Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears in Patients Younger than 50 Years: Minimum Five-year Outcomes, Survivorship, and Risk Factors for Reoperations

Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up

PURPOSE

To compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years.

METHODS

A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve.

RESULTS

Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P = .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P = .999), or conversion to THA (age ≥40: 13.2%, age <40: 3.8%, P = .161) were identified. On Kaplan-Meier analysis, no significant difference (P = .321) was demonstrated in overall gross survivorship between cohorts.

CONCLUSIONS

Patients with age ≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts.

LEVEL OF EVIDENCE

Level III, retrospective comparative prognostic trial.

Outcomes of Painful Hips After Hip Arthroscopy Surgery for Femoroacetabular Impingement

The benefits of hip arthroscopic surgery for femoroacetabular impingement are well-established. Hip arthroscopic surgery rates have risen dramatically over the last decade. Some patients, however, may continue to experience hip symptoms after surgery and are dissatisfied with their inability to return to desired optimal activity levels. The purpose of the study is to understand the long-term outcomes of patients with painful hips after hip arthroscopy for femoroacetabular impingement. This is a retrospective study of the outcomes of painful hips after hip arthroscopy for femoroacetabular impingement, with four to 14-year follow-up from 2008 to 2022. A total of 84 hip arthroscopies were performed. Most of the patients had labral tear debridement and shaving of the aspherical femoral head also known as cam lesion, and five patients had repair for labral tear. There were eight patients who had bilateral hip involvement. There were 27 men and 57 females between the second to fifth decades. The electronic patient's records and radiological images were reviewed, and patient outcomes were graded as pain-free hip (asymptomatic) or painful hip (persistent pain and symptoms of instability). After hip arthroscopy surgery, 55% (46) of hips were graded pain-free in patients who were mostly in their 20s and 30s, while 45% (38) of hips had persistent pain. These patients were in their third or fifth decade. In the painful hip cohort, 33 patients had one hip arthroscopic surgery, while five patients had multiple repeat hip arthroscopies in the same hip over a three to six-year period. Bilateral hip arthroscopies were performed at different times in eight patients of which five individuals experienced painful hip outcomes. There were seven females and one male in their 30s and 40s. The labral tear was repaired in five patients, and two patients had painful hip outcomes. Both were females in their 20s and 30s. Patients with chronic painful hips after hip arthroscopic surgery were investigated to identify the cause of the pain. If no cause was established, then they were finally referred to pain specialist clinicians for pain management. This cohort had seven patients between 28 and 43 years. Six were female and one was male. Total hip replacement (THR) was performed in four patients (4.7%). Conversely, 95.3% of patients did not need THR during the study period of 14 years. Hip arthroscopy can be an effective treatment for femoroacetabular impingement. Careful patient selection and a holistic approach are vital for a good patient outcome. The success rate of the pain-free hip after hip arthroscopy decreases with increasing age of the patient, particularly in the female gender. Patients with grade II and more degenerative chondral changes do not perform well. Patients in their fourth and fifth decade can benefit from hip arthroscopy provided a comprehensive discussion of the expected outcomes is conducted prior to surgery. Overall, hip arthroscopy remains a valuable tool, but it is important to be conscious of its limitations and potential challenges.

The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates

Purpose

To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations.

Methods

International Classification of Diseases, Ninth and Tenth Revision, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis).

Results

There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission.

Conclusions

HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations.

Level of Evidence

Level III, retrospective comparative trial.

Outcomes After Hip Arthroscopy Show No Differences Between Sexes: A Systematic Review

PURPOSE

To assess differences in postoperative outcomes between male and female patients following hip arthroscopy.

METHODS

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Cochrane, and PubMed databases were searched. Key words included "hip," "arthroscopy," "outcome," "gender difference," "sex difference," "gender," and "patient-reported outcome." Studies were included that reported sex-specific analysis of outcomes following primary hip arthroscopy with minimum 2-year follow-up. Methodological Index for Non-Randomized Studies criteria were applied to each study. Data collected included patient-reported outcome measures (PROMs), complications, rates of revision arthroscopy (RA), and conversion to total hip arthroplasty (THA). Forest plots were generated for the most frequently reported PROMs, RA, and THA rates.

