Background:There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy. Purpose:To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs). Study Design:Cohort study; Level of evidence, 3. Methods:This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°). Results:In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m2. Women experienced a higher frequency of SLT than men (59.8% vs 40.2%; P = .003). Student t tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS, HOS-ADL, and iHOT-33. Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that LLT size can predict worse long-term outcomes after hip arthroscopy for mHHS and HOS-ADL (P < .05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT was significantly greater than that for SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; P < .0001). Conclusion:Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area of Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. The purpose of the present study is to investigate the influence of neighborhood-level socioeconomic status (SES) on functional outcomes following hip arthroscopy. Methods: This retrospective analysis of prospectively collected data queried patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears secondary to FAI. The study population was divided into ADILow and ADIHigh cohorts according to ADI score, a validated measurement of neighborhood-level SES standardized to yield a score between 1 and 100. Collected patient-reported outcomes measures (PROMs) included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), VAS pain score, and patient satisfaction. Results: 228 patients met inclusion criteria and were included in the final analysis. After stratifying patients by ADI score, the ADILow (n = 113; mean ADI: 5.8 ± 3.0; range: 1 to 12) and ADIHigh (n=115; mean ADI: 28.0 ± 14.5; range: 13 to 97) cohorts had no differences in baseline patient demographics. ADIHigh patients reported significantly worse pre-operative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, patients in both cohorts achieved similar rates of MCID for all 5 PROMs and PASS for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving MCID for all PROMs except for iHOT-33. Conclusions: Although hip arthroscopy patients experiencing greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving MCID. The present study is merely a first step towards understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research are necessary to advance care for patients from disadvantaged communities.

Introduction: While the impact of social determinants of health (SDOH) has become increasingly emphasized across orthopaedic surgery, to date, there exists limited research assessing the role of SDOH in hip arthroscopy. The purpose of this study was to investigate the impact of SDOH on 30-day emergency department (ED) visits, 90-day postoperative complications, and 5-year revision rates after primary hip arthroscopy using a large national database. Methods: A national administrative claims database was used to identify patients who underwent primary hip arthroscopy between 2015 and 2022. Patients were queried for whether they experienced any SDOH, including economic, educational, environmental, or social disparities; those experiencing SDOH within 1 year prior to primary hip arthroscopy were matched 1:1 by age, sex, Elixhauser Comorbidity Index score, diabetes, obesity, and tobacco use to patients not experiencing any lifetime SDOH. Rates of 90-day complications and 30-day ED visits were compared using multivariable logistic regression. Rates of revision hip arthroscopy within five years were compared by Kaplan-Meier analysis. Results: A total of 3,383 primary hip arthroscopy patients who experienced SDOH were matched 1:1 to a control cohort of 3,383 patients who had not experienced SDOH. Rates of adverse events following arthroscopy were low and not significantly different between cohorts (SDOH: 1.51%, vs. No SDOH: 1.57%). Additionally, there was no significant difference in rates of 30-day ED visits (SDOH: 5.65%, vs. No SDOH: 4.79%). The rate of 5-year revision hip arthroscopy was significantly greater among patients experiencing SDOH (5.4% vs. 4.1%). Conclusions: Patients experiencing SDOH within one year prior to primary hip arthroscopy had similar rates of postoperative complications and ED visits but greater odds of 5-year revision hip arthroscopy compared to a matched-control cohort of patients not experiencing SDOH. These data highlight the significant impact of SDOH on long-term postoperative outcomes and bring to light the growing importance of multidisciplinary, culturally-competent orthopaedic care that equitably improves the health of all patients.

Background: Global acetabular retroversion has been associated with an increased risk of hip osteoarthritis, femoroacetabular impingement, and intra-articular soft tissue abnormalities. However, the role of global acetabular retroversion on total hip arthroplasty (THA)–free survivorship has not been explored. Purpose: To compare long-term THA-free survivorship after primary hip arthroscopic surgery between patients with global acetabular retroversion and a propensity score–matched control group without global acetabular retroversion. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study examined patients aged ≥18 years with a minimum 8-year follow-up who underwent primary hip arthroscopic surgery by a single surgeon between May 2001 and September 2013 for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. Patients with global acetabular retroversion, indicated by the combined presence of a crossover sign, ischial spine sign, and posterior wall sign on preoperative supine pelvic radiographs, were 1:1 propensity score matched by age, sex, body mass index, and labral treatment (repair vs debridement) to controls without global acetabular retroversion. Patient, radiographic, and intraoperative variables were compared between groups. Cox multivariate regression, controlling for global acetabular retroversion and Tönnis grade, was used to assess conversion to THA. Patient-reported outcome measure (PROM) scores were also compared between groups. Results: Overall, 49 patients (49 hips) with global acetabular retroversion were 1:1 matched to 49 controls, with a mean follow-up of 10.7 ± 2.1 and 11.1 ± 2.8 years, respectively ( P = .524). There were no significant differences in patient characteristics and radiographic findings between groups. Patients with global acetabular retroversion had significantly greater rates of severe chondrolabral junction breakdown ( P = .010). Unadjusted Kaplan-Meier survival curves analyzed by the log-rank test demonstrated significantly decreased survivorship among patients with global acetabular retroversion (68.6%) compared with matched controls (83.9%) at final follow-up ( P = .036). Cox multivariate regression demonstrated that patients with global acetabular retroversion had a significantly greater risk of conversion to THA (hazard ratio, 3.94; P = .039). There were no statistically significant differences in any PROM scores at final follow-up. Conclusion: Patients with global acetabular retroversion had significantly inferior THA-free survivorship at a minimum 8-year follow-up after hip arthroscopic surgery relative to matched controls as well as greater rates of severe chondrolabral junction breakdown, despite no statistically significant differences in PROM scores at final follow-up among patients not converting to THA. These findings suggest that global acetabular retroversion on preoperative radiographic assessments may be a valuable predictor of long-term failure after hip arthroscopic surgery.

