EP8.71 A Novel Analysis of the Impact of Body Mass Index on Long-Term Outcomes Following Hip Arthroscopy using the Win Ratio

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ID: 331062
2026
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Abstract
Abstract Purpose Obesity has been associated with inferior outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Traditional analyses often evaluate endpoints in isolation, which may not capture the relative clinical importance of competing outcomes. The win ratio is a hierarchical composite method that enables prioritized comparison of clinically meaningful events and is infrequently used in orthopedics. The purpose of this study was to apply a win ratio framework to compare long-term outcomes between patients with normal and elevated body mass index (BMI), hypothesizing that lower BMI would be associated with superior outcomes. Methods Patients undergoing primary hip arthroscopy for FAIS with minimum 10-year follow-up were retrospectively reviewed and stratified by BMI (normal vs overweight). Outcomes included survivorship (conversion to total hip arthroplasty [THA], revision arthroscopy), achievement of clinically meaningful thresholds (minimal clinically important difference [MCID], patient acceptable symptom state [PASS]), complications, and changes in patient-reported outcomes (PROs) (Nonarthritic Hip Score [NAHS] and modified Harris Hip Score [mHHS]). A hierarchical win ratio analysis prioritized THA and revision surgery, followed by clinically meaningful outcomes, complications, and PRO improvement. Stratified analyses adjusted for age and sex. Results A total of 161 patients were included (70 overweight, 91 normal BMI) with a mean follow-up of 14.25 ± 1.14 years. Normal BMI patients demonstrated significantly higher 10-year NAHS and mHHS scores, greater improvements in PROs, and higher rates of PASS achievement, as well as lower overall failure rates (5.5% vs 18.6%, p = 0.018). In win ratio analysis, normal BMI patients demonstrated superior outcomes for both NAHS (win ratio 1.73, 95% CI 1.19-2.58; p = 0.006) and mHHS (1.64, 95% CI 1.14-2.44; p = 0.004). Findings remained significant after adjustment for age and sex (NAHS: 1.57, p = 0.03; mHHS: 1.55, p = 0.038). Win probability favored the normal BMI cohort (NAHS: 0.63; mHHS: 0.62). Conclusion Lower BMI is associated with significantly improved long-term outcomes following hip arthroscopy, including superior patient-reported outcomes, higher likelihood of achieving clinically meaningful improvement, and lower rates of failure. These findings were consistent in both unadjusted and adjusted hierarchical win ratio analyses.
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Authors Mallory Ehlers, Thomas J. Youm
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.450
URL
https://doi.org/10.1093/jhps/hnag043.450
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