RESULTS

In total, 38 studies met the inclusion criteria, with 40,194 (57% female) hips included. The most common indications for hip arthroscopy were femoroacetabular impingement and labral tears. Eighteen studies reported PROMs, with no clear trend towards sex differences. Eleven studies reported on RA rates, with 4 showing a significantly greater rate of RA in female patients. Seventeen studies reported on conversion to THA, with an overall conversion rate of 9.64%. There were no clear sex differences in conversion to THA.

CONCLUSIONS

There was no difference between sexes for postoperative PROM scores. Male patients were less likely to reach the MCID for the HOS-SSS than female patients in the majority of studies, and there were no sex differences for PASS rates. There were no significant differences between sexes in revision arthroscopy rates and conversion to total hip arthroplasty.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II, III and IV studies.

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.

Patient-Reported Outcomes Improve at 2-Year Minimum Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review

PURPOSE

To provide an updated review of recent literature on postoperative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), focusing on larger-population studies with a minimum 2-year follow-up published within the last 5 years.

METHODS

A literature search of the PubMed, Ovid Medline, Web of Science, and Cochrane databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were screened for clinical studies published from 2017 to 2022 with greater than 100 patients and minimum 2-year follow-up. Exclusion criteria included failure to report postoperative patient-reported outcomes (PROs), no preoperative radiographic measurements, and surgery for pathology other than FAIS. Data collection included study characteristics, patient demographics, radiographic findings, intraoperative findings, procedures performed, postoperative PROs, and subsequent surgeries.

RESULTS

Nine studies met inclusion criteria. Mean or median patient ages ranged from 32.3 to 41 years, with 4 studies reporting on greater than 50% female patients. Mean preoperative lateral center edge angles and alpha angles ranged from 30.2° to 37° and from 56.2° to 71°, respectively. Labral repairs (range 69.7%-100%) were performed more commonly than debridements (range 0%-26.3%). All studies demonstrated improved PROs at most recent follow-up. Seven studies reported mean or median modified Harris Hip Scores, with preoperative and postoperative values that ranged from 53.1 to 80 and from 67.4 to 100, respectively. Revision hip arthroscopies and conversions to hip arthroplasty ranged from 0.8% to 11.6% and from 0% to 34%, respectively.

CONCLUSIONS

All included studies found improvements in PROs after hip arthroscopy for FAIS at a minimum of 2-year follow-up. Conversion to total hip arthroplasty is most common in older patients at minimum 10-year follow-up.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I through IV studies.

Arthroscopy Confers Excellent Clinical Outcomes in Femoroacetabular Impingement Syndrome (FAIS) Patients Aged 50 Years and Above

OBJECTIVE

Hip preservation surgery has expanded to include treatment of hip pathology in elderly patients. Most data on efficacy of arthroscopy treatment in patients with femoroacetabular impingement syndrome (FAIS) has been generated from Western populations, while studies in the older Asian FAIS population are lacking. Here, we report efficacy of hip arthroscopy for treatment of Asian patients aged 50 years and above.

METHODS

We retrospectively reviewed data from 775 hips that were treated arthroscopically for FAIS between 2016 and 2019. Patients with a history of hip surgery, contralateral surgery during the follow-up period, lateral center-edge angle (LCEA) <25°, Tӧnnis grade ≥2, and incomplete records were excluded. Patient-reported outcomes (PROs), such as modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), International Hip Outcome Tool 12-component form (iHOT-12), and Visual Analog Scale (VAS) were compared pre- and post-operation. We also recorded radiographic measures, intraoperative findings, procedures, complications, and subsequent surgical revisions. Finally, we correlated demographics with PRO improvement among the study group.

RESULTS

A total of 57 hips met the inclusion and exclusion requirements and were therefore included in the final analysis. After the follow-up period (3.3 years), most patients exhibited significantly higher PROs than preoperative values, HOS-ADL (65.0-81.7), iHOT-12 (44.3-69.1), mHHS (58.9-81.7), and VAS (5.8-2.2; all p < 0.001). Shorter symptom duration was significantly correlated with improved HOS-ADL (p = 0.015), and mHHS score (p = 0.022). The overall rate of complications and rate of revisions were 5.3% and 7.0%, respectively, and none of the patients required total hip arthroplasty (THA).