Abstract Background: The purpose of this study was to investigate the effects of neighborhood-level socioeconomic disadvantage on healthcare accessibility and long-term functional outcomes for patients undergoing hip arthroscopy. Methods: This retrospective analysis queried patients ≥18 years old with minimum 8-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. Utilizing the ADI score as a validated measurement of neighborhood-level socioeconomic disadvantage, the study population was divided into quartiles. Patients in the least and most disadvantaged quartiles represented the ADILow and ADIHigh cohorts, respectively. Healthcare accessibility and socioeconomic disadvantage were compared between ADI cohorts using rural classification, health professional shortage area designation (HPSA), medically underserved area/population (MUA/P) designation, insurance status, level of education, and household income. Collected PROMs included mHHS, HOS-ADL, HOS-SSS, NAHS, iHOT-33, pain levels, patient satisfaction, and rates of conversion to THA. Results: 86 patients were stratified to the ADILow (n=43; ADI score: 4.0±2.1) and ADIHigh (n=43; 37.7±12.1) cohorts. When comparing healthcare accessibility, a greater proportion of ADIHigh patients resided in rural communities, primary care HPSAs, and MUA/Ps. At a patient level, the ADIHigh cohort had lower levels of insurance coverage, education, and household income. Finally, ADIHigh patients achieved worse functional outcome scores for mHHS (79.3±14.6 vs. 90.1±13.9; P=.008), NAHS (80.7±14.9 vs. 87.5±15.3; P=.043), HOS-ADL (84.7±14.8 vs. 91.6±11.8; P=.020), and iHOT-33 (66.8±26.0 vs. 78.2±24.2; P=.0041). By multivariate logistic regression, ADIHigh patients were approximately 5 and 10 times less likely to achieve 10-year clinically meaningful thresholds for HOS-ADL (OR: 0.22; P=.031) and mHHS (OR: 0.10; P=.002), respectively. Despite having significantly worse PROMs, ADIHigh patients converted to THA at a statistically similar rate (ADIHigh: 11.6% vs. ADILow: 20.9%; P=.243). Discussion and Conclusions: Hip arthroscopy patients from neighborhoods with greater ADI scores experience worse healthcare accessibility and inferior long-term functional outcomes at minimum 8-year follow-up.

Introduction: Global acetabular retroversion has been associated with increased risk of hip osteoarthritis, femoroacetabular impingement (FAI), and intraarticular soft tissue pathology. However, to date, the role of global retroversion on total hip arthroplasty (THA)-free survivorship has not been explored. The purpose of the present study was to compare long-term survivorship following primary hip arthroscopy between patients with global acetabular retroversion and a propensity-matched control group. Methods: This retrospective study queried patients >18 years, with preoperative hip and pelvic radiographs, and minimum 8-year follow-up that underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients with global acetabular retroversion, as indicated by the presence of a crossover sign, ischial spine sign, and posterior wall sign on preoperative pelvic radiographs, were propensity-score matched 1:1 by age, sex, body mass index (BMI), and labral treatment (repair versus debridement) to controls. Baseline demographic, radiographic, and intraoperative variables were compared between cohorts. Cox multivariate regression controlling for global retroversion and Tönnis grade was used to assess conversion to THA. Patient-reported outcome measures (PROMs) were compared between cohorts. Results: Overall, 49 patients with global retroversion were 1:1 matched to 49 controls, with mean follow-up of 10.7 ± 2.1 years and 11.1 ± 2.8 years, respectively. There were no significant differences in baseline demographics, radiographic findings, or intraoperative findings between cohorts (P>0.05 for all). Unadjusted Kaplan-Meier survival curves analyzed by log-rank test demonstrated a significantly decreased survivorship among patients with global retroversion (68.6%) compared to controls (83.9%) at final follow-up (P=0.036). Cox multivariable regression controlling for Tönnis grade demonstrated that patients with global retroversion had a significant greater risk of THA conversion (hazard ratio, 3.94; p=0.038). There were no differences in PROMs at final follow-up between cohorts (P>0.05 for all). Conclusion: Patients with global acetabular retroversion had significantly inferior THA-free survivorship at minimum 8-year follow-up relative to matched controls, despite no differences in PROMs at final follow-up for patients who did not undergo THA. These findings suggest that global retroversion by preoperative radiographic assessment may be a useful predictor of long-term failure and that patients should be counseled accordingly.

