For Femoroacetabular Impingement Research Articles

THE IMPACT OF SOCIOECONOMIC STATUS ON OUTCOMES FROM TREATMENT FOR FEMOROACETABULAR IMPINGEMENT

There is little known about how patient socioeconomic status impacts clinical outcomes in hip preservation surgery. The aim of this study was to evaluate the relationship between indices of multiple deprivation, funding provider (NHS Funded or Private Funded) and clinical outcomes following surgery for femoroacetabular impingement (FAI)The study analysed the data of 5590 patients recorded in the NAHR who underwent primary hip arthroscopic treatment for FAI between November 2013 and July 2023. Records were matched to the UK National index of multiple deprivation using the lower layer super output area. Using iHOT12 score, patient reported outcome measures were analysed at base line and 1 year following surgery.2358 records were matched to LLSOA deciles. Between the lowest (most deprived) 3 deciles and the highest (least deprived) the average baseline iHOT12 score was 28.98 (n=366) and 35.33 (n=821). The proportion of patients receiving treatment through NHS funding compared to independent funding for the most deprived, 292 (90%) 37 (10%) respectively compared to the least deprived 515 (70%) and 244 (30%) respectively. At 1year, iHOT12 scores for each group were 51.64 (29.1 SD) compared to 61.5 (28.06 SD) respectively.The study demonstrates that patients from lower socioeconomic backgrounds had poorer baseline and one-year post-surgery iHOT12 scores compared to those from higher socioeconomic strata. Furthermore, a higher reliance on NHS funding was observed among the most deprived, while more affluent patients predominantly opted for private funding. These findings underscore the significant influence of socioeconomic status on both the quality of healthcare received and recovery outcomes in hip preservation surgery, calling attention to the need for more equitable healthcare solutions.

Long-Term Outcomes of Arthroscopic Labral Treatment of Femoroacetabular Impingement in Adolescents: A Nested Propensity-Matched Analysis.

Hip arthroscopy has demonstrated effectiveness as a treatment for femoroacetabular impingement (FAI) in adult patients, with promising long-term outcomes. However, there is a paucity of literature regarding the adolescent population. The purposes of our study were to report on survivorship and patient-reported outcomes (PROs) at a minimum 10-year follow-up in adolescent patients who underwent hip arthroscopy for FAI and labral tears and to compare the survivorship and outcomes of this population with those of a nested, propensity-matched adult control group. Data regarding adolescent patients who underwent primary hip arthroscopy between February 2008 and January 2012 were reviewed. Patients with a minimum 10-year follow-up for the modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain were eligible. The exclusion criteria were previous ipsilateral hip conditions or surgical procedures, a Tönnis grade of >1, or dysplasia. In the subanalysis, adolescent patients were matched to young adult patients with use of a 1:1 ratio on the basis of sex, body mass index, Tönnis grade, lateral center-edge angle (LCEA), labral treatment, capsular treatment, and additional procedures performed during the surgery. A total of 74 patients (61 female and 13 male; 74 hips) with a mean (and standard deviation) age of 16.7 ± 1.4 years and a minimum follow-up of 10 years were included. The latest follow-up occurred at a mean of 125.4 ± 5.3 months (range, 120.0 to 144.1 months). Significant improvement in all PROs from baseline and 100% survivorship were demonstrated at the 10-year follow-up. In the subanalysis, 58 adolescent hips were propensity-matched to 58 young adult hips. The adolescent group had higher postoperative scores for the HOS-SSS (p = 0.021), NAHS (p = 0.021), and iHOT-12 (p = 0.042) than the young adult group. Patient satisfaction at the latest follow-up was also significantly higher in the adolescent group (p = 0.00061). The rate of survivorship free from conversion to THA was similar between the adolescent and control groups (100% versus 96.6%; p = 0.200). Adolescents undergoing hip arthroscopy for the treatment of FAI and labral tears demonstrated excellent outcomes and a high rate of survivorship. These outcomes were superior to those seen in a matched adult group. The results of this study indicate that hip arthroscopy in adolescents is a safe procedure that leads to improvement in outcomes at long-term follow-up. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparative analysis of hip arthroscopy and open surgical dislocation for treating femoroacetabular impingement

