FP8.1 Patient Psychosocial Factors are the Most Predictive of Poor Outcomes Following Hip Arthroscopy with Periportal Capsulotomy of Femoroacetabular Impingement Syndrome

Abstract ICLA08 - AI and 3D Simulations: Trustworthy Clinical Partners or Tech Hype?, Auditorium B (BMCC Level 1), October 8, 2026, 14:00 - 16:00 Background Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has expanded rapidly with sustained improvements in outcomes. However, predictive models remain limited, and periportal-specific modeling incorporating intraoperative traction data is incompletely understood. Methods A retrospective review of a single-surgeon database identified patients undergoing primary hip arthroscopy with periportal capsulotomy for FAIS (2021–2024). Patients with standardized imaging, intraoperative traction measurements, and ≥2-year patient-reported outcomes were included. Demographic, clinical, radiographic, and intraoperative traction variables were collected. Poor outcome was defined as lowest quartile PROMIS-PF scores or additional surgery at 2 years. A secondary analysis evaluated failure to achieve Minimal clinically important difference (MCID) using a distribution-based threshold. Hierarchical multivariable modeling was performed, with model performance assessed using area under the curve (AUC). Results A total of 164 patients met inclusion criteria (mean follow-up 2.5 years); 70.0% were female with a mean age of 34.5 ± 12.1 years. Psychiatric comorbidity was present in 32.0%, and 9 patients (5.5%) underwent additional surgery. Poor outcome was associated with greater preoperative symptom burden and psychosocial factors (all p<0.05), while only frog-leg alpha angle was significant among radiographic variables (p<0.01); intraoperative distraction was not associated with outcomes. Model discrimination improved from AUC 0.593 to 0.847. Psychosocial factors were the strongest predictors, including migraines (OR 8.31, p=0.014) and psychiatric comorbidity burden (OR 1.69 per diagnosis, p=0.032). Female sex (OR 0.31, p=0.041) and greater frog-leg alpha angle (OR 0.93, p=0.040) were associated with lower risk, while intraoperative traction was not predictive (p=0.442). In the MCID analysis, failure to achieve clinically meaningful improvement was independently associated with lower preoperative PROMIS-PF scores and absence of prior hip injection, whereas psychosocial, radiographic, and traction variables were not predictive. Model discrimination improved from AUC 0.592 to 0.767. Conclusion Psychosocial factors, particularly psychiatric comorbidity burden and migraines, are the primary predictors of poor outcomes following periportal hip arthroscopy for FAIS, whereas intraoperative traction provides limited predictive value. In contrast, achievement of clinically meaningful improvement is driven by baseline function and treatment-related factors, highlighting that MCID and poor outcome represent distinct dimensions of recovery.