Short-term Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Underweight Patients
Authors: Quesada-Jimenez R, Keane JC, Kahana-Rojkind AH, Kingham YE, Strok MJ, Domb BG
DOI: 10.1177/03635465251343299
Background
Underweight status (BMI ≤18.5 kg/m²) is associated with increased surgical risk in multiple orthopedic procedures. However, limited data exist on the effect of low BMI on outcomes after hip arthroscopy for femoroacetabular impingement (FAI) and labral tears. This study investigates short-term functional and clinical outcomes in underweight patients undergoing hip preservation surgery.
Methods
This retrospective case series analyzed 234 patients who underwent primary hip arthroscopy for FAI and labral tears (2008–2022). The underweight group was matched 1:2 to a normal-BMI control group (18.6–24.99 kg/m²) by sex, age, surgical treatment type, and acetabular cartilage grade.
All patients had ≥2 years of follow-up with complete patient-reported outcomes (PROs) and visual analog scale (VAS) pain scores.
Key Findings
- Underweight patients showed statistically significant improvement in all PRO measures and reported high satisfaction.
- Compared to matched normal-weight controls, underweight patients had comparable gains in:
- Modified Harris Hip Score (mHHS)
- Nonarthritic Hip Score (NAHS)
- International Hip Outcome Tool–12 (iHOT-12)
- VAS for pain
- Inferior results were observed in the Hip Outcome Score–Sports Specific Subscale (HOS-SSS):
- Lower magnitude of improvement (p < .05)
- Lower rates of achieving Patient Acceptable Symptom State (PASS)
- Underweight patients had a 2.16-fold increased risk of requiring revision hip arthroscopy (p < .05)
Conclusion
While underweight patients can experience meaningful clinical improvements after hip arthroscopy, they may demonstrate reduced functional gains in sports-specific activities and a higher risk of revision surgery. These findings highlight the need to factor in nutritional and metabolic status during preoperative planning and patient selection.
What Does This Mean for Providers?
- Preoperative nutritional status matters: Low BMI may predispose patients to suboptimal functional recovery, especially in physically demanding or athletic populations.
- Consider early nutritional intervention: Providers may benefit from incorporating preoperative nutritional assessments or referrals as part of optimization protocols for underweight patients.
- Manage expectations: While pain relief and general functional improvement are likely, sports-specific performance may be more limited in this group.
- Increased vigilance for revision risk: The elevated revision rate among underweight patients warrants closer postoperative monitoring and discussion of potential need for additional intervention.