Hip Arthroscopy for Femoroacetabular Impingement: 1-Year Outcomes Predict 5-Year Outcomes

Long-term Survivorship and Outcomes of Patients Without Dysplasia Undergoing Capsular Repair During Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

BACKGROUND

There is a paucity of literature evaluating long-term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS).

PURPOSE

To report 10-year survivorship and patient-reported outcomes (PROs) after primary hip arthroscopy with capsular repair for FAIS and evaluate the effect of capsular repair in patients at the highest risk for conversion to arthroplasty.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with a minimum 10-year follow-up on the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale for pain (VAS) scores were selected. The preoperative and minimum 10-year follow-up Hip Outcome Score-Sports Specific Subscale (HOS-SSS) scores were also reported, if available. Patients with ipsilateral hip surgery, worker's compensation, Tönnis osteoarthritis grade >1, and hip dysplasia (lateral center-edge angle <25°) were excluded. Survivorship, PROS, and clinical benefit-minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS)-were reported. An additional propensity-matched subanalysis was performed on patients at the highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair to patients with unrepaired capsules.

RESULTS

A total of 145 (n = 130 patients) out of 180 eligible hips (n = 165 patients) had a minimum 10-year follow-up (80.6%). Also, 126 hips (86.9%) belonged to women, and 19 hips (13.1%) belonged to men. The mean patient age was 30.3 ± 12.9 years. The survivorship rate was 91% at the 10-year follow-up. The cohort experienced significant improvements (P < .001) in the mHHS, NAHS, HOS-SSS, and VAS for pain scores. Moreover, the cohort achieved high rates of the PASS for the mHHS (89.8%), high rates of the MCID for the mHHS (82.4%), and high rates of the MCID for VAS for pain (80.6%) scores. In the propensity-matched subanalysis performed on patients with the highest risk for arthroplasty, 29 hips with capsular repair were matched to 81 hips with unrepaired capsules. While both groups experienced significant improvements in all PROs (P < .05), the group without capsule repair trended toward a higher conversion to arthroplasty rate when compared with the repair group. In addition, an odds ratio was calculated for the likelihood of converting to arthroplasty after having an unrepaired capsule compared with capsular repair (2.54 [95% CI, 0.873-7.37]; P = .087).

CONCLUSION

Patients undergoing primary hip arthroscopy with capsular repair experienced a high survivorship rate of 91% at a minimum 10-year follow-up. Patients who did not convert to arthroplasty saw favorable improvements in PROs and achieved high clinical benefit rates. In addition, among those patients at the highest risk for conversion to arthroplasty, a trend toward greater survivorship was observed with capsular repair.

Association of Patient Satisfaction 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Minimum 10-Year Patient-Reported Outcomes and Survivorship

BACKGROUND

Previous studies have shown that short-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) predict midterm outcomes, but a limited number of studies have evaluated whether short-term outcomes predict long-term outcomes and survivorship.

PURPOSE

To evaluate whether achieving clinically significant outcomes at 2 years after hip arthroscopy for FAIS can predict patient-reported outcomes (PROs) and survivorship at 10 years.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Patients who underwent primary hip arthroscopy for FAIS between June 2012 and December 2012 with a minimum 10-year follow-up were identified. Using previously established thresholds, we classified patients who achieved the 2-year Patient Acceptable Symptom State (PASS) for the visual analog scale (VAS) for satisfaction as the high satisfaction group and patients who did not as the low satisfaction group. Minimum 10-year PROs were then compared between the groups, including scores for the Hip Outcome Score (HOS)-Activities of Daily Living and -Sports Specific, the modified Harris Hip Score, the VAS for pain, and the VAS for satisfaction. Reoperation-free survivorship was compared.

