Management Of Femoroacetabular Impingement Research Articles

EFFICACY OF PERICAPSULAR NERVE GROUP BLOCK AS A MODALITY FOR POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT

The postoperative pain after hip arthroscopy remains a major challenge in the immediate postoperative period. Adequate postoperative analgesia has been associated with increased patient satisfaction and decreased consumption of opioids. We evaluated the efficacy of pericapsular nerve group block (PENG) versus fascia iliaca block (FIB) in reducing post-operative pain and analgesic consumption within the first 24 hours following arthroscopic management of femoroacetabular impingement (FAI).Thirty-nine patients (17 females and 25 males, ages 18–42 years, mean ± SD (27.9 ± 6.2), and mean BMI of 25.13±5.08 kg/m2 were scheduled for primary arthroscopic management of FAI. Included patients were randomized into two groups according to the block used in each. Group (A) 19 patients were included and had FIB and group (B) 20 patients were included and received PENG block. The efficacy of both techniques was clinically and statistically valuated using VAS score and quadriceps muscle power.There was a statically significance difference in the mean at rest between the two groups at all measured time points following surgery (6, 12, 18 and 24 h). Also, in dynamic pain scores (with hip flexion) scores were statistically significant at 24 hours post-operative (P = .001). Total opioid consumption in the first 24 hours postoperative was lower in the PENG group with significant difference of mean 16.5 ±9.9 mg for PENG group versus 27.5±9.6 mg for FIB group (P < .005). Five patients (26.31%) in FIB group had weaker quadriceps muscle power while none in PENG group patients had quadriceps weakness.PENG block might be considered as an ideal regional anesthesia modality for hip arthroscopy. As an alternative to more conventional regional nerve blocks such as a fascia iliaca block. PENG block is easily performed in the preoperative setting, and appears to spare motor function while providing a prolonged sensory pain relief.

Risk factors for conversion to arthroplasty after hip arthroscopy for femoroacetabular impingement

Background: Hip arthroscopy is a surgical procedure that is increasingly used worldwide, mostly in the management of femoroacetabular impingement (FAI). The purpose of this study is to evaluate risk factors for conversion of hip arthroscopy to THA within 3 years after the procedure. Methods: Hip arthroscopies for FAI performed at our institution between 2013 and 2019 were reviewed. Inclusion criteria included a minimum 3-year follow-up or a conversion to THA within 3 years. Patient characteristics and radiographic evaluation was made for each patient. This collected data were compared in the two groups Total hip arthroplasty vs non total hip arthroplasty (THA vs non-THA). Results: A total of 136 patients met the inclusion criteria (69 men, 67 women, mean age 38,21 years). During the follow-up period, 22 underwent a THA in less than 3 years after the procedure (16.2%). A statistically significant association was found between conversion to THA and the Tönnis grade (p<0.05), Kellgren-Lawrence grade (p<0.05) and the joint space (p<0.05). It was also found that the patient's age, body mass index (BMI), race and sex did not add independent predictive information. Conclusions: Our analysis demonstrates a strong and significant association between the radiographic evaluation of osteoarthritis (Tönnis grade, Kellgren-Lawrence grade and joint space narrowing) and the risk of early conversion to THA. Other patient characteristics, like patient's age, BMI, race and sex, doesn´t seem to increase the risk.

Comparison of Gait and Functional Outcomes Between Open and Arthroscopic Treatment of Adolescent and Young Adult Femoroacetabular Impingement.

