This retrospective cohort study asks whether hip arthroscopy for FAI provides long-term protection against osteoarthritis progression. It compares 132 arthroscopically treated hips with 982 nonsurgically managed hips drawn from a population registry. Mean follow-up was 12.5 years.
The big unanswered question in FAI management has always been whether fixing the bony deformity actually changes the joint's fate, or just relieves symptoms while OA marches forward anyway.
This paper gives the most compelling long-term data yet that arthroscopy does more than symptom relief. The halving of Tönnis grade 2 OA (12% vs 22%) is a real signal, even if THA conversion rates haven't diverged significantly at 13 years — the cohort may simply be too young (mean age 40 at final follow-up) to see that endpoint.
When counseling a young patient with symptomatic FAI, use these numbers: roughly 7% will convert to THA by 13 years after arthroscopy. Red flags that substantially raise that risk are cam morphology, male sex, any preoperative Tönnis grade 1 change, and age above the mid-30s at presentation.
One critical nuance the authors highlight: surgery appears to abolish the negative predictive value of early OA. In nonsurgical patients, Tönnis grade 1 at baseline is a powerful failure predictor. In surgical patients, it is not. This supports operating before arthritic changes advance. Waiting for symptoms to worsen may forfeit the window of maximal benefit.
This retrospective cohort study asks whether hip arthroscopy for FAI provides long-term protection against osteoarthritis progression. It compares 132 arthroscopically treated hips with 982 nonsurgically managed hips drawn from a population registry. Mean follow-up was 12.5 years.
The big unanswered question in FAI management has always been whether fixing the bony deformity actually changes the joint's fate, or just relieves symptoms while OA marches forward anyway.
This paper gives the most compelling long-term data yet that arthroscopy does more than symptom relief. The halving of Tönnis grade 2 OA (12% vs 22%) is a real signal, even if THA conversion rates haven't diverged significantly at 13 years — the cohort may simply be too young (mean age 40 at final follow-up) to see that endpoint.
When counseling a young patient with symptomatic FAI, use these numbers: roughly 7% will convert to THA by 13 years after arthroscopy. Red flags that substantially raise that risk are cam morphology, male sex, any preoperative Tönnis grade 1 change, and age above the mid-30s at presentation.
One critical nuance the authors highlight: surgery appears to abolish the negative predictive value of early OA. In nonsurgical patients, Tönnis grade 1 at baseline is a powerful failure predictor. In surgical patients, it is not. This supports operating before arthritic changes advance. Waiting for symptoms to worsen may forfeit the window of maximal benefit.