Objectives: Preliminary findings in the literature suggest that treatment with bone marrow aspirate concentrate (BMAC) at the time of hip arthroscopy is a potentially viable solution to improve outcomes in patients with cartilage degradation concomitant to acetabular labral tearing; however, functional scores to date have not eclipsed 24 months. Therefore, the present study compares minimum five-year outcomes in patients treated with or without BMAC augmentation to address chondral damage during arthroscopic labral repair. Methods: This is a case-control study analyzing prospectively collected data in patients who underwent acetabular labral repair from a single surgeon between May 2014 and January 2019. Patients were stratified into either the 1) BMAC cohort or the 2) control cohort depending on whether or not BMAC was used to address chondrolabral junction breakdown secondary to femoroacetabular impingement (FAI) and labral tearing during surgery. Patients were only included for data analysis if they: 1) underwent primary acetabular labral repair on their affected hip and 2) completed PROMs preoperatively and at 60 months after surgery. Exclusion criteria consisted of: 1) previous ipsilateral hip arthroscopy; 2) labral debridement; 3) a lateral center edge angle (LCEa) of <20º; and 4) <5 years of follow-up. Univariate analyses were performed using unpaired t test and chi-square/Fisher exact test as appropriate to draw baseline comparisons between groups. Informed by these unadjusted analyses, primary regressions included the following variables as fixed effects to compare PROMs at each timepoint via mixed-effect modeling: time (months), BMAC augmentation, BMAC*time interaction, age, sex, osteoplasty procedure performed, and intraoperative breakdown of chondrolabral junction. Statistical analysis was performed using R Version 4.2.1 or SPSS Version 29.0.2.0 and P < 0.05 was considered significant. Results: 81 hips were included for analysis: 39 from the BMAC cohort and 42 from the control cohort. Univariate analyses demonstrated similar baseline characteristics between both groups with regard to BMI (BMAC: mean=39.0kg/m 2 ± SD of 3.9kg/m 2 versus no BMAC: 25.3kg/m 2 ± 4.4; p=0.856); Tönnis angle (1.4º ± 7.9º vs. 2.6º ± 7.2º; p=0.502), lateral center edge angle (LCEa) (35.5º ± 7.2º vs. 35.7º ± 6.2º; p=0.879); and alpha angle (54.3º ± 14.9º versus 50.3º ± 16.6º; p=0.262) ( Tables 1 & 2 ). In the adjusted analysis, patients treated with and without BMAC experienced similar PROMs at enrollment, 3 months, and 6 months, with the exception of iHOT-33 at enrollment (BMAC: mean = 48.3 [95% CI = 39.5, 57.0] versus no BMAC: 38.1 [30.1, 46.1]; p = 0.033) ( Table 3 ). At 12 months, patients treated with BMAC demonstrated significantly higher HOS-ADL scores than those without (92.7 [86.8, 98.7] versus 85.7 [80.2, 91.2]; p = 0.037); however, mHHS, iHOT-33, and HOS-SS scores were similar at this timepoint (p > 0.05). At 24 months, patients treated with BMAC reported significantly higher mHHS (91.7 [85.7, 97.7] versus 82.1 [76.6, 87.6]; p = 0.004), iHOT-33 (86.3 [77.5, 95.1] versus 74.2 [66.2, 82.2]; p = 0.012), and HOS-ADL (93.9 [87.9, 99.8] versus 85.0 [79.6, 90.5]; p = 0.008) scores. This trend continued at 60 months, as patients treated with BMAC showed significantly higher mHHS (95.5 [89.6, 100.0] versus 83.9 [78.4, 89.4]; p < 0.001), iHOT-33 (91.5 [82.7, 100.0] versus 78.3 [70.2, 86.3]; p = 0.006), and HOS-SS (87.7 [75.7, 99.7] versus 71.4 [60.4, 82.4]; p = 0.012) scores. These results held in the unadjusted sensitivity analyses ( Figure 1 ). Conclusions: Patients who underwent BMAC augmentation during arthroscopic labral repair outperformed patients who underwent labral repair alone without BMAC. This difference started to manifest at 12 months postoperatively and steadily increased in contrast until 5 years after surgery. These findings remain consistent with short-term reports and add mid-term outcomes to the growing body of literature that describes the patient-reported effect of BMAC as an adjuvant therapy during hip arthroscopy.