CONCLUSIONS

Arthroscopic surgery confers significant clinical outcomes in most FAIS patients in the Asian population who are aged 50 years and above. These benefits are accompanied by either a low revision rate or conversion to THA, while shorter symptom duration is positively correlated with improved HOS-ADL and mHHS scores.

Does Femoral Osteoplasty Improve Long-term Clinical Outcomes and Survivorship of Hip Arthroscopy? A 15-Year Minimum Follow-up Study

BACKGROUND

Although femoral osteoplasty is common practice in treating cam-type femoroacetabular impingement (FAI), long-term data are lacking that support the ability of this procedure to optimize outcomes and alter natural history.

PURPOSE

To compare long-term clinical outcomes and survivorship of treatment for symptomatic FAI via arthroscopic correction of labral or chondral pathology with and without femoral osteoplasty.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A retrospective cohort study was performed across 2 consecutive cohorts of patients with isolated cam-type FAI who underwent hip arthroscopic treatment of labral or chondral pathology without femoral osteoplasty (HS group) or with femoral osteoplasty (HS-OST group). These unique cohorts were established at a distinct transition time in our practice before and after adoption of femoral osteoplasty for treatment of FAI. Clinical outcomes were measured using the modified Harris Hip Score (mHHS). Kaplan-Meier analysis was used to assess for total hip arthroplasty (THA)-free and reoperation-free survivorship.

RESULTS

The final HS group included 17 hips followed for 19.7 ± 1.2 years, and the final HS-OST group included 23 hips followed for 16.0 ± 0.6 years. No significant patient or morphological differences were found between groups. Compared with the HS group, the HS-OST group had significantly higher final mHHS (82.7 vs 64.7 for HS-OST vs HS, respectively; P = .002) and mHHS improvement (18.4 vs 6.1; P = .02). The HS-OST group also had significantly greater 15-year THA-free survivorship versus the HS group (78% vs 41%, respectively; P = .02) and reoperation-free survivorship (78% vs 29%; P = .003).

CONCLUSION

This study demonstrated superior long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared with hip arthroscopy alone. These long-term data strongly support the practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI at long-term follow-up.

Isolated Acetabuloplasty for Femoroacetabular Impingement: Favorable Patient-Reported Outcomes and Sustained Survivorship at Minimum 5-Year Follow-Up

PURPOSE

To evaluate minimum 5-year outcomes and conversion rate to total hip arthroplasty (THA) for the treatment of femoroacetabular impingement (FAI) syndrome with an isolated acetabular osteoplasty.

METHODS

Patients undergoing hip arthroscopy with an isolated acetabular osteoplasty from March 2009 to June 2014 for FAI syndrome with pincer and/or cam morphology and a labral tear were identified. Those who underwent femoroplasty or prior ipsilateral hip surgery or who had previous hip conditions, ipsilateral hip dysplasia, or a Tönnis grade higher than 2 were excluded. Patient-reported outcomes (PROs) collected included Patient-Reported Outcomes Measurement Information System (PROMIS) scores specific to physical functioning and pain interference, modified Harris Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and Numeric Pain Rating Scale. Patients were also queried about secondary surgical procedures and conversion to THA.

RESULTS

We identified 86 patients at minimum 5-year follow-up (average, 7.4 years). The average patient age was 39.8 ± 12.3 years, 70.9% of patients were female, and 7% of patients had Tönnis grade 2. The mean PRO scores were 52.0 ± 8.9 for the PROMIS physical functioning score, 39.6 ± 7.5 for the PROMIS pain interference score, 78.7 ± 12.0 for the modified Harris Hip Score, 73.3 ± 23.1 for the International Hip Outcome Tool 12 score, 89.9 ± 12.0 for the Hip Outcome Score-Activities of Daily Living, and 81.4 ± 21.0 for the Hip Outcome Score-Sport-Specific Subscale. Of the patients, 72.1% achieved the patient acceptable symptomatic state (PASS) according to previously established PASS scores for FAI syndrome treated with hip arthroscopy at minimum 5-year follow-up. The overall rate of revision arthroscopy was 3.5%, and the rate of conversion to THA was 5.8%.

CONCLUSIONS

An isolated acetabular osteoplasty can provide sustained clinical benefits for the treatment of FAI syndrome with labral tears, with good to excellent PROs and PASS rates and a low rate of conversion to THA at minimum 5-year follow-up.

LEVEL OF EVIDENCE

Level IV, case series.

