Superior functional outcomes after staged bilateral versus matched unilateral hip arthroscopy for femoroacetabular impingement syndrome at minimum 5-year follow-up.

Abstract

To evaluate the mid-term clinical outcomes of staged bilateral hip arthroscopy for patients with bilateral femoroacetabular impingement syndrome (FAIS) and to assess the influence of age on these outcomes, using unilateral hip arthroscopy as a control. Patients with bilateral FAIS who underwent staged bilateral hip arthroscopy between 2011 and 2020 was included in the study group. They were matched 1:2 by age, sex, and body mass index to a control group of patients who underwent unilateral hip arthroscopy. A total of 59 patients (118 hips) undergoing staged bilateral arthroscopy were matched to 118 unilateral cases. Patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were collected preoperatively and minimum 5-year postoperatively. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated and compared between groups. Subgroup analysis was performed within the study group to assess the effect of age on clinical outcomes. At a minimum 5-year follow-up, both groups showed significant improvements in all PROs (all P < 0.001). Compared to the unilateral group, the bilateral group exhibited significantly greater improvements from baseline in mHHS, iHOT-12, HOS-ADL and HOS-SSS (all p < 0.001), with comparable improvements in VAS (n.s.). According to subgroup analysis by age, significantly worse postoperative HOS-ADL (p = 0.019) and lower rate of achieving the PASS for iHOT-12 (p = 0.033) were found in patients ≥ 40 years. At a minimum 5-year follow-up, staged bilateral hip arthroscopy for patients with bilateral FAIS demonstrated superior functional improvement and similar pain relief compared to unilateral procedure performed for unilateral FAIS. Patients aged ≥40 years in the bilateral group had inferior outcomes compared to those < 40 years. These findings highlight the clinical relevance of staged bilateral hip arthroscopy as a viable treatment option for patients with bilateral FAIS, especially in younger individuals. Level III.