AbstractThe purpose of this study was to compare the impact of hip arthroscopy group and open surgical dislocation group as treatments for femoroacetabular impingement (FAI) in young athletes, specifically in relation to early hip osteoarthritis. A systematic search was conducted across four databases to identify controlled trials comparing hip arthroscopy and open surgical dislocation for FAI treatment. The selected studies (9 in total) underwent rigorous literature assessment and data analysis using Review Manager (RevMan) 5.3 software. The meta‐ analysis revealed that there was no statistically significant difference between hip arthroscopy group (the test group) and the open surgical dislocation group (the control group) concerning the improvement of the alpha angle (Standardized Mean Difference [SMD]: ‐5.54; 95% Confidence Interval [CI]: ‐ 12.45,1.38; p = 0.117), the Modified Harris Hip Score (mHHS) after a 12‐ month follow‐ up (SMD:0.94; 95% CI:‐ 2.87,4.75; p = 0.629) and the complication rate (OR: 0.66; 95% CI: 0.26,1.65; p = 0.372). However, the meta‐ analysis revealed that the Nonarthritic Hip Score (NAHS) after a 12‐ month follow‐ up of the test group was significantly higher than that of the control group (SMD: 6.31; 95% CI: 0.53, 12.09; p = 0.032). In terms of the reoperation rate, it demonstrated a significantly lower rate in the test group compared to the control group (OR: 0.48; 95% CI: 0.29, 0.82; p < 0.01). These findings suggest that hip arthroscopy may have better outcomes for patients with FAI, as it is associated with improvements in hip function and a lower reoperation rate. However, these conclusions should be validated by further high‐ quality studies.

Hip Arthroscopy in Recreational Athletes: Risk Factors For Failure to Return to Sport and Factors That Influence Psychological Readiness to Return to Sport

Objective: High level athletes achieve high rates of return to play and improved patient reported outcomes (PROMs) after hip arthroscopy for femoroacetabular impingement (FAI). However, few studies have evaluated return to sport rates in recreational athletes, risk factors for failure to return to sport, and the effect of psychological readiness to return to sport (RTS) within this population. We hypothesize that recreational athletes undergoing hip arthroscopy for FAI achieve high PROMs and rates of RTS and that psychological readiness is a risk factor for failure to RTS. Additionally, we hypothesize that male athletes and younger age are positively associated with psychological readiness to RTS. Methods: Retrospective review of prospectively collected data in our institution's Center for Hip Pain and Preservation Outcomes Registry identified recreational athletes with a minimum of 12 months follow-up, who underwent hip arthroscopy for FAI between 2008-2018. The primary outcome was RTS. The secondary outcomes were ---Hip-RSI (SF) score, modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport (HOS-Sport), and International Hip Outcome Tool (iHOT33). Results: 84.8% of recreational athletes returned to sport with 70.52% returning to the same level of play. Athletes who failed to RTS were younger (p-value=0.0427), last participated 9-12 months prior to surgery (32.26%) or had stopped participating in sports altogether (70.97%) (p-value=0.0002 and p-value=0.0013). Hip-RSI Score was a statistically significant predictor of failure to RTS at one and two years respectively (OR 0.915 (95%CI 0.87, 0.962) and OR 0.904 (95%CI 0.818, 0.999)). Increasing age had a positive effect on psychological readiness to RTS (0.5004-point increase in RSI score (p-value=0.0002)) while sex, BMI, additional ipsilateral surgery, and last participation in sport were not predictive of psychological readiness (p-values>0.05). Conclusions: Recreational athletes undergoing hip arthroscopy achieve high rates of RTS, return to the same level of play, and demonstrate significant improvements in PROMs. The Hip-RSI-score was a statistically significant predictor of failure to RTS at 1 and 2 years post operatively. Lastly, higher psychological readiness for return to sport was seen in older recreational athletes undergoing hip arthroscopy for FAI.

