Hip Arthroscopy in Patients With Global Acetabular Overcoverage Shows Significant 5‐Year Improvements but Poses a Higher Risk of Revision Surgery Compared With Matched Controls

Purpose To evaluate minimum 5‐year patient‐reported outcomes (PROs) after primary hip arthroscopy for femoroacetabular impingement syndrome and labral tears in patient with global acetabular overcoverage (GO), with a secondary comparison of outcomes to a propensity‐matched control group without GO. Methods Prospectively collected data was analyzed for all patients who underwent primary hip arthroscopy between 2008 and 2020. Patients were included if they completed the preoperative and minimum 5‐year postoperative questionnaires for at least 1 of the following PROs: modified Harris Hip Score, Non‐Arthritic Hip Score, Hip Outcome Score‐Sport‐Specific Subscale, Visual Analog Scale, and patient satisfaction or reaching an endpoint (revision hip arthroscopy or total hip arthroplasty). Patients with radiographic findings of GO on the anteroposterior pelvis radiograph (lateral center‐edge angle ≥40°) and coxa profunda were included in the GO cohort and were propensity‐matched to controls without coxa profunda and with a lateral center‐edge angle between 25° and 39° in a 1:3 ratio based on age, sex, body mass index, acetabular Outerbridge grade, labral, and capsular treatment. Results Two hundred four patients were included: 51 in the GO group and 153 matched controls. The GO cohort showed significant improvements across all PROs ( P < .001). Compared with the control group, similar magnitudes of improvement and postoperative scores for all PROs were observed, reaching minimal clinically important difference and patient acceptable symptom state at similar rates. The GO group had a higher frequency of revision hip arthroscopy (15.69% vs 7.84%; relative risk = 2.00) with similar rates of total hip arthroplasty‐free survivorship. Conclusions Hip arthroscopy for the treatment of femoroacetabular impingement syndrome and labral tears in patients with radiographic evidence of GO shows significant improvements in PROs at a minimum 5‐year follow‐up. However, it carries a 2‐fold increased relative risk of revision hip arthroscopy compared with that of the control group. Level of Evidence Level III, retrospective comparative case series.