RESULTS

Of 120 eligible consecutive patients, 85 patients were included (70.8% follow-up rate), of whom 61.2% were female. The mean age was 34.0 ± 12.8 years, and the mean body mass index was 25.4 ± 4.6. Of the 85 patients, 29 (34.1%) did not achieve PASS for the VAS for satisfaction at 2 years postoperatively compared with 56 (65.9%) who did. The low satisfaction group had significantly worse acetabular chondral grades at the time of surgery (P = .008). At minimum 10-year follow-up, the high satisfaction group showed significantly better HOS-Activities of Daily Living, HOS-Sports Specific, modified Harris Hip Score, VAS pain, and VAS satisfaction scores (P≤ .031). Compared with the low satisfaction group, the high satisfaction group had a significantly lower rate of secondary surgery (1.8% vs 24.1%, respectively; P = .002).

CONCLUSION

Patients who achieved PASS for the VAS for satisfaction at 2 years after hip arthroscopy demonstrated superior minimum 10-year outcomes compared with patients who did not, including greater PRO scores and a higher survivorship rate. The high satisfaction group had lower grade acetabular cartilage damage at the time of surgery compared with those who did not achieve PASS for the VAS for satisfaction at 2 years.

Mid- to Long-Term Outcomes in Patients After Hip Arthroscopy With Labral Reconstruction: A Systematic Review

Background

There is a paucity of aggregate data documenting mid- to long-term outcomes of patients after hip arthroscopy with labral reconstruction.

Purpose

To report mid- to long-term outcomes in patients after undergoing either primary or revision hip arthroscopy with labral reconstruction for the treatment of irreparable labral tears.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review of the PubMed, Cochrane, and Scopus databases in May 2022 was conducted with the following keywords: "hip arthroscopy,""labral reconstruction,""irreparable,""labrum,""reconstruction,""five-year,""midterm,""5 year,""long-term,""10 year," ten-year," and "femoroacetabular impingement" using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Midterm was defined as mean 5-year follow-up, and long-term was defined as mean 10-year or longer follow-up. For each included article, the demographic, radiographic, intraoperative, and surgical variables, as well as patient-reported outcomes (PROs), psychometric thresholds, and secondary surgeries were recorded. Forest plots were created for PROs that were reported in ≥3 studies; heterogeneity was assessed using I2 values.

Results

Out of 463 initial articles, 5 studies including 178 hips with primary and 41 hips with revision surgeries were included. One study had an average 5-year follow-up, three studies had a minimum 5-year follow-up and one study had a minimum 10-year follow-up. The most common indications for hip arthroscopy with labral reconstruction were irreparable labral tears. The most common PRO was the modified Harris Hip Score (mHHS), which was reported in all 5 studies. The mean preoperative mHHS ranged from 58.9 to 66, and the mean postoperative mHHS at minimum 5-year follow-up ranged from 80.2 to 89. The preoperative and postoperative mHHSs for the single long-term follow-up study were 60 and 82, respectively. All 5 studies demonstrated significant improvements in reported PROs. All 5 studies reported secondary surgery rates, with 1 study reporting rates at both 5- and 10-year follow-up. Conversion to total hip arthroplasty ranged from 0% to 27%, while overall secondary surgery rates ranged from 0% to 36%.

Conclusion

Findings demonstrated that patients undergoing primary and revision hip arthroscopy with labral reconstruction experienced favorable outcomes and high rates of clinical benefit and survivorship at mid- to long-term follow-up.

Six-Month Outcomes Correlate With 10-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To identify whether 6-month outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) correlate with outcomes at minimum 10-year follow-up.

METHODS

Patients who underwent primary hip arthroscopy for FAIS from 2012 to 2013 were reviewed and included if they had 6-month and minimum 10-year follow-up. Patient-reported outcome (PRO) measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) subscale, Hip Outcome Score Sports-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction. We compared 6-month and 10-year outcome scores and analyzed the relations between 6-month and 1-, 2-, 5-, and 10-year outcome scores using Pearson correlation coefficients (r). Six-month scores and clinically significant outcome achievement were then compared with 10-year clinically significant outcome achievement and reoperations, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), using logistic regressions and the Fisher exact test.

