Paper #23 - ISHA Annual Scientific Meeting 2016

Arthroscopic Hip Surgery In The Elite Athlete: Comparison Of Female And Male Elite Athletes

Kotaro Roberts Shibata, MD, PhD, Toyonaka, Osaka JAPAN
Marc R. Safran, MD, Redwood City, CA UNITED STATES

Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, UNITED STATES

FDA Status Not Applicable

Summary: This study reviews and compares the clinical outcomes of 38 female and 42 male high-level elite athletes following arthroscopic hip surgery for their non-arthritic hip pain. A similar high percentage of both groups were able to return to same level of sports activity. Distinct differences in diagnosis, treatment and participating type of sports were seen when comparing the two groups.

Abstract:
Background: While several studies have evaluated the outcomes of hip arthroscopy in athletes, few, if any, have studied only elite athletes in various sports, and most of those studies had predominantly males. The purpose of this study was to review and compare clinical outcomes of female and male elite competitive athletes following hip arthroscopy for non-arthritic hip pain.

Methods: Prospectively obtained data on all high-level elite athletes (professional, NCAA collegiate and/or Olympic) treated between 2007 and 2014 were retrospectively reviewed. The clinical and surgical records of 547 hips in 484 consecutive patients who underwent primary hip arthroscopy by the senior author for non-arthritic hip pain during the study period were included. Elite athletes (HSAS >6) were identified. Patients completed a pre-operative questionnaire that included medical and sports activity history and level of competition, hip-specific outcome scores (MHHS and iHOT-33) at baseline and most recent follow-up. Surgical findings and time to return to competitive sports activity were documented.

Results: A total of 98 elite athletes with a mean follow up period of 18.8 months (±12.7) were identified. There were 49 females and 49 males. 27 athletes had bilateral hip arthroscopy, 5 of which had one operation elsewhere. All patients were available for follow up. Of the 80 patients desiring to return to their original competitive activity, 38 were female (42 hips) (Female Athlete group [FA]) and 42 were male (54 hips) (Male Athlete group [MA]) their mean ages were 21.5(±3.9) and 20.5(±1.9), duration of pain prior to surgery was 12.1 (±10.3) months and 15.1 (±1.9) months, respectively. 84.2% of women and 83.3% of men were able to return to the same level of competition at a mean of 8.3 (±3) and 8.8 (±2.9) months, respectively. Statistically significant improvements between pre- and post-operative mean MHHS and iHOT-33 scores were seen in both groups (p <.0001 for both scores). FA had significantly higher proportions of hips that were diagnosed with Pincer type FAI (p =.0004), and Instability (p <.0001). Conversely, the MA had significantly higher proportions of hips that were diagnosed with Combined type FAI (p <.0001), had extensive chondral rim damage (p =.0002), particularly more hips that required microfracture (p =.001). The category of sports the FA participated in were more flexibility (11%) and endurance (24%) type sports. MA participated more in cutting (33%), contact (14%) and asymmetric (31%) type sports. Patients who were able to return to same level of competitive activity had a significantly shorter duration of pre-operation symptoms compared to those who could not (p <0.05). Whether or not an athlete had a microfracture did not affect the ability to return to sports.

Conclusion: A similar high percentage of both female and male elite athletes were able to return to competitive sports activity after arthroscopic treatment of FAI and/or hip instability. Distinct differences in diagnosis, treatment and participating type of sports activities were seen when comparing female and male athletes. Duration of symptoms negatively correlated with outcomes. Microfracture did not affect outcome / return to sports.