EP3.11 Outside-in versus inside-out hip arthroscopy in patients aged 30-50 years - a single surgeon cohort study

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ID: 331229
2026
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Abstract
Abstract Hip arthroscopy for femoroacetabular impingement, labral pathology and early osteoarthritis can be performed using outside-in or inside-out exposure strategies, but comparative medium-term data are limited. We performed a retrospective cohort study of adults aged 30–50 years who underwent hip arthroscopy between 1 February 2014 and 30 November 2024 with ≥24 months follow-up. Outcomes were the Forgotten Joint Score-12 (FJS-12), the International Hip Outcome Tool-12 (iHOT-12) and time to ipsilateral total hip replacement (THR). Unadjusted THR-free survival was estimated using Kaplan Meier and log-rank tests; the prespecified adjusted analysis used a parsimonious Cox model (age and technique). Sensitivity analyses included multiple imputation, penalised (glmnet) Cox regression, and Firth correction, and an additional model adjusting for baseline hip pain. The cohort comprised 117 hips (outside-in n = 60, inside-out n = 57); mean age 41.5 years (SD 6.0) and mean follow-up 63.03 months (SD 32.6). Eighteen hips (15.4%) progressed to THR. In the prespecified Cox model technique was not associated with THR (adjusted HR 0.87; 95% CI 0.32–2.34; p = 0.78) and age was not significant. Pooled (imputed) FJS-12 and iHOT-12 means were similar between groups. Baseline history of hip pain was strongly associated with THR (HR 0.15; 95% CI 0.04–0.52; p = 0.003) and materially altered the estimated technique effect when included in sensitivity analyses. In this single-surgeon medium-term series, outside-in and inside-out approaches demonstrated comparable survivorship on the prespecified analysis; multicentre studies are required for definitive comparison.
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Authors Immanuel de Wilde, Abdirashid Aden, Sebastian K Magobotha, M. Jingo, Marisa Burger, Zander Kotze
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.296
URL
https://doi.org/10.1093/jhps/hnag043.296
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