Arthroscopic Surgery For Femoroacetabular Impingement Syndrome Research Articles

Increased combined anteversion is associated with larger posterior acetabular rim ossification in patients with femoroacetabular impingement syndrome.

(1) To determine the prevalence, magnitude and distribution pattern of acetabular rim ossification in patients with femoroacetabular impingement syndrome (FAIS) and (2) to determine the association between acetabular rim ossification and rotational abnormalities of the hip. Patients underwent hip arthroscopic surgery for FAIS at our institute between January 2021 and May 2022 were retrospectively reviewed. Patients were included if preoperative computed tomography (CT) images of the operated hip and ipsilateral distal femur were available for the measurement of femoral and acetabular anteversion. The presence and size of acetabular rim ossification were evaluated on coronal CT sections for the superior half of the acetabulum on each clockface location. The associations between acetabular rim ossification and radiographic parameters of hip rotational morphology were examined. A total of 214 hips were included. Acetabular rim ossification was found in 167 hips (78%) and the most common locations were 10 and 11 o'clock. Patients presenting with acetabular rim ossification had a mean size of 4.6 ± 1.6 mm. It was the largest at 9 o'clock position (4.9 ± 2.2 mm), with a decreasing trend in size from posterior to anterior. Logistics regression analysis found age was associated with the occurrence of posterior ossification (p = 0.002). Linear regression analysis found age (p = 0.049) and male sex (p < 0.001) were significantly correlated with the size of ossification. Patients with increased cranial combined anteversion had larger posterior ossification than patients with normal and decreased cranial combined anteversion (4.2 ± 2.9 vs. 3.1 ± 2.5 mm, p = 0.016; 4.2 ± 2.9 vs. 2.5 ± 2.4 mm, p = 0.005). Increased combined anteversion is associated with greater posterior acetabular rim ossification. The presence and size of acetabular rim ossification are positively associated with older age and male sex. Level III.

Poster 214: Cross Sectional Area of Hip Muscles Before and After Surgery for Femoroacetabular Impingement

Objectives: Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain and surgery is a treatment option for patients who do not respond to conservative treatment. Previous studies have identified increases in postoperative hip muscle volume and cross-sectional area (CSA) as associated with increases in patient reported outcomes following hip surgery. There has been a lack of literature analyzing the change of hip muscle cross sectional CSA on MRI following arthroscopic hip surgery for FAI and the effect of changes in hip muscle CSA on patient reported outcomes following surgery. The purpose of this study is to analyze the change in hip muscle cross sectional area (CSA) after arthroscopic surgery for FAI syndrome. Methods: This is a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023. All patients who had a pre-operative MRI within 1 year of their date of surgery and at least one postoperative MRI were included in the study. Cross sectional areas were measured by one blinded researcher and results were checked for reliability by a musculoskeletal radiologist. Statistical analysis was completed using SPSS, Version 24 and normally distributed continuous variables between cohorts were compared using the two-sample Student t test. Results: Initially 1390 patients were included in the study but only 95 were found to have a preoperative hip MRI within 1 year of their date of surgery as well as a postoperative MRI. The average age of the cohort was 35.8 ± 15.7, the cohort was 33.7% male and 66.3% female, and had an average BMI of 23.3 ± 8.1. The mean time between surgery and postoperative MRI was 14.8 ± 8.3 months. There was a significant difference between preoperative and postoperative hip muscle CSA for gluteus maximus (4298.6±883.6 mm2 vs. 4384.6±967.6 mm2, p&lt;0.01), gluteus minimus (1037.0±199.2 mm2 vs. 1074.9±202.3 mm2, p&lt;0.001), and pectineus (415.7±121.9 mm2 vs. 426.7±106.3 mm2, p=0.04). There were no other significant differences between preoperative and postoperative hip muscle CSA values between the other muscles analyzed. A linear regression found that an increase in the change in CSA of the gluteus maximus significantly predicted an increase in mHHS at 1 year (β=3.103, p=0.046) when controlling for age, sex, BMI and time from surgery to postoperative MRI. A linear regression found that an increase in the change in cross sectional area of the pectineus significantly predicted an increase in NAHS at 1 year when controlling for age, sex, BMI and time from surgery to post-op MRI (β=0.186, p=0.037). Conclusions: Patients who undergo surgery for FAI have significantly increased gluteus maximus, gluteus minimus and pectineus muscle CSA on post-operative MRIs. Furthermore, increases in both gluteus maximus and pectineus muscle CSA was found to be significantly associated with increases in mHHS and NAHS at 1 year follow up respectively.

