Preoperative osteoarthritis severity influences quality of life trajectories following hip arthroscopy in individuals with femoroacetabular impingement syndrome.

Abstract

Femoroacetabular impingement syndrome (FAIS), a known contributor to hip osteoarthritis, is frequently treated through hip arthroscopy. However, the impact of preoperative hip osteoarthritis severity on quality of life (QoL) post-surgery remains unclear. This study tested the hypothesis that individuals with moderate-to-severe hip osteoarthritis would show smaller QoL improvement over two years compared to those without or mild hip osteoarthritis. In this retrospective cohort study, 259 patients diagnosed with FAIS were included from a single orthopaedic clinic. Participants were categorized based on hip osteoarthritis severity using the Kellgren and Lawrence grade (KLG), with 147 classified as having no hip osteoarthritis (KLG ​= ​0), 77 with mild osteoarthritis (KLG ​= ​1), and 36 with moderate-to-severe osteoarthritis (KLG≥2 (72 ​% KLG ​= ​2, 25 ​% KLG ​= ​3, 3 ​% KLG ​= ​4)). QoL was assessed pre-operatively and at multiple post-operative time points using the 33-item International Hip Outcome Tool (iHOT-33). Linear mixed effects modelling assessed QoL changes over two years. All groups, regardless of hip osteoarthritis severity, demonstrated statistically significant improvements in iHOT-33 scores over two years postoperatively (p ​< ​0.001, d ​= ​0.20-0.79). Patients without hip osteoarthritis (β ​= ​0.32, 95%CI: 0.01:0.64, p ​= ​0.049) and those with mild osteoarthritis (β ​= ​0.28, 95%CI: 0.04:0.52, p ​= ​0.031) showed steady improvements in QoL. Conversely, those with moderate-to-severe osteoarthritis exhibited more limited QoL improvement (β ​= ​0.05, 95%CI: -0.14:0.23, p ​= ​0.452). Pre-operative hip osteoarthritis severity influenced postoperative QoL outcomes following hip arthroscopy in individuals with FAIS. Individuals without or with mild hip osteoarthritis experienced more consistent QoL improvements over two years compared to those with moderate-to-severe osteoarthritis. These findings highlight the importance of tailoring treatment strategies and managing patient expectations based on hip osteoarthritis severity. Level III (Observational Studies).