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Lucenti L, Maffulli N, Bardazzi T, Saggini R, Memminger M, Simeone F, Migliorini F. Return to Sport Following Arthroscopic Management of Femoroacetabular Impingement: A Systematic Review. J Clin Med 2024; 13:5219. [PMID: 39274432 PMCID: PMC11395971 DOI: 10.3390/jcm13175219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Femoroacetabular impingement (FAI) is common. The present systematic review updates the current evidence on return to sport (RTS) in patients who have undergone arthroscopic surgery for FAI in any of its variants (CAM, pincer, or both). Methods: The outcomes of interest were sports-related patient-reported outcome measures (PROMs) and the level and time to RTS. All available clinical studies concerning the RTS following arthroscopic management of FAI were considered. In July 2024, the following databases were accessed following the PRISMA guidelines: Embase, Web of Science, and PubMed. Only studies with a minimum of six months of follow-up were eligible. Results: From 1245 initially identified articles, 43 studies (4103 patients) met the inclusion criteria, in which 32.1% (1317 of 4103 patients) were women. The mean length of follow-up was 33.7 ± 15.8 months. The mean age was 28.1 ± 7.2 years, the mean BMI was 24.7 ± 6.4 kg/m2, and 79.6% ± 27.8% of patients returned to sport at the same or higher level at a mean of 14.3 ± 9.6 months. The mean time away from sports was 8.0 ± 3.3 months. Conclusion: Arthroscopic management for FAI leads to a high rate of RTS, with approximately 80% of patients returning to their preinjury level. Future research should focus on standardised definitions of RTS, sport-specific rehabilitation protocols, and the influence of deformity and procedures on RTS.
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Affiliation(s)
- Ludovico Lucenti
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185 Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 4DG, UK
| | - Tommaso Bardazzi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Raoul Saggini
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Michael Memminger
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
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AlMousa SA, Hegazi T, AlKhamis HA, AlTayyar ZA, AlMutairi MD, AlGhamdi SA, Almuhaish MI, Alzaid MM, Alsubaie SS, Alzahrani MM. Cam-type hip morphology in asymptomatic patients. Hip Int 2024; 34:372-377. [PMID: 38263909 DOI: 10.1177/11207000231225184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The alpha angle has been widely used in the assessment of cam-type of impingement, but recent studies have shown that this angle may also be high in asymptomatic patients. The aim of this study is to report the prevalence of cam-type morphology in asymptomatic volunteers and explore its correlation with hip clinical and radiological parameters. METHODS This single-centre prospective study included 48 asymptomatic male volunteers (96 hips). All candidates fulfilled the inclusion and exclusion criteria. Physical examination and 1.5 -T MRI imaging were done for bilateral hips on the same day. Alpha angle measurements were obtained from 4 different positions and cam-type morphology was considered positive using 2 different cut points >55° and >60°. Descriptive statistics were analysed and correlations were performed where appropriate and p-value < 0.05 was considered to be significant. RESULTS The prevalence of cam-type morphology using alpha angle >55° was 68.8%, 87.5%, 50% and 34.4% in the 12, 1, 2 and 3 o'clock positions respectively. While it was 38.5%, 69.8%, 26% and 12.5% in the 12, 1, 2 and 3 o'clock positions of the studied hips respectively using alpha angle >60°. The maximum alpha angle was more frequently prevalent at the 1 o'clock position in 71 (74%). Labral tear was detected in 26 (27.1%) hips and impingement test was positive in 12 (12.5%) hips. There was no correlation between the presence of cam-type morphology and range of motion of the hip, presence of positive impingement test nor labral tears. CONCLUSIONS Cam-type morphology prevalence is high among asymptomatic males, and mostly pronounced at the 1 o'clock position. A correlation between high alpha angle and positive impingement test or labral tear was not found in our cohort. Future studies are required to determine the natural history of asymptomatic cam-type morphology and risk of hip derangement.
