High Survival and Continued Sports Participation After Arthroscopy for Femoroacetabular Impingement in Athletes With and Without Lateral Rim Dysplasia With Minimum 4.5‐Year Follow‐Up

PURPOSE: To quantify the outcomes, including sporting capability, of hip arthroscopy (HA) in athletes for femoroacetabular impingement (FAI) in the presence of concomitant lateral rim dysplasia (LR-Dysplasia) compared with a matched athletic control group. METHODS: Athletes undergoing unilateral primary HA for FAI with or without LR-Dysplasia between January 2009 and May 2020 were considered. All athletes with a lateral center-edge angle of <25° on anteroposterior view were matched to those with normal overcoverage (lateral center-edge angle >30°). Patients were contacted a minimum of 4.5 years after the procedure. Outcomes included survival (avoidance of total hip replacement), revision HA, and patient-reported outcomes (PROMs) consisting of the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA) activity score, 36-Item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Substantial clinical benefit thresholds were determined for each PROM, and the proportion of cases achieving substantial clinical benefit was compared between groups. Finally, the ability to continue to play sports and satisfaction were determined. RESULTS: Forty-eight patients with LR-Dysplasia were matched to 97 controls with a mean follow-up of 72 ± 19 months (54-120 months). At follow-up, survival was 100% in the LR-Dysplasia group versus 99% in controls. The revision HA rates were 6% in LR-Dysplasia patients and 9% in controls. Both groups showed significant improvements in PROMs. In the LR-Dysplasia group, mHHS improved from 82 to 100 (P < .001), UCLA from 8 to 9 (P = .114), SF-36 from 74 to 87 (P = .002), and WOMAC from 15 to 2 (P < .001). In the control group, mHHS improved from 82 to 96 (P < .001), UCLA from 7 to 10 (P = .003), SF-36 from 72 to 89 (P < .001), and WOMAC from 17 to 4 (P = .005). Between-group comparisons showed no significant differences in pre- or postoperative mHHS (P = .498; P = .183), UCLA (P = .684; P = .388), SF-36 (P = .487; P = .602), or WOMAC (P = .814; P = .390). Substantial clinical benefit was achieved by most patients for each PROM and similar between groups (P > .05 for all). No significant differences were observed between groups in PROMs or overall satisfaction with surgery (P > .05 for all). Sports participation at 5 years was 84% in the LR-Dysplasia group and 90% in controls (P = .103). CONCLUSIONS: In the absence of arthritic changes, athletes treated with arthroscopy for FAI where LR-Dysplasia is present showed high survival rates and improved pain and function. Furthermore, most athletes can maintain their preoperative levels of sport. Importantly, the outcomes observed in this specific patient cohort are comparable to those seen in athletes with normal acetabular coverage, indicating that the presence of LR-Dysplasia does not compromise the effectiveness of arthroscopic intervention for FAI in athletes. LEVEL OF EVIDENCE: Level III, therapeutic retrospective comparative study.