Life expectancy has increased and elderly people have the desire to live an active lifestyle with participation in sports. Hip arthroscopy has not yet been established as standard treatment in this group of patients. The purpose of this study is to assess the outcomes after hip arthroscopy for FAI in patients aged over 50, as well as to report the factors that can lead to conversion to a hip replacement.

Prospectively collected data were retrieved from our database in patients aged 50 years or older undergoing hip arthroscopic surgery for FAI and disabling pain. Demographics, clinical examination, imaging signs of impingement and operative findings were recorded. Patients completed MHHS pre and postoperatively and patients’ satisfaction. Factors that may indicate a conversion to a hip replacement were statistically analysed.

We included 149 patients (163 hips) with a mean age 56.7 years (50–80). There were 75 males and 74 females. Median follow-up was 19 months. All patients had signs of FAI on radiographs and osteoarthritic changes 0–3 according to Tonnis classification. Hip replacement was required in 12 patients (8.05%). The MHHS improved from mean 57.14 (26–96) preoperatively to 79.24 (28–100) postoperatively. The mean patients’ satisfaction was 85 (0–100). Statistically, hip arthroscopy was significantly more likely to fail in patients who were older at the time of surgery (OR=1.09, P=0.05). Patients were also significantly more likely to progress to a hip replacement with poor acetabular articular cartilage (OR=2.59, P=0.05) and with severe cartilage changes on the femoral head (OR=6.63, P=0.008). It was significantly more likely for patients with a higher age at the time of surgery to undergo a labral resection (OR=1.09, P=0.007). The group of patients who underwent a labral resection was significantly more likely to need a hip replacement when compared with the group of patients who had a labral repair (OR=10.67, P=0.028). Patients with lateral sourcil height less than>2mm were significantly more likely to undergo a total hip replacement (OR=9.11, P=0.05).

In patients with FAI aged 50 years or older good results can be achieved with therapeutic hip arthroscopy and with low conversion to a hip replacement. Factors that can lead to a failure of hip arthroscopy are>2mm joint space, labral resection, higher age and severe osteoarthritic changes, especially on the femoral head.