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Affiliation(s)
- Sulaiman A AlMousa
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tarek Hegazi
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hashem A AlKhamis
- Department of Orthopaedic Surgery, Asir Central Hospital, Abha, Saudi Arabia
| | - Ziyad A AlTayyar
- Department of Family Medicine and Community Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq D AlMutairi
- Department of Orthopaedic Surgery, King Fahd Military Medical Complex, Dhahran, Eastern Province, Saudi Arabia
| | - Salim A AlGhamdi
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona I Almuhaish
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed M Alzaid
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shayma S Alsubaie
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad M Alzahrani
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Thirumaran AJ, Murphy NJ, Fu K, Hunter DJ. Femoroacetabular impingement - What the rheumatologist needs to know. Best Pract Res Clin Rheumatol 2024; 38:101932. [PMID: 38336510 DOI: 10.1016/j.berh.2024.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Femoroacetabular impingement (FAI) syndrome is a common cause of hip and groin pain in young individuals. FAI syndrome is a triad of signs, symptoms, and imaging findings. Necessary but not sufficient for the diagnosis of FAI syndrome is the presence of cam and/or pincer morphology of the hip. However, pathological thresholds for cam and pincer morphologies are not well-established. Management of FAI syndrome is typically through either physiotherapist-led therapy or surgical intervention. Physiotherapist-led management involves exercises aimed to optimise movement patterns of the hip and pelvis to prevent impingement from occurring, activity modification and analgesia, whereas surgical management involves arthroscopic resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions or ligamentum teres tears. Careful consideration of intervention is required given that FAI syndrome may predispose those affected to developing future osteoarthritis of the hip. In most clinical trials, hip arthroscopy has been found to provide greater improvement in patient-reported outcomes in the short-term compared to physiotherapy, however it is unknown whether this is sustained in the long-term or affects the future development of hip osteoarthritis.
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Affiliation(s)
- Aricia Jieqi Thirumaran
- Nepean Hospital, Kingswood, NSW, 2747, Australia; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; University of Newcastle and Department of Orthopaedic Surgery, John Hunter Hospital, New Lambton, NSW, 2305, Australia
| | - Kai Fu
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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Shankar DS, Bi AS, Buldo-Licciardi M, Rynecki ND, Akpinar B, Youm T. Five-Year Outcomes of Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Among Female Patients: Higher Body Mass Index Is Associated With Reduced Clinically Significant Outcomes. Arthroscopy 2024; 40:732-741. [PMID: 37394153 DOI: 10.1016/j.arthro.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To evaluate the impact of age, body mass index (BMI), and symptom duration on 5-year clinical outcomes among females following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS We conducted a retrospective review of a prospectively collected database of hip arthroscopy patients with a minimum 5-year follow-up. Patients were stratified by age (<30, 30-45, ≥45 years), BMI (<25.0, 25.0-29.9, ≥30.0), and preoperative symptom duration (<1 vs ≥1 year). Patient-reported outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Pre- to postoperative improvement in mHHS and NAHS was compared between groups using the Mann-Whitney U test or Kruskal-Wallis test. Hip survivorship rates and minimum clinically important difference (MCID) achievement rates were compared with Fisher exact test. Predictors of outcomes were identified using multivariable linear and logistic regression. P values <.05 were considered significant. RESULTS In total, 103 patients were included in the analysis with a mean age of 42.0 ± 12.6 years (range, 16-75) and mean BMI of 24.9 ± 4.8 (range, 17.2-38.9). Most patients had symptoms of duration ≥1 year (60.2%). Six patients (5.8%) had arthroscopic revisions, and 2 patients (1.9%) converted to total hip arthroplasty by 5-year follow-up. Patients with BMI ≥30.0 had significantly lower postoperative mHHS (P = .03) and NAHS (P = .04) than those with BMI <25.0. Higher BMI was associated with reduced improvement in mHHS (β = -1.14, P = .02) and NAHS (β = -1.34, P < .001) and lower odds of achieving the mHHS MCID (odds ratio [OR] = 0.82, P = .02) and NAHS MCID (OR = 0.88, P = .04). Older age was predictive of reduced improvement in NAHS (β = -0.31, P = .046). Symptom duration ≥1 year was predictive of higher odds of achieving the NAHS MCID (OR = 3.98, P = .02). CONCLUSIONS Female patients across a wide range of ages, BMIs, and symptom durations experience satisfactory 5-year outcomes following primary hip arthroscopy, but higher BMI is associated with reduced improvement in patient-reported outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael Buldo-Licciardi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Nicole D Rynecki