Background:Despite the increasing utilization of hip arthroscopy and identification of predictors of poor outcomes, the effect of short-term improvement on long-term functional outcomes has been understudied. Purpose:To determine whether improvements in patient-reported outcomes (PROs) 6 months after hip arthroscopy predict 5-year outcomes. Study Design:Case-control study. Methods:A retrospective review of prospectively collected data identified patients ≥18 years who underwent primary hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears. Included patients had a Tönnis grade <2 and completed PROs at baseline, 6-month, and minimum 2-year follow-up, and annually thereafter. The minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS), 8 points, was used to stratify patients into cohorts based on high improvement (HI) versus low improvement (LI) at 6 months. PROs were compared at 1, 2, 3, 4, and 5 years postoperatively by rates of MCID achievement and linear mixed-effects modeling. Subsequent surgery rates were compared by chi-square or Fisher exact tests, as appropriate. Results:Overall, 175 patients (age, 37.2 ± 11.4 years; 52.0% female) met inclusion criteria. Of these, 131 HI patients were compared with 44 LI patients. At 5 years, 88.3% of HI patients reached MCID, versus 42.1% of LI patients (P < .001). By multivariable logistic regression, achievement of 6-month MCID (adjusted odds ratio [AOR], 17.43; P < .001) and labral management (augmentation, relative to debridement: AOR, 14.5; P = .01) predicted achievement of 5-year MCID. mHHS scores were greater for HI versus LI patients through 3-year follow-up (P < .05) but were not significantly different at 4 and 5 years. Subsequent surgery rates were 9.9% and 11.4% in HI versus LI patients, respectively (P > .05). Conclusion:The study demonstrates that early functional improvements after hip arthroscopy, assessed by 6-month MCID, predicted clinically meaningful outcomes at 5-year follow-up, underscoring the importance of early cautious recovery to prioritize labral healing while also meeting appropriate, stepwise rehabilitation milestones to advance functionally during these 6 months. Despite this, LI patients continued improving for 5 years, demonstrating that late functional improvements are still possible for certain patients in the event of a poor 6-month rehabilitation period.

Background: Reduced absolute joint space width (JSW) has been shown to correlate with higher rates of total hip arthroplasty (THA) after hip arthroscopy. Purpose: To determine if quantitative differences in JSW between the operative and contralateral hips at the time of hip arthroscopy affect the risk of conversion to THA. Study Design: Case-control study; Level of evidence, 3. Methods: This retrospective analysis queried patients with preserved JSW (>2 mm) who underwent arthroscopic acetabular labral repair with minimum 5-year follow-up, performed by a single surgeon. Patients were grouped based on whether they received subsequent THA. Preoperative anteroposterior supine pelvic radiographs were obtained for each patient, and quantitative JSW measurements were performed at 3 fixed locations (10°, 30°, and 50° in a polar coordinate system, relative to the 0° line drawn from the center of the femoral head to the lateral edge of the acetabular roof). Measurements were obtained by an independent, blinded assessor in a semiautomated fashion, with intraclass correlation for this approach >0.8. JSW differences at each angle were calculated by subtracting the width in the operative hip from that of the nonoperative hip. Cox proportional hazards modeling identified predictors of THA conversion. Results: A total of 106 patients with mean follow-up of 8.23 ± 2.24 years were included; 21 (19.8%) converted to THA and 85 (80.2%) did not. THA patients had higher mean age (40.4 ± 13.1 years; P = .006), body mass index (27.2 ± 3.9 kg/m 2 ; P = .02), Tönnis grade (90.5% ≥ grade 1; P < .001), and Outerbridge grade (90.5% grade 3-4; P = .01). THA patients had a significantly greater difference in JSW at 10° (0.494 ± 0.985 mm vs −0.064 ± 0.609 mm; P = .009), 30° (0.779 ± 0.839 mm vs 0.029 ± 0.507 mm; P < .001), and 50° (0.358 ± 0.832 mm vs −0.044 ± 0.527 mm; P = .045) compared with those not requiring THA. Adjusting for differences in JSW at all 3 locations in Cox regression, the 30° difference remained associated with conversion to THA ( P < .001). In final modeling with age, sex, and Tönnis grade, greater JSW reductions at 30° were correlated with increased risk of THA (hazard ratio, 3.07; 95% CI, 1.75-5.38; P < .001). Conclusion: This study found that greater JSW reductions in the operative versus nonoperative hip were associated with increased risk of THA conversion. In conjunction with known predictors of failure after hip arthroscopy, preoperative JSW differences may be used as an adjunct to assess risk of early THA and counsel patients appropriately.

