Patients With Global Acetabular Overcoverage Have Inferior Outcomes at 10 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Previous studies on the outcomes of hip arthroscopy in patients with global acetabular overcoverage and focal lateral acetabular overcoverage have been limited by short- and intermediate-term follow-up periods and inconsistent radiographic criteria in defining these specific subpopulations with femoroacetabular impingement syndrome (FAIS). Purpose: To evaluate the long-term outcomes of hip arthroscopy in patients with FAIS and global acetabular overcoverage, lateral acetabular overcoverage, or normal acetabular coverage over a 10-year period. Study Design: Retrospective cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients who underwent hip arthroscopy for FAIS with a minimum follow-up of 10 years. Patients were categorized based on acetabular coverage: global overcoverage (lateral center-edge angle LCEA >40° with coxa profunda), lateral overcoverage (LCEA >40° without coxa profunda), and no overcoverage (LCEA = 20°-40°). Functional outcomes were measured using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS). Survivorship rates, including revision arthroscopy and conversion to total hip arthroplasty (THA), were also evaluated. Statistical significance was set at P < .05. Results: A total of 163 patients were included with a mean age of 38.90 ± 12.61 years, mean body mass index of 24.86 ± 4.03 kg/m 2 , and mean follow-up of 11.63 ± 1.07 years. Overall, 73.6% (120/163) had no acetabular overcoverage, 17.2% (28/163) had lateral acetabular overcoverage, and 9.2% (15/163) had global acetabular overcoverage. Revision rates were 0.0% for the global overcoverage group, 7.7% for the lateral overcoverage group, and 5.2% for the no overcoverage group ( P = .679). THA conversion rates were 0.0% for the global overcoverage group, 11.5% for the lateral overcoverage group, and 8.3% for the no overcoverage group ( P = .585). The global overcoverage group exhibited lower mHHS ( P = .004) and NAHS ( P = .007) scores compared with the other groups. Female sex and higher body mass index were associated with worse long-term hip function ( P ≤ .05). Conclusion: At a minimum of 10 years postoperatively, there was no significant difference in reoperation or THA rates between groups. However, patients with global overcoverage demonstrated worse functional outcomes compared with those with lateral or no overcoverage.