Hip Arthroscopy for Femoroacetabular Impingement is Associated with Significant Improvement in Early Patient Reported Outcomes: Analysis of 4963 Cases from the UK Non-arthroplasty Registry (NAHR) Dataset

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2022 Jul 14

PMID 35833961

Authors

Richard Holleyman

Mark Andrew Sohatee

Stephen Lyman

Ajay Malviya

Vikas Khanduja

Affiliations

Soon will be listed here.

Abstract

Purpose: Results from recent randomised controlled trials demonstrate the superiority of surgery over physiotherapy in patients with femoroacetabular impingement (FAI) of the hip in early follow-up. However, there is paucity of evidence regarding which factors influence outcomes of FAI surgery, particularly notable is the lack of information on the effect of impingement subtype (cam or pincer or mixed) on patient reported outcomes measures (PROMs). This study aims to evaluate the early outcomes of hip arthroscopy for FAI, and their determinants.

Methods: This is a retrospective analysis of prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) of patients undergoing arthroscopic intervention for FAI between 2012 and 2019. The null hypothesis was that there is no difference in PROMs, based on morphological subtype of FAI treated or patient characteristics, at each follow-up timepoint. The outcome measures used for the study were the iHOT-12 score and the EQ5D Index and VAS 6- and 12-month follow-up.

Results: A cohort of 4963 patients who underwent arthroscopic treatment of FAI were identified on the NAHR database. For all FAI pathology groups, there was significant improvement from pre-operative PROMs when compared to those at 6 and 12 months. Overall, two-thirds of patients achieved the minimum clinically important difference (MCID), and almost half achieved substantial clinical benefit (SCB) for iHOT-12 by 12 months. Pre-operatively, and at 12-month follow-up, iHOT-12 scores were significantly poorer in the pincer group compared to the cam and mixed pathology groups (p < 0.01). Multivariable analysis revealed PROMS improvement in the setting of a higher-grade cartilage lesion.

Conclusion: This registry study demonstrates that hip arthroscopy is an effective surgical treatment for patients with symptomatic FAI and results in a statistically significant improvement in PROMs which are maintained through 12 months follow-up.

Level Of Evidence: III.

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References

Lin L, Akpinar B, Bloom D, Youm T . Age and Outcomes in Hip Arthroscopy for Femoroacetabular Impingement: A Comparison Across 3 Age Groups. Am J Sports Med. 2020; 49(1):82-89. DOI: 10.1177/0363546520974370. View

McCormick F, Nwachukwu B, Alpaugh K, Martin S . Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis. Arthroscopy. 2012; 28(10):1359-64. DOI: 10.1016/j.arthro.2012.04.059. View

Sochacki K, Jack 2nd R, Safran M, Nho S, Harris J . There Is a Significant Discrepancy Between "Big Data" Database and Original Research Publications on Hip Arthroscopy Outcomes: A Systematic Review. Arthroscopy. 2018; 34(6):1998-2004. DOI: 10.1016/j.arthro.2018.01.018. View

Philippon M, Briggs K, Yen Y, Kuppersmith D . Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2008; 91(1):16-23. DOI: 10.1302/0301-620X.91B1.21329. View

Krych A, Kuzma S, Kovachevich R, Hudgens J, Stuart M, Levy B . Modest mid-term outcomes after isolated arthroscopic debridement of acetabular labral tears. Knee Surg Sports Traumatol Arthrosc. 2014; 22(4):763-7. DOI: 10.1007/s00167-014-2872-1. View

Kivlan B, Martin R, Christoforetti J, Wolff A, Nho S, Salvo Jr J . The Patient Acceptable Symptomatic State of the 12-Item International Hip Outcome Tool at 1-Year Follow-Up of Hip-Preservation Surgery. Arthroscopy. 2019; 35(5):1457-1462. DOI: 10.1016/j.arthro.2018.11.072. View

Skendzel J, Philippon M, Briggs K, Goljan P . The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement. Am J Sports Med. 2014; 42(5):1127-33. DOI: 10.1177/0363546514526357. View

Mygind-Klavsen B, Lund B, Nielsen T, Maagaard N, Kraemer O, Holmich P . Danish Hip Arthroscopy Registry: predictors of outcome in patients with femoroacetabular impingement (FAI). Knee Surg Sports Traumatol Arthrosc. 2018; 27(10):3110-3120. DOI: 10.1007/s00167-018-4941-3. View

Sansone M, Ahlden M, Jonasson P, Thomee C, Sward L, Collin D . Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis-A prospective study. J Hip Preserv Surg. 2016; 3(1):61-7. PMC: 4808260. DOI: 10.1093/jhps/hnv079. View

10.

Kaldau N, Brorson S, Holmich P, Lund B . Good midterm results of hip arthroscopy for femoroacetabular impingement. Dan Med J. 2018; 65(6). View

11.

Imam S, Khanduja V . Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop. 2011; 35(10):1427-35. PMC: 3174304. DOI: 10.1007/s00264-011-1278-7. View

12.

Nwachukwu B, Fields K, Chang B, Nawabi D, Kelly B, Ranawat A . Preoperative Outcome Scores Are Predictive of Achieving the Minimal Clinically Important Difference After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med. 2016; 45(3):612-619. DOI: 10.1177/0363546516669325. View

13.

Menge T, Briggs K, Rahl M, Philippon M . Hip Arthroscopy for Femoroacetabular Impingement in Adolescents: 10-Year Patient-Reported Outcomes. Am J Sports Med. 2020; 49(1):76-81. DOI: 10.1177/0363546520973977. View

14.

Moon J, Yoon J, Kim C, Lee S, Kekatpure A, Yoon P . Hip Arthroscopy for Femoroacetabular Impingement and Concomitant Labral Tears: A Minimum 2-Year Follow-Up Study. Arthroscopy. 2020; 36(8):2186-2194. DOI: 10.1016/j.arthro.2020.04.041. View

15.

Griffiths E, Khanduja V . Hip arthroscopy: evolution, current practice and future developments. Int Orthop. 2012; 36(6):1115-21. PMC: 3353094. DOI: 10.1007/s00264-011-1459-4. View

16.

Martin R, Kivlan B, Christoforetti J, Wolff A, Nho S, Salvo Jr J . Minimal Clinically Important Difference and Substantial Clinical Benefit Values for the 12-Item International Hip Outcome Tool. Arthroscopy. 2019; 35(2):411-416. DOI: 10.1016/j.arthro.2018.09.028. View

17.

Hetsroni I, Torre K, Duke G, Lyman S, Kelly B . Sex differences of hip morphology in young adults with hip pain and labral tears. Arthroscopy. 2012; 29(1):54-63. DOI: 10.1016/j.arthro.2012.07.008. View

18.

Mardones R, Giai Via A, Rivera A, Tomic A, Somarriva M, Wainer M . Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years. Muscles Ligaments Tendons J. 2017; 6(3):397-401. PMC: 5193531. DOI: 10.11138/mltj/2016.6.3.397. View

19.

Khanduja V, Villar R . The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007; 15(8):1035-40. DOI: 10.1007/s00167-007-0319-7. View

20.

Saltzman B, Kuhns B, Basques B, Leroux T, Alter J, Mather 3rd R . The Influence of Body Mass Index on Outcomes After Hip Arthroscopic Surgery With Capsular Plication for the Treatment of Femoroacetabular Impingement. Am J Sports Med. 2017; 45(10):2303-2311. DOI: 10.1177/0363546517705617. View