Introduction: Preliminary findings in the literature suggest that treatment with bone marrow aspirate concentrate (BMAC) at the time of hip arthroscopy is a potentially viable solution to improve outcomes in patients with cartilage degradation concomitant to acetabular labral tearing; however functional scores to date have not eclipsed 24 months. Therefore, the present study compares minimum five-year outcomes in patients treated with or without BMAC augmentation to address chondral damage during arthroscopic labral repair. Methods: This is a case-control study analyzing prospectively collected data in patients who underwent acetabular labral repair with concomitant acetabular breakdown between May 2014 and January 2019. Patients were stratified into either the 1) BMAC cohort or the 2) control cohort depending on the presence or absence of BMAC during surgery. Comparisons were made between cohorts with respect to baseline demographics, intraoperative variables, radiographic measurements, and patient-reported outcomes (PROMs) at 3, 6, 12, 24, and 60 months post-repair. Results: 81 hips were included for analysis: 39 from the BMAC cohort and 42 from the control cohort. At baseline, both groups presented with similar BMI (BMAC: mean=39.0kg/m2 ± SD of 3.9kg/m2 versus no BMAC: 25.3kg/m2 ± 4.4; p=0.856); Tônnis angle (1.4º ± 7.9º vs. 2.6º ± 7.2º; p=0.502), lateral center edge angle (LCEa) (35.5º ± 7.2º vs. 35.7º ± 6.2º; p=0.879); and alpha angle (54.3º ± 14.9º versus 50.3º ± 16.6º; p=0.262); as well as similar adjusted baseline scores according to mHHS (mean=59.8 [95% confidence interval = 56.1 to 68.0] vs. 61.1 [55.6, 66.6]; p=0.760); HOS-ADL (70.8 [64.9, 76.7] vs. 68.5 [63.0, 74.0]; p=0.490); and HOS-SS (40.6 [28.6, 52.6] vs. 33.4 [22.4, 44.4]; p=0.267). By 60 months, treatment with BMAC yielded significantly improved results compared to the control cohort according to mHHS (95.5 [89.6, 100.0] vs. 83.9 [78.4, 89.4]; p=<.001); iHOT-33 (91.5 [82.7, 100.0] vs. 78.3 [70.2, 86.3]; p=0.006); and HOS-SS (87.7 [75.7, 99.7] vs. 71.4 [60.4, 82.4]; p=0.012). Discussion/Conclusion: This study adds to the growing body of literature that describes the use of BMAC during acetabular labral repair, as it agrees with previous 24-month findings and includes mid-term follow-up to examine how this relationship persists over time.

Background: To investigate if bone marrow aspirate concentrate (BMAC) is an efficacious and cost-effective adjuvant therapy for preventing long-term conversion to total hip arthroplasty (THA). Methods: This study queried patients who underwent arthroscopic repair of symptomatic acetabular labral tears secondary to femoroacetabular impingement (FAI). Patients between 18 and 50 years old with minimum 2-year follow-up and Tönnis grade 0 or 1 were included. The study population was divided into cohorts (BMAC vs. No BMAC) according to BMAC augmentation at the time of labral repair. The study’s survival endpoint was the longest follow-up timepoint completed by a BMAC patient; “failure” was defined as conversion to THA. A weighted Cox regression estimated BMAC’s efficacy for improving hip arthroscopy survivorship. BMAC cost-effectiveness was measured by comparing quality-adjusted life-years (QALY) gained using Kaplan Meier survival analysis. At an estimated institutional cost of $10,000, BMAC was considered cost-effective if its incremental cost-effectiveness ratio (ICER) was below a threshold of $50,000. Results: Overall, 359 patients (BMAC: 124 [34.5%] vs No BMAC: 235 [65.5%]) met inclusion criteria. Besides sex and FAI-type, there were no differences between cohorts. Within 6.2 years, a significantly greater proportion of No BMAC patients underwent THA (14 [5.96%] vs 1 [0.81%]; P=.020). Although not statistically different, a weighted cox regression controlling for sex and FAI type suggests that BMAC augmentation reduces the risk of converting to THA by 77% (P=.163). According to the Kaplan Meier survival analysis, BMAC patients had a greater QALY (6.13 vs. 5.99). At a cost of $10,000, however, BMAC had an ICER of $76,228.77 and was not considered cost-effective. Re-arranging the ICER equation and maintaining the 0.14 QALY-gained, BMAC must cost less than $6,559.20 to be considered a cost-effective treatment for preventing THA. Discussion/Conclusions: According to the present study, BMAC must cost less than $6,559.20 to be considered a cost-effective treatment for improving long-term hip arthroscopy survivorship.

Introduction: Despite the increasing utilization of hip arthroscopy and identification of predictors of poor outcomes, the impact of short-term improvement on long-term functional outcomes has been understudied. The purpose of this study was to determine whether early improvements in patient-reported outcome measures (PROMs) 6 months after hip arthroscopy predict five-year outcomes. Methods: A retrospective review of prospectively-collected data identified patients >18 years that underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement (FAI). Included patients had a Tönnis grade <2 and complete PROMs at baseline, 6-month, and minimum 2-year follow-up. The minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS) was used to stratify patients into cohorts based on high improvement (HI) versus low improvement (LI) at 6 months. PROMs were compared between these cohorts at 1-5 years postoperatively by rates of MCID achievement and linear mixed effects modeling. Results: Overall, 175 patients met inclusion criteria. Of these, 131 HI patients were compared to 44 LI patients. At 5 years, 88.3% of HI patients reached MCID, versus 42.1% of LI patients. By multivariate logistic regression, achievement of 6-month MCID (adjusted odds ratio [AOR], 17.42) and labral management (augmentation, relative to debridement: AOR, 14.5) predicted achievement of 5-year MCID. mHHS scores were greater for HI versus LI patients at all time points through 3-year follow-up, but were not significantly different at 4 and 5 years. Conclusion: Early improvements in PROMs following hip arthroscopy, assessed by 6-month MCID, predicted clinically meaningful outcomes at 5-year follow-up, underscoring the importance of progressive but cautious recovery during these six months. Despite this, LI patients continued improving for 5 years and by absolute PROM scores, did not differ significantly from HI patients at 5-year follow-up, demonstrating that late functional improvement is still possible in patients in the event of a poor 6-month rehabilitation period.

