Comparison Of Patient-reported Outcomes And Functional Measures In Staged Bilateral Versus Unilateral Hip Arthroscopy Procedures

Hip arthroscopy is an increasingly common surgical intervention utilized to treat femoroacetabular impingement syndrome (FAIS). A growing number of patients receive bilateral hip arthroscopy to treat FAI. However, minimal evidence exists regarding outcomes in patients who have surgery on both hips when compared to those with a unilateral procedure. Purpose: This study aimed to compare patient reported outcomes (PROs) and objective return to sport (RTS) measures between patients who underwent bilateral and unilateral hip arthroscopy. METHODS: Patients eligible were identified using retrospective review of the Hip Preservation Patient Registry from the years 2018-2022, 25 staged bilateral hip arthroscopy (BHA) were identified that had both PRO measures (ihot-12, HOS ADL and sport subscales and modified harris hip scores (mHHS)) and RTS testing completed (y-balance, single leg squat test, and jump/hop testing), 25 unilateral hip arthroscopy (UHA) were matched based on age and gender with both PRO and RTS data available. RESULTS: Median time between procedures in the BHA group was 24 weeks. RTS functional measures were all similar between groups and demonstrated <10% asymmetry (p = 0.45 - 0.99) for y-balance composite score (BHA = 90.7, UHA = 91.7), single leg squat points (BHA = 2.7, UHA = 2.7), countermovement up force symmetry (BHA = 1.0, UHA = 0.98) and landing force symmetry (BHA = 0.95, UHA = 0.98), single leg hop height symmetry (BHA = 0.99, UHA = 0.98,) and 4-hop height symmetry (BHA = 1.1, UHA = 1.0). All PROs improved from baseline to 6 months in both groups (after each side in the BHA group) and that improvement remained at 12 months (p < 0.01). Improvements in both groups at 12 months exceeded the minimal clinically important difference (MCID) for each PRO measure (ihot12 MCID is 15.1: UHA average improvement was 36.4 points, BHA: 45.0 HOS-ADL MCID is 8.8, UHA: 15.3, BHA: 20.2, HOS-sport MCID is 13.9, UHA 29.3, BHA 41.3, mHHS MCID is 6.9, UHA: 15.9, BHA 21.6) CONCLUSION: Undergoing staged bilateral hip arthroscopy does not have an adverse effect on subjective patient reported outcomes nor on objective return to sport assessments. Both groups improved on PROs and had good symmetry on functional testing suggesting it is an effective treatment tool for patients with bilateral FAIS.