Patients Aged ≥60 Years Achieve Comparable Improvement but Lower Patient Acceptable Symptom States After Hip Arthroscopy for Femoroacetabular Impingement Syndrome Using Contemporary Techniques: A Propensity Score‐Matched Cohort Study

PURPOSE: To compare patients ≥60 years and ≤40 years old undergoing contemporary hip arthroscopy for femoroacetabular impingement syndrome managed with labral repair and capsular closure using a propensity score-matched cohort design controlling for sex, body mass index, and Tönnis grade. METHODS: A single-center retrospective review identified patients ≥60 years undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (January 2015-May 2024) with a minimum 12-month follow-up. Exclusion criteria included prior ipsilateral surgery, non-femoroacetabular impingement syndrome pathology, Tönnis grade ≥2, concomitant procedures, osteotomy, Ehlers-Danlos syndrome, and isolated labral debridement. Patients were matched 1:2 by sex, body mass index, and Tönnis grade to those aged 18 to 40 years. Patient-reported outcomes included pre- and postoperative Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score Sports-Specific subscale, and 12-Item International Hip Outcome Tool. Cohort-specific minimal clinically important difference, patient acceptable symptom state (PASS), and reoperation-free survivorship were assessed. RESULTS: Forty-eight patients (48 hips) ≥60 years (63.7 ± 3.6 years; follow-up 27.1 [12.0-72.0] months) were matched to 91 patients (95 hips) 18 to 40 years (31.6 ± 3.5 years; follow-up 27.5 [12.0-65.2] months). Both groups improved across all patient-reported outcomes (P < .001). Hip Outcome Score Sports-Specific subscale and 12-Item International Hip Outcome Tool were comparable pre- and postoperatively (P > .05). The ≥60 cohort had lower HOS-ADL at baseline (53.0 ± 21.3 vs 63.8 ± 18.2, P = .006) and postoperatively (76.8 ± 23.2 vs 87.3 ± 14.5, P = .002). Minimal clinically important difference achievement and score improvements were similar (P > .05), as were PASS rates for Hip Outcome Score Sports-Specific subscale and 12-Item International Hip Outcome Tool. HOS-ADL PASS was lower in the ≥60 cohort (47.6% vs 71.6%, P = .015). Survivorship was 93.8% in the ≥60 cohort versus 100% in controls, with reoperations occurring in patients with baseline Tönnis grade 1, bipolar cartilage lesions, and grade ≥2 cartilage lesions. CONCLUSIONS: Patients ≥60 years achieved comparable improvement and minimal clinically important difference rates but lower absolute function and HOS-ADL PASS rates. Survivorship was 94% at 27 months (minimum 12), with failure driven by cartilage damage. Meaningful improvement is achievable in appropriately selected older patients, although expectations and outcome thresholds may differ by age. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.