TP5.2 Discordance Phenotypes of Mechanical Versus Symptomatic Failure at 15 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

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ID: 330938
2026
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Abstract
Abstract Background Long-term outcomes after primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) may diverge into structural (mechanical) failure and/or persistent symptomatic failure, but phenotype-level risk patterns are not well defined. Hypothesis/Purpose To characterize 15-year discordance phenotypes of mechanical versus symptomatic failure and identify associated preoperative factors. Methods A retrospective single-center cohort study was performed using a prospectively collected 15-year hip database. Mechanical failure was defined as conversion to total hip arthroplasty (THA). Symptomatic failure was defined as failure to meet either modified Harris Hip Score (mHHS) or Non-Arthritic Hip Score (NAHS) patient acceptable symptom state (PASS) threshold at 15 years. PASS thresholds were derived from the 10-year cohort using anchor-based receiver operating characteristic (ROC) curve analysis and the Youden index, then applied to 15-year patient-reported outcome scores. Minimal clinically important difference (MCID) thresholds were calculated separately using a distribution-based method and were not used to assign the primary failure phenotypes. Patients were classified into 4 phenotypes: neither failure, symptomatic-only failure, mechanical-only failure, and both failures. Univariable one-vs-rest analyses were performed for age, sex, BMI, Tönnis grade, and preoperative morphology (lateral center-edge angle [LCEA], anterior center-edge angle [ACEA], and alpha angles). Results The cohort consisted of 138 eligible hips. Phenotype distribution was: neither failure (n=103), symptomatic-only failure (n=20), mechanical-only failure (n=11), and both failures (n=4). In the neither-failure phenotype, lower BMI (P=.0001), male sex (P=.005), and younger age (P=.005) were significant. In the symptomatic-only phenotype, female sex (P=.003) and higher BMI (P=.010) were significant. In the mechanical-only phenotype, older age (P=.002), lower preoperative LCEA (P=.020), and lower ACEA (P=.020) were significant. The both-failure phenotype was interpreted descriptively because of sparse cell size. Conclusion Mechanical and symptomatic failure to represent distinct 15-year phenotypes after primary hip arthroscopy. Lower BMI, younger age, and male sex characterize a favorable phenotype, while symptomatic-only failure is associated with higher BMI and female sex. Mechanical-only failure is associated with older age and lower acetabular coverage. These phenotype-level patterns may improve long-term counseling and guide risk stratification after primary hip arthroscopy.
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Authors BS Jade Refuerzo, Amanda Avila, Andrew Bi, Ariana Lott, Spencer Stein, Daniel James Kaplan, Thomas J. Youm
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.163
URL
https://doi.org/10.1093/jhps/hnag043.163
Keywords Keywords not found

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