Hip Arthroscopy Followed by 6-Month Rehabilitation Leads to Improved Periarticular Muscle Strength, Except for Abductors and External Rotators

PurposeTo evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI) MethodsA retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of eight hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after six months of rehabilitation in terms of relative strength changes between time-points. ResultsA total of 29 patients (aged 26.9±7.1, 86% of women) were included. Except for the abductors which remained of comparable strength than before surgery, a statistically significant (p<0.05) increase in hip muscles strength on the operated side could be noted at 6 postoperative months for hamstrings (9%±17%, p=0.041), quadriceps (11%±27%, p=0.045), extensors (17%±32%, p=0.006), flexors (17%±29%, p=0.003), adductors (18%±23%, p<0.001), and internal rotators (32%±36%, p<0.001). The proportion of patients who reached a strength level above their pre-operative status ranged from 62% (quadriceps) to 86% (adductors and flexors) depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13%±26%, p=0.002) and non-operated (-17%±25%, p<0.001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48% respectively). ConclusionsArthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators which remained comparable and weakened, respectively.

Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up

PurposeTo determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. MethodsRetrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. ResultsSeventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2–3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). ConclusionCumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Benefits of a Postoperative Hip Orthosis After Routine Arthroscopy of the Hip: A Retrospective Cohort Study.

No consensus currently exists among orthopaedic surgeons regarding the benefits of hip orthosis after routine hip arthroscopy. To compare patient-reported outcome measures (PROMs) and reoperation rates between patients who were braced versus those who were not braced after routine hip arthroscopy. Cohort study; Level of evidence, 3. A retrospective review was conducted of 193 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) from January 1, 2018, to December 31, 2021, by 2 orthopedic surgeons at a single institution. Patients before July 1, 2019, were immobilized in a hip orthosis after hip arthroscopy (braced group; n = 101), whereas those after July 1, 2019, were not (nonbraced group; n = 92). Baseline PROMs (visual analog scale for pain, modified Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey [VR-12] Physical Component Summary and Mental Component Summary) were obtained for all patients and were repeated postoperatively at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 years. The study groups were compared to evaluate differences in PROMs over time and 2-year postoperative reoperation rates. Group comparisons were also stratified by patient sex. There were no significant differences on any PROM between the braced and nonbraced cohorts at any timepoint. There were also no significant group differences in reoperation rates, with 8 braced patients (7.9%) undergoing reoperation and 1 nonbraced patient (2.3%) undergoing reoperation (P = .208). In the sex-stratified analyses, nonbraced male patients had significantly higher VAS pain and lower VR-12 Mental Component Summary scores at 6 months postoperatively compared with braced male patients (P = .043 and .026, respectively). The study findings suggested that the use of an orthosis after routine hip arthroscopy for FAI does not improve patient-reported outcomes or negatively affect the 2-year reoperation rate. Postoperative bracing increases perioperative cost, and by foregoing routine bracing, patients may avoid the morbidity associated with wearing a brace for a prolonged period.

Association of Hip Dysplasia With Trochlear Dysplasia in Skeletally Mature Patients.

