Midterm Outcomes in Patients After Central Acetabular Decompression for Central Acetabular Stenosis: A Comparison With a Matched Control Group.
Authors
Kuhns BD, Kahana-Rojkind AH, McCarroll TR, Kingham YE, Domb BG
Background
Central acetabular stenosis (CAS)—an osteophyte within the acetabular fossa—is linked to increased femoral head cartilage damage and poorer short-term results after hip arthroscopy if untreated. Central acetabular decompression (CAD) is an arthroscopic technique used to resect the osteophyte and resurface the fossa to optimize joint contact and function.
Methods
A cohort of 189 patients who underwent CAD during primary hip arthroscopy for femoroacetabular impingement (FAI) was studied, with 155 (82%) reaching a minimum of 5-year follow-up. Outcomes included rates of conversion to total hip arthroplasty (THA), need for revision arthroscopy, patient-reported outcome (PRO) scores, and satisfaction. These were compared with a control group of FAI patients without CAS, matched by age, sex, BMI, and Tönnis grade. Multivariate regression was used to assess predictors of THA.
Key Findings
- 5-year arthroplasty-free survivorship in the CAD group was 80.6% (125/155).
- Patients who did not convert to arthroplasty showed significant and durable improvements in PROs (p < 0.001) and reported high satisfaction.
- Severe acetabular cartilage damage was the strongest predictor of conversion to THA.
- Compared to the matched control group, the CAD group had:
- Higher rates of cartilage damage
- Lower THA-free survivorship (p < 0.01)
- Among patients who avoided THA, outcome scores and satisfaction were comparable between groups.
Conclusion
Patients with CAS treated with CAD during hip arthroscopy for FAI experienced sustained improvements and high satisfaction at 5 years. Despite a higher rate of cartilage damage and lower survivorship free from arthroplasty, most patients benefited from the procedure, achieving outcomes similar to those without CAS—supporting CAD as a viable treatment when CAS is identified.
What Does This Mean For Patients
Patients with central acetabular stenosis can achieve significant symptom relief and functional improvement with hip arthroscopy and CAD. Although there is a higher risk of needing a hip replacement down the line, most patients do well and are satisfied with their outcomes at 5 years.