Management of femoroacetabular impingement (FAI) through an arthroscopic or surgical hip dislocation (SHD) approach has been shown to have similar clinical success and patient-reported outcomes. However, there are limited data comparing functional outcomes. The purpose of this study was to compare gait and functional outcomes of adolescent/young adult patients with FAI treated by either an arthroscopic or open SHD approach. We identified prospectively enrolled adolescent/young adult patients (≤20 years old) who underwent surgical treatment for FAI through an SHD or arthroscopic approach. Participants were evaluated in a movement science lab preoperatively and postoperatively (minimum 8 months postoperatively) with barefoot walking and a 30-second single-limb balance trial on the affected side. Participants also completed the Harris Hip Score at the same timepoints. Differences from preoperative to postoperative were determined using a paired-samples t test for each surgical technique, and differences between the SHD and arthroscopic groups were determined using an independent samples t test (α=0.05). Fifty-five participants (42F, 16.2±1.4y) were tested and grouped by surgical intervention. The SHD and arthroscopy groups consisted of 28 and 27 participants, respectively, with no significant difference between the SHD and arthroscopic cohorts in age (16.4±1.2 vs. 15.9±1.5y, respectively, P=0.218) or sex distribution (78.6% vs. 74.1% females, respectively, P=0.75). Each group demonstrated significant postoperative improvement in Harris Hip Score (SHD: 64.8±16.4 to 81.8±17.8; arthroscopy: 57.0±16.7 to 84.7±19.7; preoperatively to postoperatively, respectively, both P<0.001). During gait, increased maximum hip flexion was observed following surgical intervention for the SHD group (32.3±5.7 vs. 36.1±5.2, P=0.003). No other clinically significant changes were detected in the SHD or arthroscopic groups preoperatively to postoperatively in trunk, pelvis, or hip kinematics in the coronal plane. During the balance task, neither cohort demonstrated markers of clinically significant abductor dysfunction. However, post operatively, the arthroscopy group was able to balance longer than the SHD group (18.8±7.8 vs. 14.2±2.7s, respectively, P=0.008), although no differences were detected in trunk or pelvis position in the coronal plane during balance. Both open SHD and arthroscopic treatment of FAI resulted in improved clinical outcomes with no clinically significant abductor dysfunction 1 year post operatively. However, further study is needed to determine whether more dynamic tasks can potentially elicit subtle differences between the groups. Level II-prospective study.

Did COVID-19 restrictions affect post-operative rehabilitation of patients who underwent arthroscopic management of femoroacetabular impingement?

Objectives: This study aimed to evaluate the impact of a home-based exercise rehabilitation protocol for post-arthroscopy femoroacetabular impingement (FAI) patients compared to the routine physiotherapy protocol and investigate the effect of COVID-19 restrictions on patient rehabilitation and clinical outcomes. Methods: The study used a prospective cohort with a matched-pair comparison research design. The study group included 26 patients who underwent arthroscopic management of FAI through osteochondroplasty and suture anchor repair from July 2020 to June 2022. Thirty patients from the existing database who underwent arthroscopic management of FAI from June 2018 to June 2020 were included as a control group. Patient demographic and baseline data, the modified Harris Hip Score and the international Hip Outcome Tool-12 (iHOT-12) Score, the surgical satisfaction questionnaire, and the COVID-19 rehabilitation questionnaire were investigated for both groups. Patients in the study group received home-based exercise booklets. Results: The iHOT-12 score was significantly improved in the study group compared to the control group at 6 and 12 months (72 ± 22.33, 80.85 ± 13.46 vs. 58.03 ± 23.89, 62.1 ± 19.52, P = 0.029, P &lt; 0. 001, respectively). Conclusion: Home-based exercise protocols successfully managed to achieve better outcomes in the study group assessed through the iHOT-12 Score at 1 year postoperatively. However, patients’ satisfaction was lower in the study group than in the control group.

Paper 66: Short-Term Outcomes in Hip Arthroscopy Patients Participating in Formal Physical Therapy vs a Home Exercise Program: A Prospectively Enrolled Cohort Analysis

