Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients Aged 45 Years and Older Produce Comparable Improvements in Outcome Scores to Younger Patients.

PURPOSE

To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group.

METHODS

All patients aged 45 years and older who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared with a case-matched control group of younger patients. All patients underwent at least 6 months of nonoperative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of patients with dysplasia aged 45 years and older without significant osteoarthritis who underwent PAO and reported patient-reported outcomes for a minimum of 1 year postoperatively. Patient-reported outcomes were quantified using the International Hip Outcome Tool 12 (iHOT-12) score and Non-arthritic Hip Score (NAHS).

RESULTS

The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center-edge angle significantly improved from preoperatively (20.1° ± 4.5°) to postoperatively (33.2° ± 3.2°, P < .001). The mean follow-up period in the PAO cohort aged 45 years and older was 2.80 years (standard deviation, 1.3 years) postoperatively. Patients reported significant improvements in the iHOT-12 score (36.6 ± 14.1 preoperatively vs 81.2 ± 21.0 at latest follow-up, P < .001) and NAHS (59.2 ± 15.5 preoperatively vs 87.4 ± 13.1 at latest follow-up, P < .001). The older cohort did not report significantly different iHOT-12 scores compared with the control group at any point, and age did not significantly affect either outcome score (P > .05).

CONCLUSIONS

Patients aged 45 years and older reported a statistically significant improvement in hip function and pain after staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings show that appropriately selected older patients with dysplasia without significant pre-existing hip osteoarthritis experience clinically meaningful improvements in hip pain and function after hip preservation surgery.

LEVEL OF EVIDENCE

Level III, retrospective, comparative case series.