JBJS - 2026-04-13 - Journal Article
Survivorship of Femoroacetabular Impingement Surgery at Mean 10-Year Follow-up: A Prospective, Multicenter Cohort Study.
Nepple JJ, Hood H, Kim YJ, Beaulé P, Sierra R, Millis M, Robben Z, Drain C, Clohisy JC, ANCHOR Study Group
Topics
Key Takeaway
FAI surgery (arthroscopy or surgical dislocation) achieved 90.6% THA-free survivorship at mean 10.4 years, with femoral head chondromalacia, obesity (BMI ≥30), older age, and male sex as independent predictors of conversion.
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Summary
This prospective multicenter cohort evaluated THA-free survivorship and predictors of THA conversion in 362 hips treated for FAI between 2008–2012 via arthroscopy or surgical dislocation. At mean 10.4 years, THA-free survivorship was 90.6%. Cox proportional-hazards modeling identified femoral head chondromalacia (p<0.001), BMI ≥30 (p=0.009), older age at surgery (p=0.01), and male sex (p=0.02) as independent risk factors for conversion to THA.
Key Limitation
The cohort is 95.6% Caucasian, making risk factor estimates and survivorship rates potentially non-generalizable to non-White populations who may have different FAI morphology prevalence and cartilage disease burden.
Original Abstract
BACKGROUND
Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship.
METHODS
A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA.
RESULTS
The cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m2 (p = 0.009), and femoral head chondromalacia (p < 0.001).
CONCLUSIONS
This study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.