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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Ross KA, Mojica ES, Lott A, Carter C, Gonzalez-Lomas G. Characterization of pincer-type Hip impingement in professional women's ice hockey players. PHYSICIAN SPORTSMED 2023; 51:610-614. [PMID: 36503339 DOI: 10.1080/00913847.2022.2157683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Femoroacetabular impingement (FAI) appears common in ice hockey, but there is a lack of data examining pincer-type impingement in women's ice hockey athletes. The objective of this study was to assess the prevalence of pincer-type impingement in National Women's Hockey League (NWHL) athletes. Our hypothesis was that there would be an increased prevalence of pincer impingement in these athletes. METHODS Data were gathered for a team of NWHL players, and age, gender, and body mass index (BMI) matched controls were also retrospectively collected. All subjects were above 18 years of age. Control patients were excluded if they had undergone prior hip surgery, were greater than age 30, or had BMI greater than 35. Radiographs of both groups were assessed for lateral center edge angle (LCEA), Tönnis angle, and crossover sign. Tönnis angle <0 or LCEA >40 degrees was considered pincer morphology. An alpha angle >55 degrees was considered cam morphology. RESULTS Thirty-seven NWHL players and 37 female controls were included. Overall 32% of the players had a pincer lesion in either hip based on LCEA, 8% had a Tönnis angle <0, and 22% had a crossover sign in either hip compared to 9%, 19%, and 13% for the controls, respectively. None of these findings were significantly different between the groups (p > 0.05). An alpha angle ≥55 degrees in either hip was found in 84% of players, but lateral Dunn images for alpha angle measurements were not available for the control group. CONCLUSIONS Pincer-type morphology and crossover signs were present in a larger portion of NWHL players than has been reported in the general population, but these findings were not statistically different than in the control group. Cam-type morphology was even more prevalent in these athletes and may be related to age at menarche due impingement at the physis prior to closure.
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Affiliation(s)
- Keir A Ross
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Cordelia Carter
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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Kim HS, Park JW, Park JW, Ha YJ, Lee YK, Lee YJ, Koo KH. Anterior and Lateral Femoroacetabular Excursion Angles Are Helpful for Assessing Femoroacetabular Impingement Syndrome: A Cross-Sectional Cohort Study. Arthroscopy 2023; 39:2012-2022.e1. [PMID: 36965541 DOI: 10.1016/j.arthro.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE To develop a radiographic measurement to evaluate the femoroacetabular space using 3-dimensional (3D) hip models in asymptomatic hips, and to evaluate the reliability and validity of the femoroacetabular excursion angle (FAEA) in symptomatic patients. METHODS From January 2020 to December 2020, we recruited patients with healthy hips to establish 3D models. Through the simulation of 14 activities of daily living (ADLs), anterior and lateral impingement-free FAEAs were measured. Another cross-sectional cohort was formed from consecutive symptomatic subjects with impingement signs during the same period. In the validation cohort, anterior and lateral FAEAs were assessed on modified Dunn's and anteroposterior views of the hip, respectively. We evaluated the reliability and clinical implications of the FAEAs. RESULTS In the discovery cohort (n = 33), hips with collisions tended to have smaller computed tomography-based FAEAs than collision-free hips, although alpha and lateral center-edge (CE) angles were comparable. Additionally, hips with a lower quartile of FAEAs had a significantly higher number of ADLs with collisions. In the validation cohort (n = 411), the FAEA measurement was highly reliable (kappa statistics >0.95 for both interobserver and intraobserver reliabilities). The femoroacetabular impingement syndrome (FAIS) group (n = 165) showed significantly smaller anterior and lateral FAEAs than the non-FAIS group (all P < .001, Cramer V = .420). The optimal cut-off values for anterior and lateral FAEAs were 32.6° and 48.9°, respectively. In univariate regression, anterior (odds ratio [OR] = 0.91; 95% confidence interval [CI] = 0.89-0.94) and lateral (OR = 0.91; 95% CI = 0.89-0.93) FAEAs were significantly associated with FAIS. Moreover, in multivariate regression adjusted for alpha and lateral CE angles, anterior FAEA remained a significant predictor (OR = 0.96; 95% CI = 0.93-0.99), and small FAEA was an independent risk factor for FAIS (OR = 1.99; 95% CI = 1.06-3.71) for any small FAEA (OR = 2.88; 95% CI = 1.32-6.31) for both small FAEAs. CONCLUSION The FAEA is a valid measurement for FAIS with high reliability. Small FAEA was an independent risk factor for FAIS in the multivariate regression model, even after adjusting for alpha and lateral CE angles. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Jun Won Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - You-Jung Ha
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Medical Device Development, Seoul National University College of Medicine, Seoul.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam; Kay Joint Center at Cheil Orthopedic Hospital, South Korea
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Owen MM, Gohal C, Angileri HS, Hartwell MJ, Plantz MA, Tjong VK, Terry MA. Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231188332. [PMID: 37547081 PMCID: PMC10403993 DOI: 10.1177/23259671231188332] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/11/2023] [Indexed: 08/08/2023] Open
Abstract
Background Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design Systematic review; Level of evidence, 4. Methods The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Conclusion Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.