RESULTS

This study included 60 patients (60.0% female sex; mean age, 36.0 ± 12.2 years). The mHHS, VAS pain score, and VAS satisfaction score significantly improved from 6-month to 10-year follow-up (P ≤ .021), whereas the HOS-ADL and HOS-SS did not (P ≥ .072). There were significant correlations between 6-month and 10-year scores for the HOS-ADL (r = 0.505), HOS-SS (r = 0.592), and mHHS (r = 0.362) (P ≤ .022 for all), as well as significant correlations between 6-month and 1-, 2-, and 5-year scores (P ≤ .014 for all). The 6-month HOS-ADL, HOS-SS, and mHHS were all significantly associated with their respective 10-year achievement of the patient acceptable symptom state (PASS) (P ≤ .044). Furthermore, 6-month HOS-ADL and mHHS were significantly associated with THA conversion (P ≤ .041). Comparable 6-month and 10-year achievement of the minimal clinically important difference (96.5% vs 97.8%, P > .999) and PASS (85.2% vs 87.5%, P > .999) for any PRO was observed.

CONCLUSIONS

After hip arthroscopy for FAIS, patients' 6-month HOS-ADL and mHHS were significantly associated with their 10-year PROs, PASS achievement, and THA conversion, although correlation strengths decreased with increasing time from surgery.

LEVEL OF EVIDENCE

Level IV, case series.

Editorial Commentary: Time to Recovery Varies After Hip Gluteus Repair: Patient Expectations Should Be Set Accordingly

Patients undergoing endoscopic gluteus medius and/or minimus repair with concomitant arthroscopic labral management have been reported to achieve excellent improvement in symptoms and outcome at as far as 5- to 10-year long-term follow-up. Although clinical outcomes at 2 years and onward are successful, few studies investigate how quickly patients improve after surgery. Most patients undergoing gluteus medius and/or minimus for predominantly partial-thickness tears achieve minimal clinically important differences as early as 6 months postoperatively, and a minimum of 1 year is needed for most patients to achieve a patient acceptable symptomatic state. From a patient counseling and satisfaction standpoint, time to recovery is of high importance.

A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy

PURPOSE

To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up.

METHODS

We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up.

RESULTS

Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P = .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P = .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P = .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P = .65).

CONCLUSIONS

A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up.

LEVEL OF EVIDENCE

Level III, retrospective comparative prognostic trial.

Intermediate-Term Outcomes of Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients With Global Versus Isolated Lateral Acetabular Overcoverage

BACKGROUND

Previous studies evaluating the outcomes of hip arthroscopy for patients with global acetabular overcoverage and focal superolateral acetabular overcoverage suffer from short-term follow-up and inconsistent radiographic criteria when defining these subpopulations of patients with femoroacetabular impingement syndrome (FAIS).

PURPOSE

To evaluate the intermediate-term postoperative outcomes for patients with FAIS in the setting of global acetabular overcoverage, lateral acetabular overcoverage, and normal acetabular coverage.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Patients undergoing hip arthroscopy for FAIS were enrolled in a prospective cohort study, and those with a minimum follow-up of 5 years were included in this analysis. Patients were grouped based on type of acetabular coverage: global overcoverage (lateral center-edge angle [LCEA] ≥40°, with coxa profunda), lateral overcoverage (LCEA ≥40°, without coxa profunda), and no overcoverage (LCEA <40°). Functional outcomes (modified Harris Hip Score and Nonarthritic Hip Score) and failure of primary hip arthroscopy were compared between groups.

RESULTS

In total, 94 patients (mean age, 41.9 ± 14.2 years) were included with a mean follow-up duration of 6.1 ± 0.9 years. Of these patients, 40.4% had no acetabular overcoverage, 36.2% had lateral overcoverage, and 23.4% had global overcoverage. There was no difference between groups with respect to percentage of patients who underwent reoperation for either revision arthroscopy or conversion to total hip arthroplasty (28.9% for the normal acetabular coverage group, 29.4% for the lateral overcoverage group, and 31.8% for the global overcoverage group; P = .971). Among patients for whom primary hip arthroscopy did not fail, there was no difference in 5-year functional outcomes between groups. Postoperative LCEA >40° (β = -13.3; 95% CI, -24.1 to -2.6; P = .016), female sex (β = -14.5; 95% CI, -22.7 to -6.2; P = .001), and higher body mass index (β = -1.9; 95% CI, -2.8 to -1.0; P < .001) were associated with worse intermediate-term hip function in terms of modified Harris Hip Score.