Developmental dysplasia of the hip (DDH) and trochlear dysplasia (TD) are distinct pathologies with several important features in common. In addition to shared risk factors, both forms of dysplasia cause abnormal joint kinematics and force transmission, predisposing patients to pain, injuries to cartilage and soft tissue stabilizers, and ultimately arthritis. To evaluate for an association between hip dysplasia and TD in skeletally mature patients with symptomatic hip dysplasia. Cross-sectional study; Level of evidence, 3. A total of 48 patients with DDH who underwent periacetabular osteotomy were compared with 48 sex-matched patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) between July 2014 and February 2021. All patients were skeletally mature. The Tönnis angle and lateral center-edge angle were measured on preoperative pelvis radiographs. Femoral version, trochlear depth, lateral trochlear inclination (LTI), tibial tubercle-trochlear groove distance (TTTG-d), and posterior lateral condylar angle (PLCA) were measured on preoperative magnetic resonance imaging scans of the symptomatic hip and ipsilateral knee. Continuous variables were compared between the patient groups using 2-sample t tests. Interobserver reliability was measured using the intraclass correlation coefficient. Patients with DDH demonstrated a reduced trochlear depth compared with patients with FAI (3.6 vs 4.6 mm; P < .001). There were no differences between groups in femoral anteversion, LTI, TTTG-d, or PLCA. Two (4.2%) patients with FAI and 17 (35.4%) patients with DDH had a trochlear depth <3 mm (P < .001). One (2.1%) patient with FAI and 7 (14.6%) patients with DDH had an LTI <11° (P = .027). There was no difference between groups in frequency of a convex proximal trochlea, patient-reported ipsilateral knee pain, or ipsilateral knee procedures. Patients with DDH had reduced trochlear depth compared with patients with FAI, demonstrating a higher incidence of dysplastic trochlear features that may predispose patients to patellofemoral joint disease. Further research is needed to determine whether screening at-risk patients and treating TD will help to prevent symptomatic patellofemoral disease.

The influence of the sacral slope on pelvic kinematics and clinical manifestations in femoroacetabular impingement

IntroductionThe radiological study of the sagittal alignment of the spine in static and dynamic positions has allowed a better understanding of the clinical results of total hip prostheses. According to the Roussouly classification, the sacral slope in a standing position characterizes the patient with a stiff spine (less than 35̊) or a flexible spine (greater than 35̊). The objectives of this study were to compare, in a population of patients operated on for femoroacetabular impingement (FAI), firstly, the kinematics of the lumbar-pelvic-femoral complex and secondly, the clinical presentation depending on whether the spine is stiff or flexible. HypothesisPatients with stiff spines (SS<35̊) were “hip users” and had less ability to compensate for their hip pathology. Material and methodThis prospective and comparative multicenter study was conducted with patients operated on arthroscopically for FAI between 2020 and 2021. All patients included received preoperative EOS imaging of the lower limbs and spine, in standing and seated positions. The following parameters were measured: pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and sacral slope (SS), as well as dynamic parameters (intrinsic mobility of the hip: delta standing/sitting femoral sacral angle, and of the pelvis: delta standing/sitting sacral slope). The functional result was evaluated at 1 year. ResultsIn the stiff spine group, 62 patients were included versus 138 in the flexible spine group. The mean follow-up was 15.1±3.3 months (9.2–24.3). Nineteen patients were lost to follow-up and there were 2 revisions for iterative arthroscopy. Intrinsic pelvic mobility and intrinsic hip mobility were 16̊±13.5 (−12; 44) and 44.5̊±28.5 (−9; 99) respectively in the stiff spine group. In the flexible spine group, these same measurements were 22̊±11.5 (−30; 45) and 29.7̊±22.7 (−33; 82) respectively. In the stiff spine group, the symptoms occurred at a significantly younger age: 28.3 years±9.5 (18–51) versus 31 years±8 (18–54) (p=0.017). DiscussionThe sacral slope is a determining factor in the kinematics of impingement and the appearance of symptoms. The sacral slope helps define the concept of a “hip user” in symptomatic FAI. Level of evidenceIV.

Force plate testing is correlated with jumping performance in elite Nordic skiers