Short-term Outcomes After Hip Arthroscopic Surgery in Patients Participating in Formal Physical Therapy Versus a Home Exercise Program: A Prospectively Enrolled Cohort Analysis

Background: Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population. Purpose/Hypothesis: The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores. Results: The patients’ mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P = .795), visual analog scale for pain score (P > .05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P = .699), 12-item International Hip Outcome Tool score (P = .582), and patient satisfaction (P > .05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P < .001). Conclusion: There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program.

High Rate of Full Duty Return to Work After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Workers Who Are Not on Workers’ Compensation

Background: Femoroacetabular impingement syndrome (FAIS) is an increasingly common diagnosis among working-age adults. Hip arthroscopy provides reliable improvements in pain and may allow patients to return to physical activities. No study to date has evaluated return to work (RTW) among a general population of adults after arthroscopic surgery for FAIS. Purpose: To evaluate (1) patients’ rate of RTW, (2) time required to RTW, and (3) factors correlated with time required to RTW after arthroscopic surgery for symptomatic FAIS. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients aged 25 to 59 years who underwent arthroscopic surgery for FAIS between June 2018 and December 2018 were reviewed. Workers’ compensation cases and patients with <1-year follow-up were excluded. The following were collected at a minimum of 1 year postoperatively: demographics, employment characteristics, Hip Outcome Score (HOS; Activities of Daily Living and Sports Specific subscales), modified Harris Hip Score, 12-Item International Hip Outcome Tool (iHOT-12), visual analog scale for pain, and RTW characteristics. Work physical activity level was classified as sedentary, light, moderate, heavy, or very heavy per established criteria. Results: A total of 97 patients were selected through inclusion and exclusion criteria. RTW surveys were collected for 79 (81.4%), and 61 were employed preoperatively. Time worked per week was 42.8 ± 12.5 hours (mean ± SD). Patients’ work level was most commonly classified as sedentary (42.6%), followed by moderate (24.6%). All 61 (100%) patients returned to work at a mean 7.3 weeks (range, <1-88 weeks) postoperatively. Sixty patients (95.2%) returned to full duty. Time required to full duty RTW was strongly correlated with expected time off from work (r = 0.900; P < .0001) and moderately correlated with work classification (r = 0.640; P = .0001). All patients had significant pre- to postoperative improvements in the HOS–Activities of Daily Living (64.8 ± 15.3 to 87.1 ± 12.2; P < .001), HOS–Sports Specific (42.8 ± 18.8 to 76.7 ± 16.5; P < .001), iHOT-12 (31.3 ± 18.8 to 69.3 ± 21.1; P < .001), modified Harris Hip Score (61.8 ± 12.1 to 80.3 ± 14.1; P < .001), and visual analog scale for pain (5.19 ± 2.11 to 2.40 ± 1.96; P < .001). Conclusion: Patients undergoing arthroscopic treatment for FAIS demonstrated a high rate of RTW at a mean of <2 months postoperatively. A patient’s expected time off from work and the level of physical demands required for work were highly associated with time required to RTW. These results are valuable for orthopaedic surgeons, patients, and employers when establishing a timeline for expected RTW after surgery.

Femoroacetabular Impingement Syndrome.

Femoroacetabular impingement (FAI) syndrome is one of the most rapidly evolving etiologies of hip pain. The 2016 Warwick Agreement consensus statement defined FAI syndrome as a triad of symptoms, signs, and radiographic findings. Cam morphology is more likely in athletes and is associated with repetitive hip loading in maximal flexion during adolescence. Much less is known about the development of pincer morphology. Physical therapy improves pain and function, justifying a trial before pursuing surgery. Musculoskeletal injections are utilized for FAI syndrome, but the evidence is limited. Arthroscopic surgery for FAI syndrome can correct the morphological changes and address the underlying soft tissue injuries. Recent studies evaluated reliable indicators of surgical outcomes, the most reliable of which is the presurgical presence of osteoarthritis. Recent studies demonstrate the efficacy of surgery, but with the risk of complication and no guarantee of a return to the same level of sport.

Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up.

Background:Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration.Purpose:To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS).Study Design:Case series; Level of evidence, 4.Methods:Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported.Results:A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found (P < .001 for all). A significant decrease was shown for VAS scores (P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients.Conclusion:In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.

Patients With Borderline Hip Dysplasia Achieve Clinically Significant Improvement After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With a Minimum 5-Year Follow-up

Background: Hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD) is becoming a more common practice. However, the literature on achieving meaningful outcomes at midterm follow-up, as well as predictors of these outcomes, is limited. Purpose: To (1) compare the rates of achieving meaningful clinical outcomes between patients with and without BHD and (2) identify the predictors for achieving clinical success among patients with BHD 5 years after undergoing hip arthroscopic surgery for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent primary hip arthroscopic surgery with routine capsular closure for the treatment of FAIS between January 2012 and August 2014 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA] 20°-25°) were matched 1:2 by age (±1 year) and body mass index (BMI; ±5 kg/m2) to control patients with normal acetabular coverage (LCEA 25°-40°). Data collected included baseline and 5-year postoperative patient-reported outcomes. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for each patient-reported outcome measure and compared between the 2 groups. A binary logistic regression analysis was used to identify significant predictors of achieving the MCID and PASS in the BHD group. Results: The MCID in the BHD group was defined as 9.6, 14.1, and 9.5 for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, and modified Harris Hip Score, respectively. Threshold scores for achieving the PASS in both groups were 90.9, 76.6, and 81.9, respectively. A total of 88 patients were identified with having BHD and were matched to 176 controls. No statistical differences were identified for age, BMI, or sex. Both the BHD and the non-BHD groups had statistically significant increases in patient-reported outcome scores over the 5-year period, but the difference in both groups was not statistically significant (P > .05 for all). There was no statistical difference in the frequency of patients in the BHD and non-BHD groups achieving the MCID (86.6% vs 85.2%, respectively; P = .804) or PASS (76.0% vs 73.7%, respectively; P = .675) on at least 1 outcome measure. The logistic regression model demonstrated that being physically active (odds ratio [OR], 27.59; P = .005) and being female (OR, 14.64; P = .025) were independent predictors of achieving the MCID, while running (OR, 11.1; P = .002), being female (OR, 7.6; P = .011), and a larger preoperative LCEA (OR, 2.3; P = .001) were independent preoperative predictors of achieving the PASS. Conclusion: The rates of achieving clinical success 5 years after undergoing arthroscopic treatment with capsular closure for FAIS were not significantly different between patients with BHD and those with normal acetabular coverage. Being physically active, running for exercise, female sex, and a larger LCEA were preoperative predictors of achieving clinical success at 5 years in patients with BHD.

No association between femoral or acetabular angles and patient-reported outcomes in patients with femoroacetabular impingement syndrome-results from the HAFAI cohort.

Patients with femoroacetabular impingement syndrome (FAIS) are diagnosed using imaging, but detailed description especially the acetabular shape is lacking and may help give more insight to the pathogenesis of FAIS. Furthermore, associations between patient-reported outcomes (PROs) and the radiological angles might highlight which radiological angles affect outcomes experienced by the patients. Hence, the aims of this study were (i) to describe computer tomography (CT) acquired angles in patients with FAIS and (ii) to investigate the association between radiological angles and the Copenhagen Hip and Groin Outcome Score (HAGOS) in patients with FAIS. Patients scheduled for primary hip arthroscopic surgery for FAIS were included. Based on CT, following angles were measured before and 1 year after surgery; femoral anteversion, alpha, lateral centre edge, acetabular index, anterior sector, posterior sector and acetabular anteversion. All patients completed the HAGOS. Sixty patients (63% females) aged 36 ± 9 were included. One year after surgery, significant alterations in the alpha angle and the acetabular index angle were found. Neither baseline PROs nor changes in PROs were associated with the radiological angles or changes in angles. Since neither changes in CT angles nor baseline scores were associated with HAGOS, the improvements felt by patients must origin from somewhere else. These findings further underlines that morphological changes seen at imaging should not be treated arthroscopically without a patient history of symptoms and clinical findings.