PURPOSE:To (1) evaluate minimum 5-year functional outcomes, (2) assess secondary surgery rates, and (3) analyze postoperative complications after hip arthroscopy for labral tears due to femoroacetabular impingement using the puncture capsulotomy technique. METHODS:This was a retrospective review of prospectively collected data from May 2014 to May 2019 that included patients aged 18 years or older who underwent hip arthroscopy via puncture capsulotomy for labral tears and concomitant femoroacetabular impingement and completed patient-reported outcome measure surveys for 5 years postoperatively. RESULTS:A total of 109 hips were included in this study (49.5% female sex; mean age ± standard deviation, 37.7 ± 14.1 years), with a mean follow-up time of 61.0 ± 1.58 months (range, 60-67 months) and mean body mass index of 25.5 ± 3.93. When compared with mean enrollment values, the mean modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and International Hip Outcome Tool-33 score were all significantly improved (P < .001) at 5-year follow-up (mHHS, 63.1 ± 14.6 preoperatively vs 88.9 ± 14.6 postoperatively; Hip Outcome Score-Activities of Daily Living, 71.1 ± 19.5 vs 92.8 ± 11.1; Hip Outcome Score-Sports-Specific Subscale, 41.8 ± 25.3 vs 81.7 ± 23.8; International Hip Outcome Tool-33 score, 41.9 ± 19.1 vs 84.4 ± 19.6). Furthermore, for the mHHS, 83.8%, 71.4%, and 52.1% of patients achieved the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit, respectively. The rate of revision hip arthroscopy was 0%, and the rate of conversion to total hip arthroplasty was 7.83%. CONCLUSIONS:At minimum 5-year follow-up, puncture capsulotomy results in significantly improved functional outcomes, as well as clinically meaningful outcomes. Overall, patients reported minimal rates of complications and conversion to total hip arthroplasty. LEVEL OF EVIDENCE:Level IV, retrospective case series.

Background: To investigate if a tiered, 6-phase prehabilitation/rehabilitation physical therapy (PT) protocol improves functional outcomes for patients undergoing endoscopic abductor tendon repair. Methods: This prospective study queried patients older than 50 years with minimum 2-year follow-up who underwent endoscopic repair for symptomatic gluteus medius and/or minimus tendon tears. All patients followed a standard 6-phase prehabilitation/rehabilitation PT protocol that consisted of: 1) Prehabilitation (3 months pre-operatively); 2) Immediate Post-Op Recovery (0-6 weeks post-operatively); 3) Endurance and Strength (6-12 weeks post-operatively); 4) Balance, Coordination, and ROM (3-6 months post-operatively); 5) Home Exercise/PT (6-12 months post-operatively); and 6) Gradual Return to Sport/Recreational Activity (12-24 months post-operatively). The Gluteus-Score-7 (GS7) was calculated to assess the risk of post-operative clinical failure. Outcomes were assessed pre-operatively and at 3-, 6-, 12-, 24-, and 60-month post-operative timepoints; they included VAS pain, hip abduction strength, Trendelenburg sign, and the following PROMs: mHHS, HOS-ADL, HOS-SSS, NAHS, and iHOT-33. Results: Overall, 26 patients (age, 67.5±7.2 (range: 50-81); BMI, 28.8±4.1; 76.9% female) met inclusion criteria. Most patients (n=23; 88.5%) had full-thickness tears, of which 52.2% (n=12) were retracted more than 2 cm. Patients had an average GS7 of 4.8±1.2, indicating a high risk of post-operative failure. Despite this, patients experienced significant improvements for VAS pain and all PROMs except for HOS-SSS at 3-, 6, 12-, 24-, and 60-month timepoints. Additionally, the MCID achievement rates were good at 2-year follow-up (n=25) (mHHS (76.0%); HOS-ADL (72.0%); HOS-SSS (60.0%); and iHOT-33 (76.0%)) and excellent at 5 years (n=9) (mHHS (100.0%); HOS-ADL (100.0%); HOS-SSS (77.8%); and iHOT-33 (100.0%)). Discussion/Conclusions: Patients older than 50 years who underwent endoscopic abductor tendon repair achieved significant improvements in functional outcomes following a 6-phase prehabilitation/rehabilitation PT protocol. PROM improvements began as early as 3-months post-operatively and were sustained at long-term follow-up with excellent 5-year MCID achievement rates.

