EP3.40 Elevated Body Mass Index Is Associated With Inferior 15-Year Outcomes and Reduced Survivorship After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Abstract
Abstract Purpose To evaluate the impact of body mass index (BMI) on patient-reported outcomes (PROs), achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS), and survivorship at 15 years following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods A retrospective cohort study was performed on patients undergoing primary hip arthroscopy for FAIS with minimum 15-year follow-up. Patients were stratified by BMI (normal, overweight, obese). Primary outcomes included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) collected longitudinally. MCID was calculated using a distribution-based method, and PASS using a data-driven threshold. Secondary outcomes included revision, conversion to total hip arthroplasty (THA), and complications. Intergroup comparisons were performed using analysis of variance and chi-square tests. Survivorship was assessed with Kaplan–Meier analysis. Results A total of 121 patients (61 normal BMI, 38 overweight, 22 obese) were included with mean follow-up of 14.8 ± 0.6 years. All groups demonstrated significant improvement in mHHS and NAHS from baseline (p < 0.001). However, obese patients had significantly lower PROs at 15 years (mHHS: 78.4 vs 94.5 normal, 87.9 overweight; p < 0.001; NAHS: 76.5 vs 91.4, 87.5; p = 0.010). PASS achievement was lowest in the obese cohort, while MCID remained high across groups but was reduced in obese patients. Revision rates were similar between groups (p = 0.679). Conversion to THA was significantly higher in overweight and obese patients. Complication rates were low and comparable (p = 0.785). Conclusion Hip arthroscopy for FAIS provides durable improvement across BMI groups at 15 years; however, obese patients demonstrate inferior PROs, lower clinically meaningful outcome achievement, and higher rates of conversion to THA. BMI should be considered an important prognostic factor when counseling patients on long-term outcomes.