IntroductionSki jumping (SJ) and Nordic combined (NC) athletes are at higher risk for femoroacetabular impingement (FAI) compared to the general population. ObjectivesThe purpose of this study was to determine the relationship between force plate testing metrics, Functional Movement Screen (FMS) scores, and radiographic signs of FAI and SJ performance. MethodsElite SJ and NC athletes were prospectively recruited. FMS testing was performed to assess muscular imbalance, instability, and immobility. Vertical jump testing was performed using a commercially available force plate device. Ski jump score and distance score were measured on a single jump for each athlete. ResultsTwenty-one athletes (10 SJ, 11 NC) with competition scores were included. On FMS testing, most SJ (67%) and NC (73%) athletes demonstrated core instability. There were higher rates of hip instability and ankle stiffness among SJ athletes, although not statistically significant (P > .05). Ski jump distance score was significantly positively correlated with force plate vertical jump height, maximum acceleration, maximum velocity, concentric impulse, counter-movement depth, and flight time (P < .05). FMS testing results and radiographic FAI were not significantly associated with competition scores. ConclusionsOur results show significant positive correlations between competition scores and force plate jump testing performance as measured by jump height, acceleration, maximum velocity, counter-movement depth, and concentric impulse in elite SJ and NC athletes. Our findings suggest that ski jumpers may benefit from training that emphasizes stretch-shortening cycles and eccentric-to-concentric contraction transition, which may optimize their performance and promote joint stability.

Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años

PurposeTo determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. MethodsRetrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. ResultsSeventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). ConclusionCumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification.

Hip arthroscopy (HA) has become the treatment of choice for femoroacetabular impingement (FAI). However, less favourable outcomes following arthroscopic surgery are expected in patients with severe chondral lesions. The aim of this study was to assess the outcomes of HA in patients with FAI and associated chondral lesions, classified according to the Outerbridge system. A systematic search was performed on four databases. Studies which involved HA as the primary management of FAI and reported on chondral lesions as classified according to the Outerbridge classification were included. The study was registered on PROSPERO. Demographic data, patient-reported outcome measures (PROMs), complications, and rates of conversion to total hip arthroplasty (THA) were collected. A total of 24 studies were included with a total of 3,198 patients (3,233 hips). Patients had significantly less improvement in PROMs if they had Outerbridge grade III and IV lesions (p = 0.012). Compared with microfracture, autologous matrix-induced chondrogenesis (AMIC) resulted in significantly reduced rates of conversion to THA (p = 0.042) and of revision arthroscopy (p = 0.038). Chondral repair procedures in these patients also did not significantly reduce the rates of conversion to THA (p = 0.931), or of revision arthroscopy (p = 0.218). However, compared with microfracture, AMIC significantly reduced the rates of conversion to THA (p = 0.001) and of revision arthroscopy (p = 0.011) in these patients. Those with Outerbridge grade III and IV lesions also had significantly increased rates of conversion to THA (p = 0.029) and of revision arthroscopy (p = 0.023) if they had associated lesions of the acetabulum and femoral head. Those who underwent labral debridement had a significantly increased rate of conversion to THA compared with those who underwent labral repair (p = 0.015). There is universal improvement in PROMs following HA in patients with FAI and associated chondral lesions. However, those with Outerbridge grade III and IV lesions had significantly less improvement in PROMs and a significantly increased rate of conversion to THA than those with Outerbridge grade I and II. This suggests that the outcome of HA in patients with FAI and severe articular cartilage damage may not be favourable.

Paper 12: Severity of Chondrolabral Junction Degeneration Predicts Conversion to Total Hip Arthroplasty after Arthroscopic Femoroacetabular Impingement Treatment at Minimum 10-Years Follow-Up

