Does Preoperative Activity Level Affect Postoperative Clinical Outcomes Following Hip Arthroscopy in Femoroacetabular Impingement Syndrome (FAIS) Patients?

Abstract

Objective: When considering surgical treatment options, many patients who undergo hip arthroscopy value continuing active lifestyles. To address these concerns, the purpose of this study was to determine the effect of preoperative activity level on postoperative patient-reported outcomes (PROs) in femoroacetabular impingement syndrome (FAIS) patients following hip arthroscopy.

Methods: Data was retrospectively reviewed for FAIS patients who received hip arthroscopy between 2016 and 2018. Patients were divided into active group and inactive group based on preoperative HOS-SSS scores. Preoperative active patients were 1:1 propensity-score matched to inactive patients based on age, sex, BMI, and follow-up period. PROs (HOS-ADL, HOS-ADL, iHOT-12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups by Student's t test.

Results: A total of 71 patients in the active group and 71 patients in the inactive group were found using propensity-score matching. Active patients had superior preoperative HOS-ADL, HOS-SSS, iHOT-12, mHHS (p < 0.001 for all), and VAS (p = 0.002) scores compared with inactive patients. At the final follow-up, active patients still had better PROs in HOS-ADL (p = 0.003), HOS-SSS (p < 0.001), iHOT-12 (p = 0.043), and mHHS scores (p = 0.003). There was no difference detected in postoperative VAS score (p = 0.117) between the two groups. However, inactive patients showed significantly higher net improvement in HOS-ADL (p = 0.009), HOS-SSS (p = 0.005), and iHOT-12 (p = 0.023).

Conclusions: Active patients have absolute higher preoperative PROs and achieve better postoperative PROs than inactive patients. However, inactive patients can obtain greater net improvements in PROs following hip arthroscopic surgery, with comparable pain alleviation as active patients.

Keywords: Activity Level; Femoroacetabular Impingement Syndrome; Hip Arthroscopy; Patient-Reported Outcomes.