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Affiliation(s)
- Madeline M. Owen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Hunter S. Angileri
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Hartwell
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Mark A. Plantz
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Vehniah K. Tjong
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Michael A. Terry
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
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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. Arthroscopy 2023; 39:285-292. [PMID: 35367300 DOI: 10.1016/j.arthro.2022.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/16/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
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.
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9
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Olympic fencer with femoroacetabular impingement syndrome uses active rehabilitation to avoid surgery: A case report. J Bodyw Mov Ther 2023; 33:1-7. [PMID: 36775503 DOI: 10.1016/j.jbmt.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 04/13/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is a musculoskeletal condition characterized by hip symptoms. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of FAI in detail. This report provides a detailed active rehabilitation plan for an elite athlete with FAI to guide future research and clinicians. CASE PRESENTATION A 30-year-old male Olympic fencing athlete presented with unilateral hip pain less than 1 year prior to the Olympic Games. Radiographic imaging demonstrated bilateral cam morphology. Hip mobilizations and stretching did not provide a meaningful pain reduction. Cortisone injection was then suggested prior to the Games where surgery was suggested following the Games. MANAGEMENT AND OUTCOME Active rehabilitative exercises targeted motor control of the lumbo-pelvic-hip complex, which led to significant pain reduction and full return to sport. Surgical intervention and cortisone injections were deemed unnecessary due to resolution of symptoms. CONCLUSION Athletes with FAI syndrome may benefit from specific active rehabilitation exercises. Future clinical trials should explore rehabilitative exercises that address improved motor control to manage individuals with FAI syndrome.
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Eyles JP, Murphy NJ, Virk S, Spiers L, Molnar R, O'Donnell J, Singh P, Tran P, Randhawa S, O'Sullivan M, Hunter DJ. Can a Hip Brace Improve Short-Term Hip-Related Quality of Life for People With Femoroacetabular Impingement and Acetabular Labral Tears: An Exploratory Randomized Trial. Clin J Sport Med 2022; 32:e243-e250. [PMID: 34516433 DOI: 10.1097/jsm.0000000000000974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine whether a hip brace can improve hip health quality-of-life (QoL) and is well-tolerated in people with femoroacetabular impingement syndrome (FAIS) or symptomatic labral tears after 6 weeks of wear. DESIGN Parallel, two-arm, exploratory randomized trial. SETTING Hospital and private clinics of orthopaedic surgeons. PARTICIPANTS Individuals >18 years with FAIS or labral tears. INTERVENTIONS Usual conservative care versus usual conservative care plus a hip brace. MAIN OUTCOMES Patient-reported outcomes were assessed with the International Hip Outcome Tool (iHOT-33), and Copenhagen Hip and Groin Outcome Scores (HAGOS). Brace acceptability was measured using the Quebec User Evaluation of Satisfaction with Assistive Technology survey. Independent t-tests assessed between-group differences. RESULTS Thirty-eight participants were recruited, 19 each group, 60% women, mean age 39.3 ± 11.8 years, body mass index 25.3 ± 4.4 kg/m2, iHOT-33 36.6 ± 24.8. Three participants dropped out (one usual care, 2 braced). The mean between-group difference for iHOT-33 was 19.4 (95% confidence interval [CI] 1.68-37.06, P = 0.03) favoring the brace. There were improvements in most HAGOS subscale scores favoring the brace. Issues with brace tolerability for some participants were perceived comfort and effectiveness. Three brace-related adverse events were reported. CONCLUSION Between-group differences favored the braced group for hip health QoL, pain, symptoms, and function. Although these were promising results, the CIs for the estimates were wide, the small sample size likely a contributing factor. Our results suggest that further investigation of the brace is warranted, we calculated sample sizes and made recommendations for the design of a future trial.