Objectives: The treatment of femoroacetabular impingement (FAI) has evolved over the last two decades, transitioning from an open hip dislocation to a more minimally invasive arthroscopic approach as the gold standard for treatment. The non-surgical management of FAI has evolved as well, and a key mainstay of the treatment paradigm for FAI has become physical therapy, both in the preoperative and postoperative periods. Previous research has demonstrated the importance of physical therapy in reducing pain and improving function in patients with FAI. As FAI treatment has changed, the delivery of patient physical therapy and rehabilitation has similarly changed, specifically with the introduction of home exercise programs that are patient-driven methods of postoperative rehabilitation. While other areas of orthopaedic surgery, such as shoulder and knee arthroplasty, have demonstrated similar results when comparing formal physical therapy programs with home-based programs, a comparable study has yet to be conducted specifically in the hip arthroscopy patient population. Given this lack of investigation, the purpose of this study was to compare the short-term outcomes of a formal physical therapy program or a home exercise program (HEP) in FAI patients treated with hip arthroscopy. Our hypothesis was that individuals in both groups would report similar outcomes at short- term follow up and would be significantly improved from their preoperative baselines. Methods: Patients undergoing hip arthroscopy for the treatment of FAI at a single center from October 2020 to October 2021 were prospectively enrolled. Inclusion criteria were 1) completion of a preoperative survey, 2) age greater than 18 years at time of surgery, and 3) lack of previous hip surgery. Patients were allowed to self-select to a formal physical therapy (FPT) program, which consisted of a traditional physical therapy course, or a home exercise program (HEP). Patients were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. Included in the survey was a single assessment numeric evaluation (SANE), visual analogue scale (VAS) pain scores, the International Hip Outcome Tool-12 (iHOT-12), the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), and patient satisfaction of physical therapy and their overall care. Demographic characteristics were collected from the electronic medical record. Statistical analysis was conducted using descriptive statistics, unpaired and paired t-tests, and Chi Square and Fisher’s Exact tests for categorical variable comparisons. A p-value of &lt; 0.05 was used to indicate statistical significance. Results: A total of 147 patients were included in this study, with 61 in the FPT group and 86 in the HEP group. There were no significant differences regarding patient sex (p = 0.675) and body mass index (p = 0.188), though the HEP group was slightly older than the FPT group (33.6 ± 9.5 years vs 30.1 ± 11.4 years; p = 0.048). At 12 months postoperative, no significant differences were reported between the FPT and HEP groups regarding hip function rated as a percent of normal (p = 0.576), VAS pain scores at rest (p = 0.262) or during activities of daily living (p = 0.214) or during sport (p = 0.066), PROMIS PF scores (p = 0.426), and iHOT-12 scores (p = 0.421). Furthermore, no differences were reported in patient satisfaction (p &gt; 0.05). Outcome scores at 12 months postoperative were significantly improved from the preoperative baseline across all measures in both groups (p &gt; 0.05). Conclusions: For patients undergoing hip arthroscopy for the treatment of FAI, formal physical therapy and home exercise programs are similarly efficacious in terms of patient-reported outcomes of hip function, with both rehabilitation options resulting in significant patient improvement at short term follow-up from their preoperative baseline. [Table: see text][Table: see text]

Inflammatory and Immunologic Contributions in Femoroacetabular Impingement Syndrome.

Femoroacetabular impingement (FAI) is one of the most common causes of labral and early cartilage damage in the nondysplastic hip. FAI is increasingly recognized as a cause for hip and groin pain in the young, active patient, and the surgical treatment of FAI with hip arthroscopy has risen exponentially. Although our understanding of FAI and the progression to degenerative osteoarthritis of the hip has historically been considered a mechanical "wear-and-tear" disease of an imperfectly shaped, aspherical, femoral head within a deep or overcovering acetabulum leading to cartilage injury, our understanding of the intrinsic pathophysiologic mechanisms underlying the development of FAI and joint degeneration of the hip remains poor. For example, many patients with FAI morphology may never develop hip pain or osteoarthritis; there remains more to discover regarding the pathophysiology of arthritis in the setting of FAI. Recent work has begun to identify a strong inflammatory and immunologic component to the FAI disease process that affects the hip synovium, labrum, and cartilage and may be detectable from peripheral clinical samples (blood and urine). This review highlights our current understanding of the inflammatory and immunologic contributions to FAI and potential therapeutic strategies to supplement and augment the surgical management of FAI.

EARLY TO MID-TERM OUTCOMES OF PERIACETABULAR OSTEOTOMY FOR DEVELOPMENTAL HIP DYSPLASIA AND FEMOROACETABULAR IMPINGEMENT: A STUDY OF 1,087 CASES USING THE NAHR DATASET