CONCLUSION

There was no difference in functional outcomes or rate of reoperation at a minimum of 5 years postoperatively between those with global acetabular overcoverage, those with regional lateral overcoverage, and those with normal acetabular coverage. Provided that an appropriate acetabuloplasty is performed, there is no evidence to suggest that global acetabular overcoverage portends a worse prognosis than other FAIS subtypes.

Stratified care in hip arthroscopy: can we predict successful and unsuccessful outcomes? Development and external temporal validation of multivariable prediction models

OBJECTIVE

Although hip arthroscopy is a widely adopted treatment option for hip-related pain, it is unknown whether preoperative clinical information can be used to assist surgical decision-making to avoid offering surgery to patients with limited potential for a successful outcome. We aimed to develop and validate clinical prediction models to identify patients more likely to have an unsuccessful or successful outcome 1 year post hip arthroscopy based on the patient acceptable symptom state.

METHODS

Patient records were extracted from the Danish Hip Arthroscopy Registry (DHAR). A priori, 26 common clinical variables from DHAR were selected as prognostic factors, including demographics, radiographic parameters of hip morphology and self-reported measures. We used 1082 hip arthroscopy patients (surgery performed 25 April 2012 to 4 October 2017) to develop the clinical prediction models based on logistic regression analyses. The development models were internally validated using bootstrapping and shrinkage before temporal external validation was performed using 464 hip arthroscopy patients (surgery performed 5 October 2017 to 13 May 2019).

RESULTS

The prediction model for unsuccessful outcomes showed best and acceptable predictive performance on the external validation dataset for all multiple imputations (Nagelkerke R2 range: 0.25-0.26) and calibration (intercept range: -0.10 to -0.11; slope range: 1.06-1.09), and acceptable discrimination (area under the curve range: 0.76-0.77). The prediction model for successful outcomes did not calibrate well, while also showing poor discrimination.

CONCLUSION

Common clinical variables including demographics, radiographic parameters of hip morphology and self-reported measures were able to predict the probability of having an unsuccessful outcome 1 year after hip arthroscopy, while the model for successful outcome showed unacceptable accuracy. The externally validated prediction model can be used to support clinical evaluation and shared decision making by informing the orthopaedic surgeon and patient about the risk of an unsuccessful outcome, and thus when surgery may not be appropriate.

Patients Maintain Clinically Significant Outcomes at 5-Year Follow-Up after Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review

PURPOSE

To assess 5-year outcomes and survival rate of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) and to determine achievement rates of clinically significant outcomes.

METHODS

Three databases were searched around the following terms: hip arthroscopy, FAIS, and 5-year follow-up. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after primary HA using either patient reported outcomes (PROs) or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using MINORS assessment, and relative agreement was calculated using Cohen's kappa.

RESULTS

Fifteen articles were included. MINORS assessment ranged from 11-22, with excellent (k=0.842) inter-rater reliability between reviewers. 2080 patients were included at a follow-up range of 60.0-84 months. Labral repair was the most commonly performed procedure (range: 8.0%-100%). All studies included PROs and all reported statistically significant improvement (p<0.05) at the 5-year timepoint. The most frequent PRO reported was modified Harris Hip Score (mHHS) (n=8). Nine studies reported on clinically significant outcome achievement, with mHHS being the most common (n=8). The rate of achieving minimal clinically important difference (MCID) ranged from 64-100%, patient-acceptable symptomatic state (PASS) ranged from 45-87.4%, and substantial clinical benefit (SCB) ranged from 35.3-66%. Conversion to THA and revision surgery varied across studies, with ranges of 0.0%-17.9% (duration: 28.8-87.1 months) and 1.3%-26.7% (duration: 14.8-83.7 months), respectively. The most common definition of failure was conversion to THA or revision (n=7). Increased age (n=5) and greater joint degeneration (n=4) were the most common predictors of clinical failure.