Computer tomography acquired hip angles and patient reported outcomes in patients with femoroacetabular impingement syndrome

Purpose: Patients with femoroacetabular impingement syndrome (FAIS) experience pain, decreased function and quality of life. Patients present with cam and/or pincer morphology in their hip joint. FAIS is diagnosed via imaging, clinical signs and symptoms. In large cohorts using radiological measures, cam morphology has been associated with later development of osteoarthritis (OA) of the hip while it is less certain how pincer morphology is related to development of OA. In the cohort studies, pincer morphology was quantified using the lateral center edge angle (CE) and the anterior CE angle. Pincer, defined this way, was not associated with development of OA. However, quantifying pincer only by these two angles may not give the full picture of pincer impingement and its relation to hip OA. Hence, further description of abnormal values in patients with FAIS could help investigate the pathogenesis of FAIS. Furthermore, associations between patient reported outcomes and the specific angles might highlight which radiological parameters affect outcomes experienced by the patients. Hence, the aims of the study were 1) to describe computer tomography (CT) acquired angles in patients with FAIS compared with reference values from the literature 2) to investigate the association between hip angles in patients with FAIS and the Copenhagen Hip and Groin Outcome Score (HAGOS) and if HAGOS scores differ between patients with hip angles above/below mean reference values. Methods: Patients were eligible for inclusion if they were scheduled for primary hip arthroscopic surgery for FAIS. The study was approved by the Central Denmark Region Committee on Biomedical Research Ethics (1-10-72-239-14) and the Danish Data Protection Agency (1-16-02-499-14). The CT images of the hip were acquired on a Philips Brilliance 64 (Philips Medical Systems, Best, the Netherlands) scanner with low-dose radiation. Furthermore, a single image through the femoral condyles was obtained to measure the femoral anteversion (FeAV). Data were transferred to a Philips Mx view station (Philips Medical Systems, Best, the Netherlands). On the reformatted images the alpha angle, the CE angle, the acetabular index (AI), the posterior acetabular sector angle (PASA), the anterior acetabular sector angle (AASA), the horizontal acetabular sector angle (HASA) and the acetabular anteversion (AcAV) was measured by an experienced musculoskeletal radiologist. All patients completed the HAGOS. Associations between patient reported outcomes and hip angles was tested with linear regression. Comparisons between HAGOS data above/below mean reference values of hip angles were performed with the Wilcoxons test for unpaired data. Results: Sixty patients aged 36 ±9, 63% females were included in the study. Hip angles (55 patients) and HAGOS scores (60 patients) are tabulated in Table 1. Hip angles were not associated with any of the HAGOS scores. Those patients with a higher FeAV, PASA and HASA than reference mean values had worse HAGOS scores compared to those with lower hip angles than reference mean values. Conclusions: Patients presented with a high FeAV angle and many patients had a low AI angle. There was no overall association between HAGOS scores and hip angles, but patients with a high FeAV, PASA and/or HASA had worse HAGOS scores. These angles should be further investigated in order to investigate the pathogenesis of FAIS and to investigate whether the angles are related to later development of hip OA. Table details: ∼ Healthy reference values from Valera et al. 2018 Arch Orthop Trauma Surg, Lepage-Saucier et al. 2014 Eur Radiol and Kierkegaard et al. 2017 Journal of Science and Medicine in Sport. ∗ For the acetabular index angle, it is %patients below the reference meanTable 1Hip angles and HAGOS scores.Patients (mean±standard deviation)Healthy reference values (mean±standard deviation) ∼%patients with scores higher than reference mean (number of pt.)Affected legAlpha51.7 ±9.653.3 ±13.138% (21)FeAV27.5 ±10.517 ±391% (50)CE33.1 ±5.635 ±640% (22)AI2.8 ±6.06 ±569% (38)*AASA59.2 ±6.663 ±631% (17)PASA94.9 ±6.8103 ±911% (6)HASA154.1 ±9.3165 ±942% (23)AcAV18.0 ±4.724 ±547% (26)HAGOSPain51 ±20100Symptoms47 ±17100Activities of daily living53 ±24100Sport34 ±18100Physical activities21 ±23100Quality of life31 ±15100 Open table in a new tab