PURPOSE:To investigate the effects of neighborhood-level socioeconomic disadvantage on health care accessibility and midterm functional outcomes for patients undergoing primary hip arthroscopy for the treatment of acetabular labral tears. METHODS:This retrospective analysis queried patients ≥18 years old who underwent primary hip arthroscopy for treatment of symptomatic labral tears secondary to femoroacetabular impingement syndrome, had complete patient-reported outcome measures (PROMs) at minimum 8-year follow-up, and resided in the United States. All patients underwent surgery between May 2001 and September 2013. Using the area deprivation index (ADI) to quantify neighborhood-level socioeconomic disadvantage, patients were divided into quartiles. Those in the least and most disadvantaged quartiles represented the ADILow and ADIHigh cohorts, respectively. Health care accessibility and socioeconomic disadvantage were compared between cohorts using rural, Health Professional Shortage Area, medically underserved area/population, insurance status, education level, and household income classifications. Collected PROMs included the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (HOS-ADL), HOS-Sports Specific Subscale (HOS-SSS), Nonarthritic Hip Score, 33-item International Hip Outcome Tool, and rates of conversion to total hip arthroplasty (THA). RESULTS:The ADILow (ADI: 4.0 ± 2.1) and ADIHigh (ADI: 37.7 ± 12.1) cohorts each consisted of 43 patients. A greater proportion of patients in ADIHigh resided in rural communities (P = .026), primary care Health Professional Shortage Areas (P = .024), and medically underserved area/populations (P = .019). At a patient level, the ADIHigh cohort had lower levels of insurance coverage (P = .035), education (P = .002), and household income (P = .002). Finally, ADIHigh patients achieved worse functional outcome scores for mHHS (P = .008), Nonarthritic Hip Score (P = .043), HOS-ADL (P = .020), and 33-item International Hip Outcome Tool (P = .041). By multivariate logistic regression, patients in ADIHigh were nearly 11.4 and 10.4 times less likely to achieve the 10-year patient acceptable symptom state for mHHS (odds ratio, 0.09; P = .008) and HOS-ADL (odds ratio, 0.10; P = .018), respectively. Despite having significantly worse PROMs, patients in ADIHigh underwent statistically similar rates of revision hip arthroscopy (ADIHigh: 7.0% vs. ADILow: 4.7%; P = .645) and conversion to THA (ADIHigh: 11.6% vs ADILow: 20.9%; P = .213). CONCLUSIONS:Patients undergoing hip arthroscopy for acetabular labral treatment from neighborhoods with greater ADI scores experience worse health care accessibility, inferior mid-term functional outcomes, and similar rates of conversion to THA. LEVEL OF EVIDENCE:Level III, retrospective cohort.

Background: Although prior literature has established the association between femoroacetabular impingement (FAI) and progressive hip osteoarthritis, no studies have investigated the effects of global acetabular overcoverage on chondral wear and long-term outcomes. The purpose of the present study is to compare long-term survivorship, joint space width (JSW), intra-operative findings, patient reported outcome measures (PROMs), pain levels, and patient satisfaction in hip arthroscopy patients with coxa profunda and acetabular overcoverage (CO) to a matched-control (MC) cohort. Methods: This retrospective analysis queried patients who underwent hip arthroscopy for acetabular labral tears secondary to FAI. Patients with complete PROMs at minimum 8-year follow-up, the presence of coxa profunda as indicated by an acetabular wall projecting medial to the ilioischial line, and a lateral center edge angle > 40° were matched 1:1 by sex, age, BMI, Tönnis grade, and labral treatment to a MC cohort that had normal acetabular coverage. Intra-operative and radiographic findings were compared between cohorts. Collected outcomes include the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), pain levels, patient satisfaction, and conversion to total hip arthroplasty (THA). Results: 38 CO patients were 1:1 matched to MC patients. The CO cohort had significantly greater chondrolabral junction (CLJ) breakdown and decreased JSW at 50o. MC and CO patients achieved similar outcomes for all 6 PROMs, rates of conversion to THA, pain levels, and patient satisfaction. By Kaplan-Meier survival analysis, patients experienced similar survivorship at 0- to 6-years after hip arthroscopy (CO: 6 [15.8%] vs MC: 4 [10.5%]; P = .384). Between 6- to 18-years, however, the CO cohort (5 [13.2%] vs 2 [5.3%]) had significantly worse long-term survivorship (P = .008). Discussion/Conclusions: Patients with global overcoverage had significantly worse long-term survivorship 6- to 18- years following hip arthroscopy. Furthermore, CO patients had significantly lower ipsilateral JSW at 50o and greater severity of CLJ breakdown. Together, these findings reveal global overcoverage as a risk factor for progressive hip osteoarthritis and conversion to THA.

Background: Although previous literature has established the association between femoroacetabular impingement and progressive hip osteoarthritis, there exists a paucity of studies investigating the effects of global acetabular overcoverage on chondral wear and long-term outcomes. Purpose: To compare baseline joint space width (JSW), intraoperative findings, long-term total hip arthroplasty (THA)–free survivorship, patient-reported outcome measures (PROMs), pain levels, and patient satisfaction in patients who underwent hip arthroscopy with global overcoverage (GO) to a matched-control (MC) cohort. Study Design: Cohort study; Level of evidence, 3. Methods: In this retrospective analysis, the authors queried patients who underwent hip arthroscopy for acetabular labral tears secondary to femoroacetabular impingement. Patients with complete PROMs at a minimum 8-year follow-up, the presence of coxa profunda as indicated by an acetabular wall projecting medial to the ilioischial line, and a lateral center-edge angle >40° were matched 1:1 by sex, age, body mass index, Tönnis grade, and labral treatment to a MC cohort of patients who had normal acetabular coverage. Baseline radiographic and intraoperative findings were compared between cohorts. Collected outcomes include the modified Harris Hip Score, Nonarthritic Hip Score, Lower Extremity Functional Scale score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Specific Subscale, 33-item International Hip Outcome Tool score, pain levels, patient satisfaction, and conversion to THA. Results: In total, 38 patients with GO were 1:1 matched to a MC cohort. The GO cohort had significantly decreased baseline JSW at 50° ( P = .002) and greater chondrolabral junction breakdown ( P = .037). The GO and MC cohorts achieved similar outcomes for all 6 PROMs, rates of conversion to THA, pain levels, and patient satisfaction. Kaplan-Meier survival analysis demonstrated that the patients experienced a similar overall 18-year THA-free survival rate (GO: 71.1% vs MC: 84.2%; P = .101). To isolate the long-term effects of GO on hip arthroscopy outcomes, 6- to 18-year THA-free survivorship was examined, revealing that the GO cohort (−13.1%) experienced a significantly greater decrease compared with the MC cohort (−5.3%) ( P = .008). Conclusion: Patients with GO had significantly lower baseline ipsilateral JSW at 50° and greater intraoperative severity of chondrolabral junction breakdown. Furthermore, the GO cohort experienced a significantly greater decrease in long-term THA-free survivorship 6 to 18 years after hip arthroscopy.