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Affiliation(s)
- Jillian P Eyles
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Australia
- Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Nicholas J Murphy
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Australia
- Department of Orthopaedic Surgery, Gosford and Wyong Hospitals, Australia
| | - Sonika Virk
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Australia
- Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia
- Swinburne University of Technology
| | - Parminder Singh
- Hip Arthroscopy Australia, Richmond, Australia
- Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia; and
| | - Michael O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, New South Wales, Australia
| | - David J Hunter
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Australia
- Department of Rheumatology, Royal North Shore Hospital, Australia
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Safran MR, Foard SJ, Robell K, Pullen WM. Incidence of Symptomatic Femoroacetabular Impingement: A 4-Year Study at a National Collegiate Athletic Association Division I Institution. Orthop J Sports Med 2022; 10:23259671221084979. [PMID: 35434170 PMCID: PMC9008859 DOI: 10.1177/23259671221084979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Femoroacetabular impingement (FAI) is an increasingly recognized
cause of hip pain in young athletes. Although there are multiple
studies that describe the radiographic prevalence of FAI in
athletes, its true incidence within this population is
unknown. Purpose: To report on the overall and sport-specific incidence of
symptomatic FAI in National Collegiate Athletic Association
(NCAA) Division I athletes. Return-to-sport times were reported
for patients treated operatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted to identify all reported hip
injuries within a large, multisport NCAA Division I institution.
Hip injuries were stratified into FAI, general pain/dysfunction,
musculotendinous, ligament, bursitis, bone stress, contusion,
and other. FAI was diagnosed based on history, physical
examinations, imaging, and symptomatic relief after a diagnostic
injection. Descriptive statistics were used to calculate the
overall and sport-specific incidence, and chi-square analysis
was performed to identify contingency data. Results: In a 3-year period, a total of 5319 musculoskeletal injuries
occurred in 1072 athletes. There were 491 (9.2%) hip injuries
that occurred in 288 athletes, of which 40 injuries were FAI.
The overall incidence of symptomatic FAI was 3.0% of the total
population, 3.7% of all injured athletes, and 13.9% of athletic
hip injuries. There were no statistically significant
differences in FAI rates among male and female athletes overall
or among male and female athletes within similar sports. Of the
19 athletes who were treated nonoperatively, 2 failed to return
to play: 1 secondary to multiple musculoskeletal injuries and 1
related to cardiac issues. There were 21 hips in 20 patients
that were treated operatively, with 1 athlete failing to return
to sport. Return to play occurred at a mean of 202 days (range,
81-360 days) after hip arthroscopic surgery. Conclusion: In this large, multisport NCAA Division I cohort, the overall
incidence of symptomatic FAI was 3.0% and represented 13.9% of
hip injuries. The successful management of FAI with return to
play was achieved by both nonoperative and operative treatment
methods. The relatively low incidence of symptomatic FAI,
despite reports of a high prevalence of FAI morphology in
athletes, serves to emphasize the importance of clinical
evaluations in treating patients with FAI.