Periacetabular osteotomy (PAO) is an established treatment for developmental hip dysplasia (DDH) in young adults and can also be utilised in the management of femoroacetabular impingement (FAI) with acetabular retroversion. This study used a national registry to assess the outcomes of PAO for DDH and FAI.PAOs recorded in the UK Non-Arthroplasty Hip Registry between 2012 and November 2022 were identified along with recorded patient and surgical characteristics. Cases were grouped according to the primary pathology (DDH or FAI). Patient reported outcome measures (PROMs) captured included the International Hip Outcome Tool (iHOT)-12 (primary outcome) and the EuroQol-5 Dimensions (EQ-5D) index preoperatively and at 6 months, 1, 2, and 5 years post-operatively.1,087 PAOs were identified; 995 for DDH (91%), 98 for FAI (9%). Most patients (91%) were female. The DDH group were significantly older (mean 31.7 years) than the FAI group (25.4 years) but had similar body mass index (mean 25.7kg/m2). Overall, significant (all p&lt;0.0001) iHOT-12 and EQ-5D improvement (delta) vs baseline pre-operative scores were achieved at 6 months (mean iHOT-12 improvement +27.4 (95%CI 25.3 to 29.5); n=515) and maintained out to 5 years (+30.0 (21.4 to 38.6); n=44 [9.8% of those eligible for follow-up at 5 years]), at which point 71% and 55% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (≥13 points) and substantial clinical benefit (≥28 points) for iHOT-12 respectively.This study demonstrates excellent functional outcomes following PAO undertaken for DDH and FAI in the short to medium term in a large national registry.

Pediatric Hip Arthroscopy: a Review of Indications and Treatment Outcomes.

The use of hip arthroscopy has expanded substantially over the last decade, including in pediatric and adolescent populations. Indications for hip arthroscopy in the pediatric population continue to be refined and research of outcomes following hip arthroscopy has increased. The purpose of this review is to provide an overview of current indications for hip arthroscopy in the pediatric population and the outcomes for each indication. Hip arthroscopy is used in the treatment of a range of pediatric hip conditions, spanning from the infant to young adult. In femoroacetabular impingement, hip arthroscopy in young adolescents has shown improvement in patient-reported outcome measures, high return to sport rates, and low complications. Intra-articular hip pathology secondary to Legg-Calve-Perthes and the persistent deformities following slipped capital femoral epiphysis can be managed with primary hip arthroscopy, and outcomes show significant improvements in patient-reported outcomes. Arthroscopy can be used safely as a reduction aid in developmental hip dysplasia, and as a primary treatment for borderline hip dysplasia in adolescents. In septic hip arthritis, arthroscopic drainage is a safe and effective treatment. Hip arthroscopy is used in the pediatric and adolescent population in the management of femoroacetabular impingement, Legg-Calve-Perthes disease, the sequelae of slipped capital femoral epiphysies, developmental hip dysplasia, and septic arthritis. Research for each of these conditions shows that arthroscopy is a safe and effective treatment when performed for the correct indications, and results are comparable to open surgical options.

HIP ARTHROSCOPY FOR THE PRIMARY MANAGEMENT OF FEMOROACETABULAR IMPINGEMENT WITH CONCOMITANT CHONDRAL LESIONS ACCORDING TO THE OUTERBRIDGE CLASSIFICATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Arthroscopic management of femoroacetabular impingement (FAI) has become the mainstay of treatment. However, chondral lesions are frequently encountered and have become a determinant of less favourable outcomes following arthroscopic intervention.The aim of this systematic review and meta-analysis was to assess the outcomes of hip arthroscopy (HA) in patients with FAI and concomitant chondral lesions classified as per Outerbridge.A systematic search was performed using the PRISMA guidelines on four databases including MEDLINE, EMBASE, Cochrane Library and Web of Science. Studies which included HA as the primary intervention for management of FAI and classified chondral lesions according to the Outerbridge classification were included. Patients treated with open procedures, for osteonecrosis, Legg-Calve-Perthes disease, and previous ipsilateral hip fractures were excluded. From a total of 863 articles, twenty-four were included for final analysis. Demographic data, PROMs, and radiological outcomes and rates of conversion to total hip arthroplasty (THA) were collected. Risk of bias was assessed using ROBINS-I.Improved post-operative PROMs included mHHS (mean difference:-2.42; 95%CI:-2.99 to −1.85; p&lt;0.001), NAHS (mean difference:-1.73; 95%CI: −2.23 to −1.23; p&lt;0.001), VAS (mean difference: 2.03; 95%CI: 0.93-3.13; p&lt;0.001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%).Patients had worse PROMs if they underwent HA with labral debridement (p=0.015), had Outerbridge 3 and 4 lesions (p=0.012), concomitant lesions of the femoral head and acetabulum lesions (p=0.029). Reconstructive cartilage techniques were superior to microfracture (p=0.042). Even in concomitant lesions of the femoral head and acetabulum, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.027).Acceptable post-operative outcomes following HA with labral repair/reconstruction and cartilage repair in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved. Patients suffering from Outerbridge 3 and 4 lesions, concomitant acetabular rim and femoral head chondral lesions that underwent HA with labral debridement, had worse PROMs. Reconstructive cartilage techniques were superior to microfracture. Even in concomitant acetabular and femoral head chondral lesions, employing either microfracture or cartilage repair/reconstruction was deemed to provide a benefit in PROMs.

