Femoral Head Osteochondral Lesions Predict Lower Survivorship but Not Inferior Patient‐Reported Outcomes After Hip Arthroscopy at a Minimum 10‐Year Follow‐Up

PURPOSE: To evaluate the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome and labral tears who were found to have femoral head (FH) cartilage lesions and to compare these results to a matched control group of patients without FH cartilage damage. METHODS: Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and labral tears between February 2008 and April 2014. Patients were included if they had completed preoperative questionnaires, with follow-up defined as having minimum 10-year postoperative patient-reported outcomes or a documented endpoint. Patients with Tönnis grade >1 were excluded. Patients with FH osteochondral lesions (Outerbridge grade ≥2) were propensity matched 1:1 to controls without FH damage based on age, sex, body mass index, lateral center-edge angle, labral treatment, capsular management, acetabular Outerbridge, and follow-up time. Clinically relevant thresholds, survivorship, and predictors of conversion to arthroplasty were included in the analysis. RESULTS: A total of 188 patients (94 per group) were included. The FH group showed comparable improvements in all evaluated patient-reported outcomes compared with the control group at the latest follow-up (P < .01), with both groups achieving the minimal clinically important thresholds at similar rates. The FH lesion group had a significantly higher rate of conversion to total hip arthroplasty (23.4% vs 11.7%, P = .03). Multivariable Cox proportional hazards regression identified increasing FH damage severity as an independent predictor of conversion (hazard ratio 3.9, 95% confidence interval 1.73-9.13, P = .001). CONCLUSIONS: Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and labral tears with concomitant FH osteochondral lesions showed significant functional improvements comparable to those of a matched control group at long-term follow-up. However, their higher conversion rate to arthroplasty supported by regression analysis highlights FH damage as a key determinant of long-term survivorship after hip arthroscopy. LEVEL OF EVIDENCE: Level III, retrospective cohort study.