EP8.40 Patient-reported outcomes of hip arthroscopy for femoroacetabular impingement and periacetabular osteotomy in NHS versus Independent-sector patients: a UK Non-Arthroplasty Hip Registry analysis

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2026
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Abstract
Abstract Background Patients undergoing hip preservation surgery in the UK are funded either through the National Health Service (NHS) or the Independent (private) sector. Whether outcomes differ between sectors is uncertain. We compared patient-reported outcomes following hip arthroscopy for femoroacetabular impingement (FAI) and periacetabular osteotomy (PAO) by funding source. Methods We analysed prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) for procedures performed between 1 January 2012 and 31 January 2025. Two parallel cohorts were defined: hip arthroscopy for FAI, and PAO. Cases were excluded for previous index-hip preservation surgery, funding not recorded as NHS or Independent, inconsistent surgical approach (non-arthroscopic FAI or arthroscopically-coded PAO), missing baseline iHOT-12, or absence of any 6- or 12-month postoperative questionnaire. We reported pre-operative iHOT-12 and EQ-5D-5L scores, mean within-group change at 6 and 12 months (paired t-test), and for hip arthroscopies the proportion of patients achieving the minimum clinically important difference (MCID, ≥13 points) and substantial clinical benefit (SCB, ≥28 points) for iHOT-12. Results 4,036 hip arthroscopies for FAI met inclusion criteria (NHS 3,010; Independent 1,026) and 942 PAOs (NHS 779; Independent 163). In FAI, Independent-sector patients were older (mean 37.2 vs 35.2 years) and less often female (51% vs 59%); for PAO, age and sex distributions were similar. Pre-operative iHOT-12 scores were higher in the Independent sector (FAI: median 39 vs 29; PAO: 35 vs 27), indicating less baseline disability. At 12 months, Independent-sector FAI patients achieved larger mean iHOT-12 gains (+30.6, 95% CI 28.7–32.6 vs +24.2, 23.1–25.4) and higher rates of MCID (74.5% vs 62.9%) and SCB (55.2% vs 43.9%). For PAO, 12-month mean iHOT-12 change was similar between sectors (+30.1, 25.3–35.0 vs +31.3, 29.3–33.3). EQ-5D Index gains followed the same pattern: greater improvement in Independent-sector FAI patients, and comparable gains for PAO. Conclusions Patients funded through the Independent sector reported less severe baseline disability and, after hip arthroscopy for FAI, achieved larger improvements and higher rates of clinically meaningful benefit than NHS patients. For PAO, outcomes were broadly equivalent. These differences are likely to reflect, at least in part, unmeasured confounders. Socio-economic deprivation, NHS waiting times, and access barriers may delay presentation, whereas privately-funded patients may seek treatment earlier and undergo surgery with less advanced chondral damage and less established secondary osteoarthritis.
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Authors Richard James Holleyman, William Cawley, Callum McBryde, Johan Witt, Nahr Group, Tony Andrade, Vikas Khanduja, Ajay Malviya
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.420
URL
https://doi.org/10.1093/jhps/hnag043.420
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