ArticleInternational orthopaedics2026
Risk factors for conversion to total hip arthroplasty after hip arthroscopy for femoroacetabular impingement: a five-year analysis in a large cohort.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo identify independent risk factors for conversion to total hip arthroplasty (THA) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in a large European single-centre cohort with minimum five-year follow-up, and to further evaluate the Hip Arthroscopy Risk (HAR) Index. We hypothesised that HAR Index ≥ 3, Tönnis grade 2, and Outerbridge grade 4 would be independently associated with THA conversion at five years.
methodsThis retrospective cohort study included 827 consecutive hips undergoing primary hip arthroscopy for FAIS between January 2007 and April 2021, with minimum five-year follow-up. The primary endpoint was THA conversion within 60 months. Kaplan-Meier analysis and multivariable Cox regression were performed. Predictors included Tönnis grade, Outerbridge grade, ALAD grade, HAR Index, age, sex, and body mass index.
resultsA total of 86 hips (10.4%) were converted to THA within five years (overall survivorship 89.6%). Conversion rates increased with Tönnis grade: 1.0% (grade 0), 7.7% (grade 1), and 36.2% (grade 2) (P < 0.001). Outerbridge grade 4 was associated with a 33.3% conversion rate versus 2.3% for grades 0-1 (P < 0.001). The HAR Index showed a dose-response from 0.3% (HAR 0) to 66.7% (HAR 4). Two pre-specified multivariable Cox models were constructed to address multicollinearity between the HAR Index and its component variables. Model 1 (composite model): HAR Index ≥ 3 (HR 8.30; 95% CI, 4.84-14.26), Outerbridge grade 4 (HR 6.32; 95% CI, 3.29-12.14), and Outerbridge grade 2-3 (HR 3.16; 95% CI, 1.48-6.73) were independent predictors (C-index 0.853; all P ≤ .003). Model 2 (component model): Tönnis grade 2-3 (HR 19.41; 95% CI, 6.03-62.53), Tönnis grade 1 (HR 7.09; 95% CI, 2.18-23.06), Outerbridge grade 4 (HR 2.16; 95% CI, 1.06-4.37), and age 50-60 years (HR 5.49; 95% CI, 2.47-12.17) were independent predictors (C-index 0.885; all P ≤ .033).
conclusionsTönnis grade, Outerbridge grade, age, and the HAR Index were independently associated with THA conversion within five years. A HAR Index ≥ 3 may help guide patient selection and preoperative counselling. External validation is required.
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