CONCLUSIONS

Patients undergoing primary hip arthroscopy for FAIS demonstrate significant improvement at 5-year follow-up, with maintained rates of achievement of MCID, PASS, and SCB. Survival rate of HA at 5-years is overall high, with ranges of 0.0-17.9% and 1.3-26.7% % conversion to THA or revision surgery, respectively. Across studies, increased age and greater joint degeneration were the most common cited predictors of clinical failure.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome Shows Good Outcomes and Low Revision Rates, With Young Age and Low Postoperative Pain Score Predicting Excellent 5-Year Outcomes

PURPOSE

To evaluate the clinical outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and their predictors at a minimum 5 years' follow-up.

METHODS

We retrospectively analyzed patients with FAIS after first-time unilateral hip arthroscopy between January 2010 and July 2016. Patient-reported outcomes (PROs) included the validated modified Harries Hip Score (mHHS) and Visual Analog Scale for Pain (Pain VAS). We included patients with Tönnis grade 0 or 1 and reported PROs, and excluded patients with previous hip diseases or bilateral symptoms. Bivariate and multivariate analyses were used for data analysis.

RESULTS

We included 159 patients with a mean follow-up of 6.4 years, aged 36.18 ± 8.61 years, 41.5% female, and a mean body mass index of 23.61 ± 3.45. The mean postoperative mHHS was 88.82 ± 11.60, and the mean Pain VAS was 1.93 ± 1.89, significantly better than before surgery (P < .001). Postoperative alpha angle (P = .003) and lateral center edge angle (P < .001) were significantly decreased. Most patients (83.7%) achieved clinically important improvement based on patient-acceptable symptom state and minimal clinically important difference (MCID). The overall revision surgery rate was 2.5%. There were no conversions to total hip arthroplasty. Bivariate analysis indicated that age (P < .001), preoperative mHHS (P = .002), and postoperative Pain VAS (P <.001) correlated with postoperative mHHS at a minimum 5 years' follow-up. Multivariate regression analysis of MCID showed that age (P <.001), preoperative PROs (P < .01 for both), and postoperative Pain VAS (P < .001) were significant outcome predictors.

CONCLUSION

Patients with FAIS after first-time unilateral hip arthroscopy showed significant improvement in PROs at mid-term follow-up, with a low revision surgery rate. Young patients and those with low postoperative Pain VAS showed excellent outcomes at a minimum 5 years' follow-up.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Relationship of Average Outcomes Scores and Change in Status Requires Further Interpretation Between 1 and 2 Years Following Hip Arthroscopy

BACKGROUND

Previous studies have demonstrated a clinically impactful change in patients between 1 and 2 years after hip arthroscopy. Assessment of differences in patient-specific factors between patients who remain the same and those who change (ie, either improve or decline) could provide valuable outcome information for orthopaedic surgeons treating those patients.

PURPOSE

To identify patients who experienced change in functional status between 1 and 2 years after hip arthroscopy for femoroacetabular impingement syndrome and assess differences in patient-specific factors between those who improved, remained the same, or declined in functional status.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Prospectively collected data for patients who underwent hip arthroscopy at 1 of 7 centers were analyzed retrospectively at 1 year and 2 years postoperatively. Patients were categorized as "improved,""remained the same," or "declined" between 1- and 2-year follow-up based on the 12-item International Hip Outcome Tool (iHOT-12) minimal clinically important difference (MCID) value. A 1-way analysis of variance was used to assess differences in iHOT-12 scores, age, body mass index (BMI), alpha angle, and center-edge angle (CEA) between groups. Chi-square analyses were used to assess differences in the proportions of male and female patients in the outcome groups.

RESULTS

The study included 753 patients (515 women and 238 men), whose mean ± SD age was 34.7 ± 12 years. Average 1-year (±1 month) and 2-year (±2 months) iHOT-12 scores for all patients were 73.7 and 74.9, respectively. Based on the calculated MCID of ±11.5 points, 162 (21.5%) patients improved, 451 (59.9%) remained the same, and 140 (18.6%) declined in status between 1- and 2-year follow-up. Those who improved between 1 and 2 years had lower 1-year iHOT-12 scores (P < .0005). We found no difference in age, BMI, alpha angle, CEA, or sex between groups (P > .05).

