A Comparison of Staged vs Simultaneous Hip Arthroscopy for Selected Patients With Symptomatic, Bilateral Femoroacetabular Impingement

Abstract

Introduction: Symptomatic, bilateral femoroacetabular impingement (FAI) has been increasingly recognized in recent years. Treatment options include staged or simultaneous (single anesthetic) bilateral hip arthroscopy, however the outcomes of the latter are largely unknown. The purpose of this study was to compare clinical outcomes and complication rates of staged versus simultaneous bilateral hip arthroscopy. Methods: Between March 2010 and June 2013, 1800 hip arthroscopy cases were reviewed, identifying 81 patients (162 hips) who underwent bilateral hip arthroscopy for symptomatic FAI. Twelve patients (24 hips) had undergone a simultaneous procedure with a minimum of 1-year follow-up. This group was matched 1:2 for age, sex, and alpha angle, to a control group of 24 patients (48 hips) that had undergone a staged procedure. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), and the Hip Outcome Score-Sport-specific Subscale (HOS-SSS) were obtained preoperatively at 6 months, 1, and 2 years postoperatively. Results: Patient demographics (age and sex) were comparable between groups (p>0.95). Mean preoperative alpha angle was 65.3 ± 9.6° in the simultaneous group and 65.9 ± 11.2° in the staged group (p=0.6). At a mean of 17.8 months (range, 12-33 months), there was significant improvement (p<0.001) in all patient reported outcome scores (mHHS, HOS-ADL, HOS-SSS). The mean single anesthetic traction time was 90.8 ± 21.9 minutes (sum of both hips) in the simultaneous group, compared with a combined two-anesthetic traction time of 85.7 ± 27.2 minutes in the staged group (p=0.579). There were no traction-related complications in either group. No patients in the simultaneous group required revision surgery, while one patient in the staged group required lysis of adhesions at 24 months postoperatively. Conclusion: Simultaneous bilateral hip arthroscopy is safe and effective, resulting in improved patient-reported outcomes at 1-year follow-up comparable with the results of staged treatment.