the minimal clinically important difference and ≥78.8% achieving the patient acceptable symptom state for ≥1 PRO. Reoperation survivorship was also similar between groups (P = .62). Response to IACS injection was not associated with differences in 10-year PROs, CSOs, or reoperation rates, despite lower preoperative pain scores in the responder group. While injections remain important tools in the evaluation of femoroacetabular impingement syndrome, our findings suggest that lack of relief after injection does not rule out the potential for successful long-term outcomes after hip arthroscopy. Level III, retrospective, matched case-control study.