CONCLUSION

Between 1- and 2-year follow-up assessments, 21.5% of patients improved and 18.6% declined in self-reported functional status. Those with iHOT-12 scores indicating abnormal function at 1 year improved beyond the MCID at 2 years follow-up. Thus, any decisions about the failure or success of arthroscopic hip procedures should not be made until at least the 2-year follow-up. Failing to thrive at 1-year follow-up may not accurately predict outcomes at year 2 or beyond. This could potentially decrease the perceived need for revision surgery in patients who do not thrive before 2-year follow-up.

Hip Spine Syndrome Negatively Impacts Arthroscopic Outcomes in the Management of Femoroacetabular Impingement Syndrome: A Systematic Review

To determine whether the presence of spine pathology affects clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in the setting of hip-spine syndrome (HSS) METHODS: A systematic review of PubMed and Cochrane was conducted. Primary research articles evaluating patient-reported outcomes (PRO) after hip arthroscopy for FAIS in the presence of concomitant spine pathology were considered RESULTS: Literature review identified 12 studies meeting criteria. In 2109 FAIS patients undergoing hip arthroscopy, 591 had concomitant spine pathology. Baseline PROs in the hip-spine (modified Harris Hip Score [mHHS]: 39.8-65.29 vs 56.9-78.8, 8 studies; non-arthritic hip score [NAHS]: 42.2-51.5 vs 68.2-75.2, 4 studies; hip outcome score-activities of daily living [HOS-ADL]: 45.9-71.1 vs 49.3-89.51, 9 studies; hip outcome score-Sport (HOS-Sport): 22.8-49.6 vs 50.6-73.1, 3 studies; international hip outcome tool-33 [iHOT-12]: 38.0 vs 66.0, 1 study; visual analog scale [VAS] Pain: 6.43-6.56 vs 1.18-3.60, 3 studies; VAS Satisfaction: 7.18-7.46 range at follow-up, 2 studies) and control (mHHS: 39.3-64.9 vs 70.2-92.6, 6 studies; NAHS: 42.8-54.2 vs 74.0-87.1, 4 studies; HOS-ADL: 59.0-76.4 vs 75.4-97.1, 4 studies; HOS-Sport: 38.1-55.1 vs 60.9-93.9, 3 studies; iHOT-12: 43.4 vs 89.8, 1 study; VAS Pain: 6.18-6.22 vs 1.82-3.44, 2 studies; VAS Satisfaction: 7.74-8.22 range at follow up, 2 studies). Minimal clinically important difference threshold rates achieved in the hip-spine (44.1-86.7, 4 studies) cohorts were significantly lower than control (79.4-88.2%; 4 studies) cohorts in 3 studies. Patient-acceptable symptomatic state threshold rates achieved in the hip-spine (42-63.5, 3 studies) cohorts were significantly lower than control (58.8-81.0, 3 studies) in 1 study. There was no statistical difference in complication and reoperation rates between cohorts CONCLUSION: FAIS patients with concomitant HSS have improved but inferior outcomes after hip arthroscopy compared to patients without HSS LEVEL OF EVIDENCE: IV, systematic review.

The minimal clinically important difference for the nonarthritic hip score at 2-years following hip arthroscopy

PURPOSE

The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

METHODS

Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon's hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method.

RESULTS

The study included 298 patients (184 females) with an average age of 40.4 ± 13.0 years and average body mass index (BMI) of 25.7 ± 4.2 kg/m². At baseline, the cohort's average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS.

CONCLUSION

This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research.

LEVEL OF EVIDENCE

IV.

A higher proportion of patients may reach the MCID with capsular closure in patients undergoing arthroscopic surgery for femoroacetabular impingement: a systematic review and meta-analysis

PURPOSE

The purpose of this review is to provide a summary of the techniques and outcomes of various capsular management strategies in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). The information this review provides on capsular management strategies will provide surgeons with operative guidance and decision-making when managing patients with FAI lesions arthroscopically.

