Combined Borderline Acetabular Dysplasia and Increased Femoral Anteversion Is Associated With Worse Outcomes in Female Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Abstract

To determine the relationship of increased femoral anteversion and borderline acetabular dysplasia on the outcomes of hip arthroscopy for femoroacetabular impingement (FAI) in a female cohort of patients. This is a retrospective study of female patients undergoing hip arthroscopy for FAI. All patients had preoperative radiographs and computed tomography scans from which lateral center edge angle (LCEA) and femoral anteversion were measured. Patient outcome was quantified by preoperative and post-operative international hip outcome tool(iHOT)-12. All patients had follow-up at two to four years postoperatively. Published values for minimum clinically important difference(MCID), substantial clinical benefit(SCB), patient acceptable symptomatic state(PASS), and a normal or abnormal hip were used to determine outcome as well as the final score and delta of the iHOT12. There were 243 female patients included in the cohort (83% follow-up) that had iHOT12 scores at two-to-four-year follow-up (Mean 36.9 months). Females with combined LCEA≤25 degrees and Femoral anteversion over 20 degrees had lower Final IHOT12(p=0.001) and Delta iHOT12(p=0.010) and were less likely to achieve a normal hip(p=0.013), MCID(p=0.018), SCB(p<0.001), or PASS(p<0.001) and more likely to have an abnormal hip(p=0.002). In addition, patients with an LCEA≤25 degrees and normal femoral version were less likely to achieve a normal hip(p=0.013), SCB(p<0.001) and PASS(p<0.001) compared to those with normal acetabular coverage (all p<0.05). There was no difference in these outcome measures between the groups with an LCEA over 25 degrees with or without increased femoral version. Female patients with femoral anteversion over 20 degrees and borderline acetabular dysplasia did poorly after hip arthroscopy. However, those with increased femoral anteversion and normal acetabular coverage had outcomes similar to control hips. Level 4 case series.