The Management of Femoroacetabular Impingement

Management of the Femoroacetabular Impingement (FAI) starts with good diagnosis. What one must remember that the natural course of FAI is the precursor to hip osteoarthritis. An excellent history taking and physical examination is mandatory to exclude many differential diagnosis surrounding the hip. A layered approach could be used. 90 degrees of flexion and internal rotation (FADIR) is specific for hip problem, although doesn’t mean the main culprit is always FAI. Radiology study is very important, several hip projection Xray that can be chosen and specific measurement like Alpha angle, Cam or Pincer or mixed deformity, and so on. Additional imaging with CT or MR Arthrography is also important. With confirmed FAI, controversies exist whether to proceed conservatively or surgery, with nuance of the evidence depends on the background of the writer. Nowadays, surgery for FAI already pushed toward full arthroscopic, while surgical hip dislocation remains a powerful arsenal. Rehabilitation after surgery is utmost importance, and it took time for the results to show it benefits, therefore, a good communication with patient and the whole team of care is advisable.

Open and arthroscopic management of femoroacetabular impingement: a review of current concepts.

Femoroacetabular impingement (FAI) is a common femoral and/or acetabular abnormality that can cause progressive damage to the hip and osteoarthritis. FAI can be the result of femoral head/neck overgrowth, acetabular overgrowth or both femoral and acetabular abnormalities, resulting in a loss of native hip biomechanics and pain upon hip flexion and rotation. Radiographic evidence can include loss of sphericity of the femoral neck (cam impingement) and/or acetabular retroversion with focal or global overcoverage (pincer impingement). Operative intervention is indicated in symptomatic patients after failed conservative management with radiographic evidence of impingement and minimal arthritic changes of the hip, with the goal of restoring normal hip biomechanics and reducing pain. This is done by correcting the femoral head-neck relationship to the acetabulum through femoral and/or acetabular osteoplasty and treatment of concomitant hip pathology. In pincer impingement cases with small lunate surfaces, reverse periacetabular osteotomy is indicated as acetabular osteoplasty can decrease an already small articular surface. While surgical dislocation is regarded as the traditional gold standard, hip arthroscopy has become widely utilized in recent years. Studies comparing both open surgery and arthroscopy have shown comparable long-term pain reduction and improvements in clinical measures of hip function, as well as similar conversion rates to total hip arthroplasty. However, arthroscopy has trended toward earlier improvement, quicker recovery and faster return to sports. The purpose of this study was to review the recent literature on open and arthroscopic management of FAI.

Automated 3D Analysis of Clinical Magnetic Resonance Images Demonstrates Significant Reductions in Cam Morphology Following Arthroscopic Intervention in Contrast to Physiotherapy

