EP8.78 Patients with Atypical Hip Pain due to Femoroacetabular Impingement Have Equivalent Outcomes 15 Years after Primary Hip Arthroscopy

Abstract Purpose Femoroacetabular impingement syndrome (FAIS) commonly presents with anterior groin pain, though some patients report atypical pain in the lateral or posterior hip. While hip arthroscopy is an established treatment for FAIS, long-term outcomes in patients with atypical pain patterns are not well documented. This study aimed to compare 15-year patient-reported outcomes (PROs) and revision rates following primary hip arthroscopy, stratified by preoperative pain location. Methods A retrospective cohort study was conducted on patients who underwent primary hip arthroscopy for FAIS between 2010 and 2013, with a minimum follow-up of 15 years. Patients were divided into two groups based on pain location: typical (anterior groin pain) and atypical (lateral or posterior pain). Cohorts were propensity-matched in a 3:1 ratio for age, sex, BMI, and Tönnis grade. Primary outcomes included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), as well as changes from baseline. Rates of achieving minimal clinically important difference (MCID) were also assessed. Secondary outcomes included revision hip arthroscopy and conversion to total hip arthroplasty (THA). Results After matching, 124 patients were analyzed (93 typical, 31 atypical). Both cohorts demonstrated substantial improvements in PROs at 15 years, with no significant differences between groups. Mean mHHS improvement was 36.9 ± 21.2 in the atypical group versus 37.3 ± 18.1 in the typical group (p = 0.922). NAHS improvement was 39.7 ± 18.9 versus 38.4 ± 18.4, respectively (p = 0.756). MCID achievement reached 100% in both groups for both measures. At final follow-up, mean mHHS scores were 84.6 ± 18.9 (atypical) and 88.7 ± 16.3 (typical) (p = 0.291), while NAHS scores were 83.9 ± 19.7 and 86.2 ± 17.4 (p = 0.565). Revision surgery occurred in 0% of atypical patients versus 11.0% of typical patients (p = 0.122). Conversion to THA was observed in 16.1% of atypical patients and 7.6% of typical patients (p = 0.302). Overall failure rates were comparable (16.1% vs. 18.3%, p = 1.000). Conclusion Hip arthroscopy for FAIS yields durable, long-term improvements in outcomes regardless of preoperative pain location, with similar survivorship and clinical benefit at 15 years.