Summary

Hip arthroscopy in patients with generalized ligamentous laxity (GLL) yield effective and similar outcomes in functional outcomes and survivorship at 5-year minimum follow-up to patients without GLL.

Abstract

Introduction

Patients with generalized ligamentous laxity (GLL) have demonstrated higher rates of hip microinstability as well as higher rates of femoroacetabular impingement syndrome (FAIS) and labral pathology. This study aims to evaluate the minimum five-year outcomes and return-to-sport rates in patients undergoing hip arthroscopy, focusing specifically on those with generalized ligamentous laxity, using a propensity-matched controlled study design.

Methods

Prospectively collected data was retrospectively analyzed for all patients who underwent primary hip arthroscopy between February 2008 and June 2022. Included patients had pre-operative and minimum 5-year follow-up for at least one patient-reported outcome (PRO) measure: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), or International Hip Outcome Tool (iHOT-12). Patients with a Beighton score >4 were matched to patients with a score of <3 using a 1:1 ratio based on age, sex, body mass index (BMI), Tönnis grade, preoperative lateral center-edge angle (LCEA), labral treatment type, and sport level. The minimal clinically important difference (MCID) was calculated for all PROs and included in the analysis. A return-to-sport subanalysis was completed. Complications and secondary surgery were reported.

Results

232 hips were included in this study, with 116 hips in the GLL group and 116 in the control group. Patients in both study groups showed significant improvement in all evaluated PROs, with high levels of patient satisfaction reported. Return-to-sport rates and survivorship were high for both groups. No significant differences were found between PROs, survivorship, and return-to-sport rates for both groups. A logistic regression sub-analysis showed a protective effect of iliopsoas bursectomy against revision arthroscopy.

Conclusion

Hip arthroscopy in patients with GLL yield effective and similar outcomes in functional outcomes and survivorship at 5-year minimum follow-up to patients without GLL, with a high percentage of patients reaching clinically important thresholds. Many athletes with GLL were able to continue playing their sport after hip arthroscopy.