Low Risk of Progressive Osteoarthritis in Elderly After Arthroscopic FAI Surgery

Overview

This study evaluated clinical outcomes of arthroscopic surgery for femoroacetabular impingement (FAI) with labral preservation across different age groups. Elderly patients in their 70s showed favorable outcomes with a low likelihood of progression to osteoarthritis or conversion to total hip arthroplasty (THA). Age alone was not a definitive predictor of poor outcomes when joint space was preserved.

Background

Femoroacetabular impingement (FAI) causes abnormal contact between the femur and acetabulum, leading to labral tears and chondrolabral damage that predispose to osteoarthritis. Arthroscopic surgery is effective in younger patients, but older patients have shown higher rates of conversion to total hip arthroplasty (THA). Previous studies identified osteoarthritic changes and joint space narrowing as predictors of poor outcomes after arthroscopy. However, the effect of age on outcomes in patients with preserved joint space remains unclear.

Data Highlights

Key Findings

• Elderly patients (≥70 years) undergoing arthroscopic FAI correction with labral preservation had low rates of progression to osteoarthritis and THA conversion.
• Patients with preserved joint space (>2 mm) had better postoperative outcomes regardless of age.
• Presence of osteoarthritic changes at surgery negatively impacted outcomes and increased THA conversion risk.
• Other predictors of poor outcomes included higher BMI, worse preoperative patient-reported outcomes, and specific hip morphology features.
• Arthroscopic surgery remains a viable option for selected older patients without advanced osteoarthritis.

Clinical Implications

Clinicians should consider arthroscopic FAI correction with labral preservation as a treatment option for elderly patients with preserved joint space, as age alone should not preclude surgery. Careful patient selection focusing on joint space and absence of advanced osteoarthritis can optimize outcomes and reduce the need for early THA. Preoperative evaluation of patient characteristics and hip morphology remains important to predict prognosis.

Conclusion

Arthroscopic surgery for FAI with labral preservation provides favorable clinical outcomes in elderly patients with preserved joint space, demonstrating a low likelihood of progressive osteoarthritis and THA conversion. Age should not be the sole determinant in surgical decision-making for FAI treatment.

References

1. Javed et al. 2015 -- Arthroscopic outcomes in patients over 60
2. Domb et al. 2014 -- Outcomes of hip arthroscopy in patients over 50
3. Philippon et al. 2012 -- Predictors of THA after hip arthroscopy
4. Byrd et al. 2012 -- Long-term outcomes of hip arthroscopy
5. Sansone et al. 2016 -- Arthroscopic treatment of FAI with OA