Objectives: To identify location and severity of intraoperative pathology at time of arthroscopic surgery for femoroacetabular impingement (FAI) as risk factors for conversion to total hip arthroplasty (THA) utilizing long-term follow-up (minimum 10 years). Methods: Retrospective study of prospectively collected data of adult patients (≥ 18 years) who underwent hip arthroscopy for FAI between 1998 and 2011 with minimum follow-up of 10 years. Location and severity of pathology at time of arthroscopic surgery were assessed as risk factors for later conversion to a primary outcome of THA. Patients with radiographic evidence of hip dysplasia and previous history of hip surgery were excluded. Patients were then grouped according to whether they had underwent THA. Differences in continuous variables including age, BMI, and center edge angle (CEA) were analyzed with independent t tests. Differences in categorical variables including type of treatment (debridement or repair), deformity (CAM vs pincer vs combined), Outerbridge grade, location of most severe chondral wear (anterosuperior acetabulum, posterosuperior acetabulum, femoral head), presence of chondral flap, and degree of chondrolabral degeneration (as measured by Beck classification) were analyzed with the Pearson’s Chi-squared test. For variables with greater than two levels (chondrolabral degeneration, etc.) adjusted residuals were calculated to determine which comparisons were statistically different, with a value of &gt;2 indicating a lack of fit with the null hypothesis of difference. A multivariable logistic regression model was constructed to estimate the influence of the exact location and severity of pathology on risk for conversion to THA. Model results are reported as odds ratios (OR) with corresponding 95% confidence intervals. Results: A total of 109 patients with a mean age of 39.41 ± 11.43 years and minimum follow-up of 10 years were eligible for inclusion in this study. The average follow-up was 12.29 ± 2.53 years. Average body mass index (BMI) was 26.19 ± 4.07 while average center edge angle (CEA) was 39.53 ± 7.24. 67 (61.5%) patients underwent debridement while 42 (38.5%) patients underwent labral repair. 32 (29.4%) patients subsequently converted to THA. BMI (1.7% difference, p = 0.072), CEA (0.3% difference, p = 0.832), sex (0.2% difference, p = 0.991), procedure type (11.8% difference, p = 0.565), and presence of a chondral flap (6.3% difference, p = 0.685) were not significantly associated with conversion to THA. FAI type, Outerbridge grade, chondrolabral junction degeneration, and location of most severe degenerative change were statistically significant, with adjusted residuals greater than 2 (Table 1). A multivariable logistic regression model demonstrated age (OR=1.08, 95% CI 1.03-1.14, p = 0.002), Grade 4 chondrolabral degeneration (OR = 3.26, 95% CI 1.16-9.17, p = 0.025) and combined FAI type (OR = 4.32, 95% CI 1.38 – 13.56, p = 0.012) as significant risk factors for conversion to THA. Conclusions: Grade 4 degeneration of the chondrolabral junction as well as combined FAI type and older age are significant risk factors for conversion to THA after arthroscopic treatment of FAI at minimum 10-years of follow-up. [Table: see text][Table: see text]

Paper 63: Return to Long Distance Running After Hip Arthroscopy for Femoroacetabular Impingement

Objectives: Arthroscopic hip surgery for femoroacetabular impingement (FAI) has shown high rates of return to different sports in athletes. No studies to date have focused on patients’ return to long- distance running, a running sport with unique characteristics and demands. The purpose of this study was to determine return to long-distance running rates and changes in running performance in long distance runners undergoing hip arthroscopic surgery for the treatment of FAI and to identify possible risk factors associated with not returning to long distance running. Methods: An institutional hip preservation registry was retrospectively reviewed for patients identified as long distance runners (half marathons and marathons) who underwent primary hip arthroscopies for FAI performed between March 2010 and January 2017. Patient demographics and injury characteristics as well as clinical and radiographic findings were recorded. All patients were contacted for return to running information using a running specific return to sport questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to long-distance running. Results: Sixty-eight long distance runners (78 hips) were included. Mean patient age and body mass index (BMI) were 37.8±8.9 years and 23.8±3.3 kg/m2, respectively. Thirty-eight (56%) were female runners. Mean weekly running milage prior to injury was 34.5±16.9 miles. Mean duration of hip symptoms prior to seeking medical evaluation was 77.3±16.9 weeks. Fifty-nine runners (87%) had to stop or modify their running for a mean duration of 44.3±45 weeks prior to surgery due to hip symptoms. Overall, 50 runners (74%) returned to any running, of which 25 runners (50%) returned to long distance running completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of re-injury (22%) and additional different injuries (22%). Among runners who did not return to any running, 12 (67%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female runners (odds ratio [OR]=0.2; confidence interval [CI]=0.0 to 0.9; p=0.034) and hips with radiologic findings of higher alpha angles (OR=0.9; 95% CI=0.9 to 1.0; p=0.045) were less likely to return to long distance running. Conclusions: Hip arthroscopic treatment for FAI in symptomatic long-distance runners, a distinctive subgroup of runners, allowed most of them (74%) to return to running, however only 40% returned to long distance running races. Female runners and runners with radiologic findings of higher alpha angles were less likely to return to long-distance running. These data can better guide clinicians and long- distance runners with realistic expectations related to the arthroscopic management of symptomatic FAI.

