EP8.88 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

Abstract Background Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has traditionally been performed in younger patients, with limited data on outcomes in those ≥60 years. As indications expand, understanding expected outcomes and prognostic factors in older patients is increasingly important. Methods A single-center review identified patients >60 years who underwent primary hip arthroscopy with labral repair and capsular closure for FAIS (January 2015–May 2024) with mean 2-year follow-up. Exclusion criteria included prior ipsilateral hip surgery, non-FAIS pathology, Tönnis grade ≥2, concomitant procedures, periacetabular osteotomy, Ehlers-Danlos syndrome, and isolated labral debridement. Patients were matched 1:2 by sex, body mass index, and Tönnis grade to those aged 18–40 years. Patient-reported outcomes (PROs) included Hip Outcome Score (HOS) Activities of Daily Living (HOS-ADL), HOS Sport Specific Subscale (HOS-SS), and the 12-Item International Hip Outcome Tool (iHOT-12). Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated and compared, along with reoperation-free survivorship. Results Forty-eight patients (48 hips) ≥60 years (63.7±3.6; follow-up 27.1 [12.0–72.0] months) were matched to 91 patients (95 hips) aged 18–40 (31.6±3.5; follow-up 27.5 [12.0–65.2] months). Both groups improved significantly across all PROs (P<0.001). HOS-SS and iHOT-12 were similar pre- and postoperatively (P>0.05). The ≥60 group had lower HOS-ADL preoperatively (53.0±21.3 vs 63.8±18.2, P=0.006) and postoperatively (76.8±23.2 vs 87.3±14.5, P=0.002). Absolute score improvements and MCID achievement were comparable (P>0.05), as were PASS rates for HOS-SS and iHOT-12. However, PASS for HOS-ADL was lower in the ≥60 group (47.6% vs 71.6%, P=0.015). Survivorship was 93.8% in the ≥60 cohort versus 100% in controls. Reoperations occurred in patients with Tönnis grade 1, femoral ICRS ≥2, and/or acetabular Beck ≥2. Conclusions Patients ≥60 years undergoing primary hip arthroscopy with labral repair and capsular closure achieve significant improvements and MCID rates comparable to younger patients, but have lower absolute function and reduced PASS achievement for HOS-ADL. Survivorship was 94% at mean 27-month follow-up, with failures associated with advanced cartilage damage. Careful patient selection and counseling are essential, as expectations and clinically meaningful thresholds may differ with age, and cartilage status remains a key prognostic factor.