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Kay J, Simunovic N, Ayeni OR, Bhandari M, Bedi A, Järvinen T, Musahl V, Naudie D, Seppänen M, Slobogean G, Thabane L, Duong A, Skelly M, Shanmugaraj A, Crouch S, Sprague S, Heels-Ansdell D, Buckingham L, Ramsay T, Lee J, Kousa P, Carsen S, Choudur H, Sim Y, Johnston K, Wong I, Murphy R, Sparavalo S, Whelan D, Khan R, Wood GC, Howells F, Grant H, Zomar B, Pollock M, Willits K, Firth A, Wanlin S, Remtulla A, Kaniki N, Belzile EL, Turmel S, Jørgensen U, Gam-Pedersen A, Sihvonen R, Raivio Sihvonen M, Toivonen Sihvonen P, Pirjetta Routapohja M. Effect of Osteochondroplasty on Time to Reoperation After Arthroscopic Management of Femoroacetabular Impingement: Analysis of a Randomized Controlled Trial. Orthop J Sports Med 2022; 10:23259671211041400. [PMID: 35400136 PMCID: PMC8988676 DOI: 10.1177/23259671211041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: A subset of patients with femoroacetabular impingement (FAI) fail arthroscopic management. It is not clear which patients will fail surgical management; however, several surgical and patient factors, such as type of procedure and age, are thought to be important predictors. Purpose: This time-to-event analysis with a 27-month follow-up analysis compared the effect of (1) arthroscopic osteochondroplasty with or without labral repair versus (2) arthroscopic lavage with or without labral repair on the time to reoperation in adults aged 18 to 50 years with FAI. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Eligible participants had been randomized in a previous study trial to a treatment of arthroscopic osteochondroplasty or arthroscopic lavage with or without labral repair. Using the comprehensive data set from the Multinational Femoroacetabular Impingement Randomized controlled Trial, all reoperations until 27 months after surgery were identified. The analysis was conducted using a Cox proportional hazards model, with percentage of patients with a reoperation evaluated in a time-to-event analysis as the outcome. The independent variable was the procedure, with age and impingement subtype explored as potential covariates. The effects from the Cox model were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha level of .05. Results: A total of 108 patients in the osteochondroplasty group and 106 patients in the lavage group were included. The mean age of the patients included in the study was 36 ± 8.5 years. Overall, 27 incident reoperations were identified within the 27-month follow-up, with an incidence rate of 6 per 100 person-years. Within the osteochondroplasty group, 8 incident reoperations were identified (incidence rate, 3.4 per 100 person-years), while within the lavage group, 19 incident reoperations were identified (incidence rate, 8.7 per 100 person-years). The hazard of reoperation for patients undergoing osteochondroplasty was 40% of that of patients undergoing lavage (HR, 0.40 [95% CI, 0.17-0.91] P = .029). Conclusion: This study demonstrated that for adults between the ages of 18 and 50 years with FAI, arthroscopic osteochondroplasty was associated with a 2.5-fold decrease in the hazard of reoperation at any point in time compared with arthroscopic lavage. Registration: NCT01623843 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | | | - Olufemi R. Ayeni
- Olufemi R. Ayeni, MD, PhD, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, Ontario L8N 3Z5, Canada ()
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Ayeni OR, Karlsson J, Heels-Ansdell D, Thabane L, Musahl V, Simunovic N, Duong A, Bhandari M, Bedi A, Järvinen T, Naudie D, Seppänen M, Slobogean G, Skelly M, Shanmugaraj A, Crouch S, Sprague S, Buckingham L, Ramsay T, Lee J, Kousa P, Carsen S, Choudur H, Sim Y, Johnston K, Sprague S, Wong I, Murphy R, Sparavalo S, Whelan D, Khan R, Wood GCA, Howells F, Grant H, Naudie D, Zomar B, Pollock M, Willits K, Firth A, Wanlin S, Remtulla A, Kaniki N, Belzile EL, Turmel S, Jørgensen U, Gam-Pedersen A, Hatanpää T, Sihvonen R, Raivio M, Toivonen P, Routapohja MP. Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement: A Randomized Controlled Trial. Am J Sports Med 2021; 49:25-34. [PMID: 32970955 DOI: 10.1177/0363546520952804] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a condition known to cause hip pain in young adults. PURPOSE To evaluate the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared with arthroscopic lavage of the hip joint with or without labral repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 220 male and female participants aged 18 to 50 years with nonarthritic FAI suitable for surgical treatment were recruited for the trial at 10 clinical centers in Canada, Finland, and Denmark between October 2012 and November 2017, of whom 214 were included in the final analysis. In the osteochondroplasty group, cam- and/or pincer-type lesions were resected using fluoroscopic guidance. In the lavage group, the joint was washed out with 3 L of normal saline. Surgeons were instructed to repair the labrum in both groups if it was mechanically unstable once probed, showing visible displacement or chondrolabral separation. The primary outcome was patient-reported pain (using the 100-point visual analog scale [VAS]) at 12 months. Secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool), physical and mental health (12-Item Short Form Health Survey), and health utility (EuroQol-5 Dimensions) at 12 months as well as any reoperations and other hip-related adverse events at 24 months. RESULTS At 12 months, there was no difference in pain (VAS) between the groups (mean difference [MD], 0.11 [95% CI, -7.22 to 7.45]; P = .98). Also, 88.3% (189/214) of participants had a labral tear, of which 60.3% were repaired. For the secondary outcomes, there were no significant differences between treatment groups, with the exception of the HOS activities of daily living domain in which lavage showed significant improvement compared with osteochondroplasty (MD, -5.03 [95% CI, -10.40 to -0.03]; P = .049). By 24 months, there were significantly fewer reoperations reported in the osteochondroplasty group (8/105) than the lavage group (19/104) (odds ratio, 0.37 [95% CI, 0.15-0.89]; P = .026). The primary reasons for a reoperation included hip pain (15/27; 55.6%) and a reinjury of the labrum (11/27; 40.7%). CONCLUSION Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year. By 2 years, the reoperation rate was significantly lower in the osteochondroplasty group. REGISTRATION NCT01623843 (ClinicalTrials.gov identifier).
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Affiliation(s)
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- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Jon Karlsson
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | | | - Lehana Thabane
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Volker Musahl
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Andrew Duong
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Asheesh Bedi
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Teppo Järvinen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Douglas Naudie
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Matti Seppänen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Gerard Slobogean
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Matthew Skelly
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Ajay Shanmugaraj
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sarah Crouch
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Lisa Buckingham
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Tim Ramsay
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - John Lee
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Petteri Kousa
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sasha Carsen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Hema Choudur
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Yan Sim
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Kelly Johnston
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Ivan Wong
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Ryland Murphy
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sara Sparavalo
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Daniel Whelan
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Ryan Khan
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Gavin C A Wood
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Fiona Howells
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Heather Grant
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Douglas Naudie
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Bryn Zomar
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Michael Pollock
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Kevin Willits
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Andrew Firth
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Stacey Wanlin
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Alliya Remtulla
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Nicole Kaniki
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Etienne L Belzile
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Sylvie Turmel
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Uffe Jørgensen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Annie Gam-Pedersen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Tays Hatanpää
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Raine Sihvonen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Marko Raivio
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
| | - Pirjo Toivonen
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
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