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Affiliation(s)
- Marc R. Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | | | | | - W. Michael Pullen
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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12
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Riedl M, Fickert S. Bedeutung des femoroazetabulären Impingements im Sport. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Endoscopic Iliotibial Band Release During Hip Arthroscopy for Femoroacetabular Impingement Syndrome and External Snapping Hip Had Better Patient-Reported Outcomes: A Retrospective Comparative Study. Arthroscopy 2021; 37:1845-1852. [PMID: 33539977 DOI: 10.1016/j.arthro.2021.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare patient-reported outcomes (PROs) in patients with femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH) treated with hip arthroscopy with or without endoscopic iliotibial band (ITB) release. METHODS Retrospective review case series with both FAI syndrome and ESH who underwent surgical treatment under same indications. According to the primary operation that was determined by patients themselves, the patients undergoing ITB release during hip arthroscopy for FAI syndrome were enrolled in the ITB-R group, and patients undergoing hip arthroscopy without ITB release were enrolled in non-ITB-R group. Patients with dysplasia, severe osteoarthritis, revision, and bilateral surgery were excluded. PROs including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain) and VAS-satisfaction, and the rates of achieving minimal clinically important difference, patient acceptable symptomatic state (PASS), and substantial clinical benefit for the PROs at 2 years operatively were comparative analyzed. RESULTS The prevalence of ESH in patients with FAI syndrome who underwent hip arthroscopy in our institution was 4.9% (30 of 612 hips). The mean age at the time of surgery was 33.1 ± 6.9 years (range 22-48 years). After exclusion, 16 patients (16 hips) were enrolled into ITB-R group and 11 patients (11 hips) enrolled into non-ITB-R group. PROs including iHOT-33, mHHS, VAS-pain, and VAS-satisfaction in patients in ITB-R group were better than that in non-ITB-R group at 2 years postoperatively (P = .013, .016, .002, and .005, respectively). The rates of achieving PASS for mHHS, PASS for VAS-pain, and substantial clinical benefit for iHOT-33 of patients in ITB-R group were significantly better than that in non-ITB-R group (P = .009, .006, and .027, respectively). CONCLUSIONS Patients with both FAI syndrome and ESH undergoing ITB release during hip arthroscopy had better PROs than those undergoing hip arthroscopy without ITB release. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Gao F, Zhang B, Hu B, Lu M, An M, Liu Y, Fang Y, Zhao G, Shi C, Zhou J, Liu Y, Li C. Outcomes of Hip Arthroscopy for Femoroacetabular Impingement in Chinese Patients Aged 50 Years or Older. Orthop Surg 2020; 12:843-851. [PMID: 32458575 PMCID: PMC7307262 DOI: 10.1111/os.12688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/15/2020] [Accepted: 03/27/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To investigate the outcomes of hip arthroscopy for femoroacetabular impingement (FAI) in patients over the age of 50 years. Method This is a therapeutic case series study. A total of 27 FAI patients over the age of 50 years who met inclusion and exclusion criteria and were being followed up for at least 2 years in the orthopaedics department at our hospital between January 2015 and October 2017 were recruited for a prospective analysis on the outcomes of hip arthroscopy. All patients underwent unilateral surgery. Of the patients included, there were 15 men and 12 women, who were aged 50–74 years old (57 ± 6.4 years). The outcomes were assessed using the visual analog scale (VAS), the modified Harris hip score (mHHS), and the International Hip Outcome Tool (iHOT‐12). Results A total of 27 patients were followed up for at least 2 years. The postoperative center‐edge angle, the alpha angle, and the offset decreased significantly compared with preoperative measurements (P < 0.01). The mHHS before surgery and at 1 year and 2 years after surgery was 62.19 ± 7.47, 86.70 ± 5.80, and 87.89 ± 5.08, respectively; iHOT‐12 scores were 30.44 ± 4.22, 73.56 ± 3.89, and 73.77 ± 3.72, respectively; VAS scores were 6.07 ± 0.78, 1.93 ± 0.73, and 1.59 ± 0.64, respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS, iHOT‐12, and VAS scores at 1 year and 2 years after surgery (P < 0.01). The mHHS score at 2‐year follow up after surgery was higher than that at 1 year after surgery, and the difference observed was statistically significant (P = 0.04). One patient with severe acetabular and femoral cartilage damage underwent total hip replacement 11 months after surgery. Conclusion Hip arthroscopy considerably improved hip symptoms and function in Chinese FAI patients aged 50 years or older who did not have severe radiographic osteoarthritis. The conversion to THA and complications were low. Strict surgical indications and appropriate surgical strategies lay the foundation for satisfactory postoperative results in elderly patients with FAI.
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Affiliation(s)
- Feng Gao
- Medical School of Chinese PLA, Beijing, China.,Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | | | - Bo Hu
- Medical School of Chinese PLA, Beijing, China
| | - Ming Lu
- Medical School of Chinese PLA, Beijing, China
| | - Mingyang An
- Medical School of Chinese PLA, Beijing, China
| | - Yufeng Liu
- Medical School of Chinese PLA, Beijing, China
| | - Yehan Fang
- Medical School of Chinese PLA, Beijing, China
| | - Gang Zhao
- Medical School of Chinese PLA, Beijing, China
| | - Chao Shi
- Xinjiang Uyghur Autonomous Region Changji Hui Autonomous Prefecture Qitai County Peoples Hospital, Xinjiang, China
| | - Jingbin Zhou
- Medical School of Chinese PLA, Beijing, China.,Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Yujie Liu
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Chunbao Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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