Intraoperative Findings and Clinical Outcomes Associated With Arthroscopic Management of Subspine Impingement: A Propensity-Matched, Controlled Study

PURPOSE

(1) To investigate intra-articular damage in the hip joint associated with subspine impingement (SSI); (2) to evaluate clinical outcomes of arthroscopic treatment of hips with SSI; and (3) to compare the findings and outcomes to a control group without SSI.

METHODS

Eligible patients had arthroscopic treatment for femoroacetabular impingement (FAI) concurrent with SSI between January 2015 and December 2017. Inclusion criteria consisted of preoperative and minimum 2-year patient-reported outcomes and preoperative measurements for Tönnis, lateral center edge angle, and alpha angle. Included patients were propensity-matched in a 1:3 ratio to patients who had FAI without SSI. Patient-reported outcomes were compared between groups. Minimal clinically important difference was calculated for modified Harris Hip Score (mHHS) and Hip Outcome Score-Sports Specific Subscale (HOS-SSS).

RESULTS

Fifty SSI cases were matched to 150 patients who had FAI without SSI. A greater proportion of the SSI cohort required labral reconstruction (P = .010). The size and locations for labral tears and chondral defects were comparable between groups (P > .05). Both groups demonstrated similar minimum 2-year outcomes for mHHS (P = .103), Nonarthritic Hip Score (P = .200), HOS-SSS (P = .119), visual analog scale (P = .231), international Hip Outcome Tool-12 (P =.300), Short Form-12 Mental (P = .426), Short Form-12 Physical (P = .328), Veterans RAND 12-Item Health Survey, Mental (P = .419), and Veterans RAND 12-Item Health Survey, Physical (P = .316). The percentage of patients achieving minimal clinically important difference for mHHS and HOS-SSS was similar (P > .05). Survivorship was 96.0% and 98.7% for the SSI and control cohorts at 2 years, respectively.

CONCLUSIONS

Arthroscopic treatment of hips with SSI with subspine decompression and concomitant treatment of labral tears and FAI yielded significant improvement in patients' outcomes, which compared favorably with the control group. SSI may correlate with more complex labral tears, not amenable to repair, and complete tears of the ligamentum teres. Other findings, such as location and size of intra-articular damage, were similar between the cohorts.

LEVEL OF EVIDENCE

III, case-control study.

Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.

Femoral Neck Over-Resection After Hip Arthroscopy Treated with Vascularized Fibula Autograft: A Case Report

CASE

We describe a case of femoroacetabular impingement syndrome treated with labral repair and arthroscopic femoral osteoplasty in a 30-year-old man. The case was complicated by resection of 50% of the femoral neck resulting in high risk of an impending femoral neck fracture. The patient was treated with a vascularized fibula autograft and internal fixation.

CONCLUSION

Complications of femoral neck over-resection can threaten the viability and structural integrity of the hip joint but may successfully be treated with vascularized fibula autograft.

Gender and Age-Specific Differences Observed in Rates of Achieving Meaningful Clinical Outcomes 5-Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To compare the impact of age and gender on achieving meaningful outcomes among minimum patients 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

METHODS

Consecutive patients undergoing hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and October 2014 were analyzed. Study inclusion criteria included any patient undergoing primary hip arthroscopy for FAIS, with 5 years follow-up. Preoperative and 5-year postoperative functional scores were collected, including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), HOS-Sport Subscale (HOS-SS), modified Harris hip score (mHHS), and Visual Analog Scale for satisfaction. Patients were matched 1:1 by gender and age to compare outcomes between these 2 demographics. Minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for each functional measure and compared by gender and age.

RESULTS

Of the 340 patients (70.5%) with 5 years' follow up, 150 were matched by gender and age into one of the following groups: female patients <30 years, female patients 30 to 45 years, female patients >45 years, male patients <30 years, male patients 30 to 45 years, and male patients >45 years of age. At minimum 5-year follow-up, all 6 groups demonstrated statistically significant improvement in the functional outcome score averages and pain (P < .001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistical differences (P > .05). Analysis of achieving MCID and PASS demonstrated that females had higher rates of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (P < .05). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS when compared to patients >45 years old (P < .05).

