Obese Patients Treated by Hip Arthroscopy for Femoroacetabular Impingement Syndrome - 10-Year Functional Outcomes and Conversion Rates to Arthroplasty Compared With Normal-Weight Patients
Author(s):Quesada-Jimenez R, McCarroll TR, Schab AR, Kahana-Rojkind AH, Sikligar D, Domb BG.
DOI Link: 10.1177/03635465251392585
Background
Obesity is a known negative prognostic factor in orthopaedic surgery, but its impact on long-term outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral pathology remains important for patient selection and counseling.
Methods
This Level 3 retrospectively analyzed prospectively matched cohort study evaluated patients undergoing primary hip arthroscopy for FAIS and labral tears between 2008 and 2013. Inclusion required BMI ≥30 kg/m² and minimum 10-year follow-up or documented endpoint. Patients were propensity-matched 1:1 to normal-weight controls (BMI 20–24.99 kg/m²) based on age, sex, acetabular cartilage status (Outerbridge grade), and capsular treatment. Outcomes included validated PROs (mHHS, NAHS, HOS-SSS, VAS), MCID/PASS achievement, revision rates, and conversion to THA. Subanalyses were performed for BMI strata and sex.
Key Findings
A total of 266 patients were included with mean follow-up of ~10 years (125 months).
Both obese and normal-weight cohorts demonstrated significant and durable improvements in all PROs with comparable postoperative scores and similar rates of MCID/PASS achievement across most measures (P < .05 as reported).
Key differences included:
- Higher conversion to THA in obese patients (OR 2.19; 95% CI 1.17–4.13; P < .05)
- Lower baseline preoperative PRO scores in obese cohort
- Morbid obesity (BMI ≥40) associated with reduced likelihood of achieving MCID/PASS
No differences were observed in complications or secondary surgeries in sex-based analysis.
Conclusion
Hip arthroscopy in obese patients yields durable 10-year functional improvement comparable to normal-weight patients; however, obesity—particularly morbid obesity—is associated with significantly increased risk of conversion to total hip arthroplasty and reduced likelihood of achieving clinically meaningful thresholds.
What Does This Mean for Providers?
Obesity should not be considered an absolute contraindication to hip arthroscopy, as long-term functional gains are comparable to normal-weight patients. However, patients—especially those with morbid obesity—should be counseled regarding increased risk of progression to THA and potentially lower rates of achieving optimal clinical thresholds. This information is critical for preoperative expectation setting and shared decision-making.