METHODS

Three databases MEDLINE, EMBASE, and PubMed were searched from database inception to November 2nd 2021, for literature addressing capsular management of patients undergoing hip arthroscopy for FAI. All level I-IV data on capsular management strategy as well as postoperative functional outcomes were recorded. A meta-analysis was used to combine the mean postoperative functional outcomes using a random-effects model.

RESULTS

Overall, there were a total of 36 studies and 4744 patients included in this review. The mean MINORS score was 10.7 (range 8-13) for non-comparative studies and 17.6 (range 15-20) for comparative studies. Three comparative studies in 1302 patients examining the proportion of patients reaching the MCID for the mHHS score in patients undergoing interportal capsulotomy with either capsular repair or no repair found that the capsular repair group had a higher odds ratio of reaching the MCID at 1.46 (95% CI 0.61-3.45, I² = 67%, Fig. 2, Table 3); however, this difference was not significant with a p value of 0.39. When looking at only level 1 and 2 studies, four studies in 1308 patients reporting on the mHHS score in patients undergoing capsular closure regardless of capsulotomy type, found a pooled standardized mean difference in the mHHS score of 2.1 (95% CI 1.7-2.55, I² = 70%, Fig. 3), while four studies in 402 patients reporting on the mHHS score in patients not undergoing capsular closure regardless of capsulotomy type found a pooled standardized mean difference in the mHHS score of 1.46 (95% CI 1.2-1.7, I² = 30%, Fig. 4).

CONCLUSION

This review may demonstrate improved postoperative outcomes in patients undergoing complete capsular closure regardless of capsulotomy type based on postoperative mHHS score. Furthermore, this review may suggest improved postoperative outcomes after closure of an interportal capsulotomy. There are limited published outcome data regarding T-type capsulotomy without closure. This review provides surgeons with operative guidance on capsular management strategies when treating patients with FAI lesions arthroscopically.

LEVEL OF EVIDENCE

IV.

Low Body Mass Index in Females May Portend Inferior Outcomes After Primary Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up

BACKGROUND

There is a paucity of literature evaluating the effect of low body mass index (BMI) in female patients undergoing primary hip arthroscopy.

PURPOSE

(1) To report minimum 2-year patient-reported outcome scores for female patients with low BMI who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare these results with a propensity-matched control group of female patients with normal BMI.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Data were collected on all female patients who had low BMI (<18.5) and underwent primary hip arthroscopy between April 2008 and January 2019. Patients were excluded if they had a previous hip arthroscopy; had workers' compensation; were unwilling to participate in the study; or had Tönnis osteoarthritis grade >1, acetabular dysplasia, or a previous hip condition. Minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale for pain, and satisfaction. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched in a 1:2 ratio to female patients with normal BMI for comparison.

RESULTS

A total of 43 patients (49 hips) were included with a mean ± SD follow-up of 26.9 ± 8.3 months, age of 24.1 ± 12.6 years, and BMI of 17.7 ± 0.67. These patients demonstrated significant improvement from presurgery to minimum 2-year follow-up for the mHHS, Non-Arthritic Hip Score, HOS-SSS, and visual analog scale (P < .05). When outcomes were compared with 93 control patients (97 hips), female patients with low BMI demonstrated lower rates of achieving the PASS for the mHHS (61.2% vs 77.3%; P = .041) and HOS-SSS (39.5% vs 57.1%; P = .031). Rates of achieving the MCID and MOIST were similar between the groups (P > .05). Female patients with low BMI also had higher rates of revision when compared with the control group, but this did not reach statistical significance (14.2% vs 7.2%; P = .171).

CONCLUSION

Female patients with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up. When compared with a propensity-matched control group with normal BMI, these patients demonstrated lower rates of achieving the PASS for the mHHS and HOS-SSS. Low BMI in females undergoing primary hip arthroscopy for FAIS may adversely affect outcomes at short-term follow-up.