CONCLUSION

The majority of patients achieve clinically significant outcome improvement at 5-year follow-up after arthroscopic FAIS surgery. Females reach the mHHS threshold for achieving MCID at significantly higher rates than males. Patients <30 years of age achieved PASS on the HOS-ADL and mHHS threshold scores at higher rates than those >45 years old.

LEVEL OF EVIDENCE

Level III, case-control study.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Provides Clinically Significant Outcome Benefit at Minimum 5-Year Follow-Up

PURPOSE

To report the rates of achieving clinically significant outcomes as defined by the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), or substantial clinical benefit (SCB) in adolescent patients and the rates of clinical failure 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

METHODS

Data from consecutive adolescent patients (defined by the American Academy of Pediatrics as age 11 to 21 years) who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS between January 2012 and January 2015 by a single, fellowship-trained surgeon was collected. Baseline data, clinical outcomes including Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports Subscale, modified Harris hip score, international Hip Outcome Tool, and clinical failure rates were recorded at 5 years after operative. Clinical failure was defined by revision hip arthroscopy or conversion to total hip arthroplasty. Clinically significant outcomes was defined as achieving MCID, PASS, or SCB on at least 1 hip-specific outcome measure.

RESULTS

Of the 139 eligible patients, a total of 85 (60.4%) patients (85 hips) were included in the final analysis, with an age and body mass index average of 17.6 ± 2.5 years (range 13-21) and 22.3 ± 3.1 kg/m², respectively. The majority of the patients were female (80.6%) and participated in sports (76.2%). There was statistically significant difference between preoperative and postoperative score averages across every reported outcome (P < .001). At 5 years, 88.4%, 67.6%, and 64.9% reached at least 1 threshold for achieving MCID, PASS, and SCB, respectively, whereas 89.2% achieved at least one of the meaningful outcome thresholds. Last, 2 patients (2.4%) failed clinically, with both undergoing revision (2.4%) because of continued pain. There were no conversions to total hip arthroplasty.

CONCLUSION

This study demonstrated that a large majority (89.2%) of adolescent patients undergoing primary arthroscopic treatment for symptomatic FAIS achieved meaningful clinically significant outcomes. Furthermore, only 2.4% of patients failed clinically, requiring revision hip arthroscopy because of continued pain.

LEVEL OF EVIDENCE

IV, Retrospective Case Series.

Best Practices: Hip Femoroacetabular Impingement

OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.

Age and Outcomes in Hip Arthroscopy for Femoroacetabular Impingement: A Comparison Across 3 Age Groups

BACKGROUND

Limited evidence exists concerning the effect of age on hip arthroscopy outcomes for femoroacetabular impingement (FAI).

PURPOSE/HYPOTHESIS

The purpose was to investigate patient-reported outcomes (PROs) and clinical failure rates across various age groups in patients undergoing hip arthroscopy for FAI. We hypothesized that older patients would experience lower improvements in PROs and higher clinical failure rates.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A total of 109 of 130 eligible consecutive patients underwent hip arthroscopy for FAI with a minimum 5-year follow-up. Patients were stratified into 3 groups for comparison (ages 15-34, 35-50, and 51-75 years). Clinical survival rates to revision surgery or total hip arthroplasty (THA) were determined by Kaplan-Meier analysis, and PROs were assessed using analysis of variance. Regression analysis was used to determine factors associated with clinical failure and ΔPROs from baseline to 5 years.

RESULTS

The 5-year survival-to-revision rate was 71% (survival time, 69.2 months; 95% CI, 62.8 to 75.5 months). A significant difference in survival to THA was found between groups (P = .030). Being in the older group versus the young and middle-aged groups predicted increased risk of THA conversion (hazard ratio, 5.7; 95% CI, 1.1 to 28.6; P = .035). Overall modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) improved from baseline to 5 years (mHHS, P < .001; NAHS, P < .001). Body mass index (mHHS: beta, -1.2; 95% CI, -2.2 to -0.3; P = .013; NAHS: beta, -1.6; 95% CI, -2.6 to -0.5; P = .005) and baseline PROs (mHHS: beta, -0.8; 95% CI, -1.1 to -0.4; P < .001; NAHS: beta, -0.7; 95% CI, -1.1 to -0.4; P < .001) were predictive of 5-year ΔPROs. A decrease was seen in minimal clinically important difference rates in middle-aged (P = .011) and old (P = .030) groups from 6-month to 5-year outcomes.