The diagnosis of femoroacetabular impingement can be made on pelvis radiographs using deep learning methods.

The aim of this study was to evaluate diagnostic ability of deep learning models, particularly convolutional neural network models used for image classification, for femoroacetabular impingement (FAI) using hip radiographs. Between January 2010 and December 2020, pelvic radiographs of a total of 516 patients (270 males, 246 females; mean age: 39.1±3.8 years; range, 20 to 78 years) with hip pain were retrospectively analyzed. Based on inclusion and exclusion criteria, a total of 888 hip radiographs (308 diagnosed with FAI and 508 considered normal) were evaluated using deep learning methods. Pre-trained VGG-16, ResNet-101, MobileNetV2, and Inceptionv3 models were used for transfer learning. As assessed by performance measures such as accuracy, sensitivity, specificity, precision, F-1 score, and area under the curve (AUC), the VGG-16 model outperformed other pre-trained networks in diagnosing FAI. With the pre-trained VGG-16 model, the results showed 86.6% accuracy, 82.5% sensitivity, 89.6% specificity, 85.5% precision, 83.9% F1 score, and 0.92 AUC. In patients with suspected FAI, pelvic radiography is the first imaging method to be applied, and deep learning methods can help in the diagnosis of this syndrome.

Timing From Symptom Onset to Hip Arthroscopy Does Not Affect Patient-Reported Outcome Measures for the Treatment of Femoroacetabular Impingement in Adolescent Patients

To evaluate symptom duration and its relationship to patient-reported outcomes (PROs) and survivorship after hip arthroscopy in adolescents. Patients ≤18 at time of primary hip arthroscopy for femoroacetabular impingement (FAI) between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year PROs (modified Harris Hip Score, Hip Outcome Score [HOS]-Activities of Daily Living, HOS-Sport Scale, Short Forms 12 [SF-12]), minimum clinically significant difference (MCID) and patient-acceptable symptom state (PASS) rates, and revision surgery rates were compared based on symptom duration. Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with a mean age of 16.4 ± 1.1 (range 13.0-18.0). The mean symptom duration was 17.2 ± 15.2 months (range 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3 ± 1.0 years (range 0.9-4.3 years). At a mean follow-up of 4.8 ± 2.2 years (range 2-10 years), there were statistically significant improvements in all PROs (P < .05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range-0.162 to-0.078, P > .05 for all). Symptom duration ≤12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% confidence interval crosses 1 for all). In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in PRO measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable. Level IV, case series.

Ultrasound Assessment of Hip Subspine Bone Morphology Soft-tissue Correlates with Clinical Diagnosis of Impingement

To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI. We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and computed tomography (CT) examination within 1 month before surgery. All of the FAI patients were divided into the SSI group and non-SSI group, according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used. A total of 71 hips were included, with a mean age of 35.4 ± 10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of the dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC= 0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC= 0.831 and PPV= 85.7%. Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT. Level IV, case series.

Patient-Reported Outcomes and Survivorship Are Not Different for Primary Hip Arthroscopy Patients of Age 50 Years and Older Compared With a 20- to 35-Year-Old Matched Cohort at Minimum 5-Year Follow-Up

