# Evolving Surgical Timing for Bilateral Hip Arthroscopy in Femoroacetabular Impingement: A Comparison of Clinical Outcomes Between Simultaneous and Staged Approaches

## TL;DR

This study compares the outcomes of simultaneous and staged hip surgeries for a hip condition called femoroacetabular impingement and finds no significant difference in results, with simultaneous surgery offering a shorter hospital stay.

## Contribution

The study provides evidence that simultaneous bilateral hip arthroscopy is not inferior to staged approaches for treating FAI.

## Key findings

- No significant differences in clinical outcomes were found between the three surgical approaches.
- The single-stage approach had a significantly shorter hospital stay compared to staged approaches.
- All groups showed significant improvement in clinical outcome scores at two-year follow-up.

## Abstract

Background and aim

Femoroacetabular impingement (FAI) commonly presents with radiographic signs in both hips, and many patients report symptoms on both sides. Hip arthroscopy is the preferred surgical treatment for symptomatic FAI. The optimal approach with the lowest procedural risk between simultaneous and staged bilateral arthroscopy remains debated in the literature. The objective of this single-center study was to compare clinical outcomes, complication rates, length of hospital stay, return to sport, and patient satisfaction among patients undergoing single-stage, early-stage, and two-stage bilateral hip arthroscopy for femoroacetabular impingement.

Materials and methods

This monocentric retrospective study evaluated patients undergoing bilateral hip arthroscopy for symptomatic FAI between 2017 and 2023, all performed by a single surgeon. Patients were divided into the following three groups: two-stage (TS; ≥6 weeks between procedures), early-stage (ES; second procedure the day after the first), and single-stage (SS; simultaneous) groups. The group assignment was based on shared decision-making, and propensity score matching was used to balance for age, gender, and BMI. Hip Outcome Score - Activities of Daily Life (HOS-ADL), Hip Outcome Score - Sports Subscale (HOS-Sport), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) were collected preoperatively and at two years postoperatively. Major complications, return to sport, and patient satisfaction were also recorded.

Results

The study included 60 TS, 30 ES, and 30 SS patients. Mean cumulative surgical times did not significantly differ between groups. No major complications, revisions, or conversions to total hip replacement were recorded at the two-year follow-up. The total length of hospital stay was significantly shorter in the SS group compared to the TS and ES groups. All clinical outcome scores improved significantly at follow-up. No significant differences were found in HOS, HOS-Sport, iHOT-12, VAS, return to sport, or satisfaction rates between the three groups.

Conclusion

There is no inferiority in clinical outcomes when using a simultaneous approach compared to more staged approaches. The single-stage group had a significantly shorter mean total length of hospital stay compared to the staged groups. The single-stage approach is a viable solution for selected patients and experienced surgical teams, allowing for outcomes that are not inferior to the early-stage or two-stage approaches.