CONCLUSION

Although hip arthroscopy for FAI yielded improvements in PROs regardless of age, middle-aged and older patients experienced greater declines in clinical outcomes over time than younger patients. Older patients remain good candidates for arthroscopy despite a greater risk for conversion to THA.

Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty

OBJECTIVES

To determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted.

METHODS

A retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented.

RESULTS

Sixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87 ± 29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors.

CONCLUSION

Conversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously.

LEVEL OF EVIDENCE

Level IV.

Hip Arthroscopy for Femoroacetabular Impingement and Concomitant Labral Tears: A Minimum 2-Year Follow-Up Study

PURPOSE

The present study investigated the minimum 2-year outcomes of hip arthroscopy for femoroacetabular impingement (FAI) and concomitant labral tears in Asian patients.

METHODS

Patients who underwent hip arthroscopy for both FAI and concomitant labral tears between January 2012 and December 2017 were included. Patients with hip osteoarthritis of Tönnis grade ≥2, previous hip surgery, or followed for less than 2 years were excluded. Clinical assessments were performed using the modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the rates of achieving threshold values of the minimal clinically important difference and patient acceptable symptomatic state at the latest follow-up. Plain radiographs were acquired pre- and postoperatively for radiologic assessments.

RESULTS

A total of 73 patients (90 hips, 58 male, 15 female; mean age 34.4 years) who underwent hip arthroscopy for FAI and concomitant labral tears were enrolled. Forty-three hips (47.8%) had cam-type, 7 (7.8%) had pincer-type, and 40 (44.4%) had mixed-type FAI. The mean follow-up duration was 5.2 years. In cam- and mixed-type FAI hips, the mean α angle significantly decreased from 66.7 ± 8.28° preoperatively to 44.9 ± 3.78° postoperatively (95% confidence interval [CI] 19.6°-22.8°; P < .001). The mean modified Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index increased from 74.8 ± 13.2 and 75 ± 12.7 preoperatively to 93 ± 8.1 (95% CI 15.4-20.9; P = .001) and 89.4 ± 8.4 postoperatively (95% CI 11.8-17; P = .001), respectively. Seventy-four hips (82.2%) crossed the minimal clinically important difference, and 85 hips (94.4%) had achieved the patient acceptable symptomatic state. There were 2 cases of pudendal nerve palsy and 1 case of sciatic nerve palsy. No additional surgeries were required.

CONCLUSIONS

Hip arthroscopy can be an effective treatment for FAI and concomitant labral tears in Asian patients as demonstrated in this study, with improved PRO scores and reoperation rates. Longer-term studies with larger cohorts are necessary.

LEVEL OF EVIDENCE

Level IV, case series.

Staged Bilateral Hip Arthroscopy Compared With a Matched Unilateral Hip Arthroscopy Group: Minimum 2-Year Follow-Up

PURPOSE

To determine the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) at 2-year follow up in patients who underwent staged bilateral hip arthroscopy versus age-, sex-, and body mass index-matched patients who underwent unilateral hip arthroscopy.

METHODS

Patients who underwent staged bilateral primary hip arthroscopy between January 2007 and December 2017 for the indication of femoroacetabular impingement (FAI) with a minimum 2-year follow-up were identified. The control group comprised patients who underwent a unilateral hip arthroscopy for FAI. The mHHS and the NAHS were analyzed.

RESULTS

Forty-two patients (84 hips) in the bilateral group were matched with 84 patients (84 hips) in the unilateral group. Both groups had significantly improved mHHS and NAHS when comparing preoperative scores with postoperative scores (bilateral group mHHS: 45.5 ± 15.1 to 81.7 ± 17.6, P < .0001, bilateral group NAHS: 49.5 ± 13.8 to 83.6 ± 20.0, P < .0001, unilateral group mHHS 48.5 ± 13.8 to 83.6 ± 15.9, P < .0001, unilateral group NAHS 48.8 ± 12.0 to 85.0 ± 16.6, P < .0001). The patient-acceptable symptomatic state was achieved in 57 hips (68%) in the bilateral group versus 62 hips (74%) in the unilateral group, P = .4. Patients with bilateral hip arthroscopy who had <17 months between index procedure and contralateral hip arthroscopy had significantly better mHHS and NAHS (85.5 ± 18.4 vs 75.71 ± 14.4, P = .013 for mHHS and 88.1 ± 17.1 vs 76.2 ± 22.4, P = .0074 for NAHS).