Background: To investigate if patients with hip dysplasia or acetabular overcoverage had significantly different femoroacetabular joint space width (JSW) and 15-year THA-free survivorship compared to patients with normal acetabular coverage. Methods: This study queried patients who underwent arthroscopic repair of symptomatic acetabular labral tears secondary to FAI. Patients were stratified into cohorts according to lateral center edge angle (LCEa): dysplasia (< 25o), overcoverage (≥ 40o), and normal coverage (25o to 39.9o). JSW was collected at 3 fixed locations per hip at 10° [lateral], 30° [central], and 50° [medial] with respect to a polar coordinate system. Patients with minimum 5-year follow-up, Tönnis grade 0 or 1, and JSW ≥ 2mm were included. A multivariate linear regression assessed the correlation between LCEa and lateral, central, and medial JSW. 15-year THA-free survivorship was assessed using an unadjusted Kaplan-Meier survival curves analyzed by log-rank test. A weighted Cox regression adjusting for baseline demographics and intraoperative findings was performed to identify independent risk factors for converting to THA. Results: Overall, 256 patients (age, 38.1±11.5 years; BMI, 25.8±4.2 kg/m2; sex, 51.6% female) with a mean 8.5±3.4 years follow-up met inclusion criteria. By multivariate linear regression, each 1o increase in LCEa was correlated with a -0.038mm (P<.001) and -0.028mm (P<.001) decrease in medial and central JSW, respectively. There were significant differences in 15-year THA-free survivorship among LCEa cohorts: dysplasia (n=15; 24.0%), overcoverage (n=65; 44.0%), and normal coverage (n=176; 89.66%) (P<.001). Patients with dysplasia or overcoverage had a 121% greater risk of converting to THA compared to normal coverage patients (P=.029). When further stratifying the normal coverage cohort, each 5o decrease in LCEa (e.g. 35o to 39.9o vs. 30o to 34.9o) increased the risk of THA by 112% (P=.046). Discussion/Conclusions: Acetabular coverage was significantly associated with femoroacetabular JSW and 15-year THA-free survivorship.

Objectives: The purpose of the present study was to compare long-term survivorship following primary hip arthroscopy between patients with global acetabular retroversion and a propensity-matched control group. Methods: This retrospective study queried patients > 18 years, with preoperative hip and pelvic radiographs, and minimum 8-year follow-up that underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients with global acetabular retroversion, as indicated by the presence of a crossover sign, ischial spine sign, and posterior wall sign on preoperative pelvic radiographs, were propensity-score matched 1:1 by age, sex, body mass index (BMI), and labral treatment (repair versus debridement) to controls. Baseline demographic, radiographic, and intraoperative variables were compared between cohorts. Cox multivariate regression controlling for global retroversion and Tönnis grade was used to assess conversion to THA. Patient-reported outcome measures (PROMs) were compared between cohorts. Results: Overall, 49 patients with global retroversion were 1:1 matched to 49 controls, with mean follow-up of 10.7 ± 2.1 years and 11.1 ± 2.8 years, respectively. There were no significant differences in baseline demographics, radiographic findings, or intraoperative findings between cohorts (P>0.05 for all) ( Table 1; Table 2 ). Unadjusted Kaplan-Meier survival curves analyzed by log-rank test demonstrated a significantly decreased survivorship among patients with global retroversion (68.6%) compared to controls (83.9%) at final follow-up (P=0.036) ( Figure 1 ). Cox multivariable regression controlling for Tönnis grade demonstrated that patients with global retroversion had a significant greater risk of THA conversion (hazard ratio, 3.94; p=0.038). There were no differences in PROMs at final follow-up between cohorts (P>0.05 for all) ( Table 3 ). Conclusions: Patients with global acetabular retroversion had significantly inferior THA-free survivorship at minimum 8-year follow-up relative to matched controls, despite no differences in PROMs at final follow-up for patients who did not undergo THA. These findings suggest that global retroversion by preoperative radiographic assessment may be a useful predictor of long-term failure and that patients should be counseled accordingly.