To assess clinical outcomes among patients aged 50 years or older after primary hip arthroscopy for femoroacetabular impingement (FAI) with or without labral tears compared with a matched control group of younger patients aged 20 to 35 years old at minimum 5-year follow-up. We conducted a retrospective comparative prognostic study using a prospectively collected database of patients who underwent hip arthroscopy with minimum 5-year follow-up. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 5-year follow-up. Patients aged ≥50 years were propensity score matched on sex, body mass index, and preoperative mHHS to controls aged 20 to 35 years. Pre- to postoperative changes in mHHS and NAHS were compared between groups using the Mann-Whitney U test. Hip survivorship rates and minimum clinically important difference achievement rates were compared between groups using the Fisher exact test. P values <.05 were considered statistically significant. In total, 35 older patients (mean age 58.3 years) were matched to 35 younger controls (mean age 29.2 years). Both groups were mostly female (65.7%) and had equal mean body mass index (26.0). Acetabular chondral lesions of Outerbridge grades III-IV were more prevalent in the older group (older 28.6% vs younger 0%, P < .001). Five-year reoperation rates were not significantly different between the groups (older 8.6% vs younger 2.9%, P= .61). There were no significant intergroup differences in 5-year improvement in mHHS (older 32.7 vs younger 30.6, P= .46) or NAHS (older 34.4 vs younger 37.9, P= .70) or in 5-year minimum clinically important difference achievement rates for the mHHS (older 93.6% vs younger 93.6%, P= 1.00) or NAHS (older 87.1% vs younger 96.8%, P= .35). There are no significant differences in reoperation rates and patient-reported outcomes between patients aged ≥50 years versus matched controls aged 20 to 35 years after primary hip arthroscopy for FAI. LevelIII, retrospective comparative prognostic study.

Proximal Anterolateral Accessory Portal Use Improves Peripheral Compartment Access and Capsular Management with T-Capsulotomy

One of the primary goals of hip arthroscopy for femoroacetabular impingement (FAI) syndrome is precise removal of pathologic FAI morphology while protecting and restoring the normal soft tissue anatomy. Adequate visualization is a key foundation of precise removal of FAI morphology and varying types of capsulotomies are frequently used to achieve necessary exposure. Anatomic and outcomes studies have influenced an increasing appreciation for repairing these capsulotomies. Thus one of the central technical challenges of hip arthroscopy is achieving both goals of capsule preservation and adequate visualization. Various techniques have been described, including suture-based capsule suspension, portal placement, and T-capsulotomy. The following technique describes how the proximal anterolateral accessory portal can be added to a capsule suspension and T-capsulotomy technique to improve visualization and facilitate repair.

Combined 3-Dimensional CT and Multidirectional CT Arthrography for Femoroacetabular Impingement and Hip Lesions: A Cross-sectional Study Comparing Imaging and Hip Arthroscopic Surgery Findings.

There is limited research investigating the diagnostic strength of 3-dimensional computed tomography (3D-CT) and multidirectional CT arthrography (CTA) for femoroacetabular impingement (FAI) and related hip lesions. To evaluate the diagnostic strength of combined 3D-CT and CTA in patients with FAI and related hip lesions by comparing it with hip arthroscopic surgery findings. Cohort study (diagnosis); Level of evidence, 2. This study included patients who were suspected of having FAI and related hip lesions and who underwent a combination of 3D-CT and CTA and subsequent hip arthroscopic surgery between December 2013 and December 2017. The CT and intraoperative arthroscopic findings were recorded and compared. The sensitivity, specificity, and accuracy of 3D-CT for FAI and those of CTA for related hip lesions were calculated. A total of 114 patients with 114 hips were included in our study. There were 101 patients with positive findings and 13 patients with negative findings for FAI (including cam, pincer, and combined morphology) according to 3D-CT. The sensitivity, specificity, and accuracy of 3D-CT for FAI were 91.58%, 57.14%, and 89.47%, respectively. The sensitivity, specificity, and accuracy of CTA for labral tears were 94.64%, 100.00%, and 94.73%, respectively. For acetabular cartilage defects, the sensitivity, specificity, and accuracy of CTA were 60.71%, 91.37%, and 76.31%, respectively. For femoral cartilage defects, the sensitivity, specificity, and accuracy of CTA were 82.22%, 76.81%, and 78.94%, respectively. The study results indicated that 3D-CT was able to provide excellent accuracy for FAI compared with hip arthroscopic surgery findings. In addition, multidirectional CTA demonstrated promising diagnostic strength for hip lesions such as labral tears and chondral defects.