CONCLUSIONS

Bilateral hip arthroscopy for the indication of FAI has improved mHHS and NAHS at 2 years of follow up compared to baseline. There was no difference in 2-year mHHS and NAHS in patients who underwent bilateral hip arthroscopy and unilateral hip arthroscopy. Patients in the bilateral hip arthroscopy group that had the contralateral surgery longer than 17 months from index procedure had lower 2 year follow up mHHS and NAHS scores than those that underwent the second surgery within 17 months of the index procedure.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Survivorship Following Hip Arthroscopy: Lessons Learned from a Comprehensive Database

PURPOSE OF REVIEW

Hip arthroscopy and its indications continue to expand. Understanding the durability of hip arthroscopic procedures remains important not only for counseling patients, but also for determining the success of certain procedures or in certain populations. Survivorship is defined as the proportion of hip arthroscopy patients who have not yet gone on to periacetabular osteotomy (PAO), total hip arthroplasty (THA), and/or revision surgery. The purpose of this review is to summarize the recent literature pertaining to survivorship after certain hip arthroscopic procedures and certain special populations.

RECENT FINDINGS

There is yet to be level 1 evidence published with relation to survivorship following hip arthroscopy. The best evidence in the recent literature is contained in just rew long-term prospective studies demonstrating good to excellent survivorship following hip arthroscopy for femoroacetabular impingement (FAI). Unfortunately, the follow-up for other conditions treated by hip arthroscopy is more limited. In summary, hip arthroscopy indications continue to expand. The most common indication for surgery is FAI, and its recently published long-term survivorship demonstrates excellent durability. Other hip arthroscopic procedures, including labral reconstruction, adjunctive procedures such as capsular closure, and special populations such as athletes, also demonstrate excellent survivorship in shorter term follow-up. Further prospective research is needed to further define survivorship of various hip conditions, associated procedures, and special populations commonly treated with hip arthroscopy.

Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

BACKGROUND

Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established.

PURPOSES

(1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score-Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12) were calculated.

RESULTS

A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups (P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications (P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS (P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS (P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12.

CONCLUSION

Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.

Preoperative Duration of Symptoms Is Associated With Outcomes 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To determine the effect of the preoperative duration of femoroacetabular impingement syndrome (FAIS)-associated symptoms on clinical outcomes at a minimum of 5 years after hip arthroscopy.

METHODS

We identified FAIS patients who underwent primary hip arthroscopy between January 2012 and January 2014 with a minimum of 5 years' follow-up. Patient demographic characteristics and clinical outcomes, comprising the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), pain score, and satisfaction score, were analyzed. The minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit were calculated. Patients were stratified based on the preoperative duration of symptoms: less than 2 years versus 2 years or longer. Multivariate regressions were constructed to determine the association between the preoperative symptom duration and clinical outcomes at 5 years after hip arthroscopy.

RESULTS

A total of 310 patients were included with a mean age (±standard deviation) of 34.1 ± 11.9 years and body mass index of 25.3 ± 5.1. The study group showed statistically significant improvements in the HOS-ADL, HOS-SS, mHHS, pain score, and satisfaction score (P < .001 for all). A preoperative duration of symptoms of 2 or more years was an independent predictor of worse HOS-ADL, HOS-SS, mHHS, and pain score (P < .05 for all). Furthermore, a longer duration of symptoms was associated with a lower likelihood of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 0.53; P = .037), HOS-SS (OR, 0.38; P = .003), and mHHS (OR, 0.43; P = .009); the patient acceptable symptomatic state for the HOS-SS (OR, 0.44; P = .006) and mHHS (OR, 0.46; P = .006) but not the HOS-ADL despite trending toward significance (OR, 0.59; P = .098); and substantial clinical benefit for the HOS-ADL (OR, 0.50; P = .011), HOS-SS (OR, 0.52; P = .020), and mHHS (OR, 0.47; P = .007).

CONCLUSIONS

Patients with a preoperative duration of FAIS-associated symptoms of 2 or more years prior to hip arthroscopy experience inferior outcomes and a lower frequency of clinically significant outcome improvement than patients with a shorter duration of symptoms at medium-to long-term follow-up.

LEVEL OF EVIDENCE

Level III, retrospective comparative trial.

Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up

BACKGROUND

Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term.

PURPOSE

(1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score-Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method.

RESULTS

The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%).

CONCLUSION

The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

BACKGROUND

Hip osteoarthritis (HOA) is the most common hip disorder and a major cause of disability in the adult population, with an estimated prevalence of end-stage disease and total hip replacement. Thus, the diagnosis, prevention, and treatment of the early stages of the disease in young adults are crucial to reduce the incidence of end-stage HOA. The purpose of this study was to determine whether (1) a relationship among the inflammatory status of labrum and synovium collected from patients with femoroacetabular impingement (FAI) would exist; and (2) to investigate the associations among the histopathological features of joint tissues, the pre-operative symptoms and the post-operative outcomes after arthroscopic surgery.

METHODS

Joint tissues from 21 patients undergoing hip arthroscopy for FAI were collected and their histological and immunohistochemical features were correlated with clinical parameters.

RESULTS

Synovial mononuclear cell infiltration was observed in 25% of FAI patients, inversely correlated with the hip disability and osteoarthritis outcome score (HOOS) pain and function subscales and with the absolute and relative change in total HOOS. All the labral samples showed some pattern of degeneration and 67% of the samples showed calcium deposits. The total labral score was associated with increased CD68 positive cells in the synovium. The presence of labral calcifications, along with the chondral damage worsened the HOOS post-op symptoms (adjusted R-square = 0.76 p = 0.0001).

CONCLUSIONS

Our study reveals a relationship between the histologic labral features, the synovial inflammation, and the cartilage condition at the time of FAI. The presence of labral calcifications, along with the cartilage damage and the synovitis negatively affects the post-operative outcomes in patients with FAI.

Hip Arthroplasty After Hip Arthroscopy: Are Short-term Outcomes Affected? A Systematic Review of the Literature

PURPOSE

To systematically review the published literature regarding intraoperative measures, patient-reported outcomes, and complications of total hip arthroplasty (THA) in patients with or without a history of prior hip arthroscopy.

METHODS

PubMed and Cochrane Library databases were searched for all publications regarding patients who had undergone a THA after a prior ipsilateral hip arthroscopy. Included studies were comparative in nature and included postoperative outcome measures. Excluded studies were opinion articles, review articles, cadaveric studies, case reports, or technique articles. Patient demographics, surgical outcomes, complications, and patient-reported outcome measures (PROMs) were recorded. This study was performed at the American Hip Institute.

RESULTS

Eight studies were included in this systematic review. These included 305 hips with a THA following a prior hip arthroscopy, with 502 matched control hips. Mean time for conversion from prior hip arthroscopy was 23 months and mean follow up was 35.9 versus 36.1, for the prior arthroscopy and control groups respectively. No significant differences were found regarding intraoperative measures and PROMs. There was no difference in rate of revisions at latest follow up. However, there was a trend toward higher rates of dislocations and infections in the prior hip arthroscopy group.

CONCLUSION

The short-term PROMs of those who underwent total hip arthroplasty with a prior history of an ipsilateral hip arthroscopy are comparable to those of patients undergoing primary THA. Although a conclusion could not be made regarding differences in complication rates between patients with a history of prior arthroscopy and patients undergoing primary THA, it is still imperative to consider the possible implications of a prior hip procedure on postoperative stability and infection rates. In summary, hip arthroplasty following a prior hip arthroscopy is a safe procedure with comparable short-term outcomes to primary arthroplasty.

LEVEL OF EVIDENCE

Level III, systematic review.

Outcomes for Surgical Treatment of Femoroacetabular Impingement in Adults

PURPOSE OF REVIEW

To assess the outcomes of modern techniques for arthroscopic surgery in the treatment of femoroacetabular impingement.

RECENT FINDINGS

While initially approached by means of open surgical hip dislocation, recent literature has shown generally good outcomes of arthroscopic treatment for femoroacetabular impingement. Modern advances in hip arthroscopy technique and implants now allow for labral repair or reconstruction when indicated. Arthroscopic treatment of femoroacetabular impingement results in significant improvements in patient pain and function, with low complication rates and high patient satisfaction. A majority of improvements in these patients occur within 1 to 2 years post-operatively. Hip arthroscopy for femoroacetabular impingement yields the best results in patients without significant arthritis or hip dysplasia.