PurposeTo obtain automated measurements of cam volume, surface area, and height from baseline (preintervention) and 12-month magnetic resonance (MR) images acquired from male and female patients allocated to physiotherapy (PT) or arthroscopic surgery (AS) management for femoroacetabular impingement (FAI) in the Australian FASHIoN trial.MethodsAn automated segmentation pipeline (CamMorph) was used to obtain cam morphology data from three-dimensional (3D) MR hip examinations in FAI patients classified with mild, moderate, or major cam volumes. Pairwise comparisons between baseline and 12-month cam volume, surface area, and height data were performed within the PT and AS patient groups using paired t-tests or Wilcoxon signed-rank tests.ResultsA total of 43 patients were included with 15 PT patients (9 males, 6 females) and 28 AS patients (18 males, 10 females) for premanagement and postmanagement cam morphology assessments. Within the PT male and female patient groups, there were no significant differences between baseline and 12-month mean cam volume (male: 1269 vs 1288 mm3, t[16] = −0.39; female: 545 vs 550 mm,3t[10] = −0.78), surface area (male: 1525 vs 1491 mm2, t[16] = 0.92; female: 885 vs 925 mm,2t[10] = −0.78), maximum height (male: 4.36 vs 4.32 mm, t[16] = 0.34; female: 3.05 vs 2.96 mm, t[10] = 1.05) and average height (male: 2.18 vs 2.18 mm, t[16] = 0.22; female: 1.4 vs 1.43 mm, t[10] = −0.38). In contrast, within the AS male and female patient groups, there were significant differences between baseline and 12-month cam volume (male: 1343 vs 718 mm3, W = 0.0; female: 499 vs 240 mm3, t[18] = 2.89), surface area (male: 1520 vs 1031 mm2, t(34) = 6.48; female: 782 vs 483 mm2, t(18) = 3.02), maximum-height (male: 4.3 vs 3.42 mm, W = 13.5; female: 2.85 vs 2.24 mm, t(18) = 3.04) and average height (male: 2.17 vs 1.52 mm, W = 3.0; female: 1.4 vs 0.94 mm, W = 3.0). In AS patients, 3D bone models provided good visualization of cam bone mass removal postostectomy.ConclusionsAutomated measurement of cam morphology from baseline (preintervention) and 12-month MR images demonstrated that the cam volume, surface area, maximum-height, and average height were significantly smaller in AS patients following ostectomy, whereas there were no significant differences in these cam measures in PT patients from the Australian FASHIoN study.Level of EvidenceLevel II, cohort study.

Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement.

There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J2022;104-B(5):532-540.

Incidence of Symptomatic Femoroacetabular Impingement: A 4-Year Study at a National Collegiate Athletic Association Division I Institution.

Background:Femoroacetabular impingement (FAI) is an increasingly recognized cause of hip pain in young athletes. Although there are multiple studies that describe the radiographic prevalence of FAI in athletes, its true incidence within this population is unknown.Purpose:To report on the overall and sport-specific incidence of symptomatic FAI in National Collegiate Athletic Association (NCAA) Division I athletes. Return-to-sport times were reported for patients treated operatively.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted to identify all reported hip injuries within a large, multisport NCAA Division I institution. Hip injuries were stratified into FAI, general pain/dysfunction, musculotendinous, ligament, bursitis, bone stress, contusion, and other. FAI was diagnosed based on history, physical examinations, imaging, and symptomatic relief after a diagnostic injection. Descriptive statistics were used to calculate the overall and sport-specific incidence, and chi-square analysis was performed to identify contingency data.Results:In a 3-year period, a total of 5319 musculoskeletal injuries occurred in 1072 athletes. There were 491 (9.2%) hip injuries that occurred in 288 athletes, of which 40 injuries were FAI. The overall incidence of symptomatic FAI was 3.0% of the total population, 3.7% of all injured athletes, and 13.9% of athletic hip injuries. There were no statistically significant differences in FAI rates among male and female athletes overall or among male and female athletes within similar sports. Of the 19 athletes who were treated nonoperatively, 2 failed to return to play: 1 secondary to multiple musculoskeletal injuries and 1 related to cardiac issues. There were 21 hips in 20 patients that were treated operatively, with 1 athlete failing to return to sport. Return to play occurred at a mean of 202 days (range, 81-360 days) after hip arthroscopic surgery.Conclusion:In this large, multisport NCAA Division I cohort, the overall incidence of symptomatic FAI was 3.0% and represented 13.9% of hip injuries. The successful management of FAI with return to play was achieved by both nonoperative and operative treatment methods. The relatively low incidence of symptomatic FAI, despite reports of a high prevalence of FAI morphology in athletes, serves to emphasize the importance of clinical evaluations in treating patients with FAI.

Outcomes After Management of Subspine and Femoroacetabular Impingement Using a Direct Anterior Mini-Open Approach.

Background:Subspine impingement (SSI) has been commonly managed with arthroscopic decompression. However, arthroscopic decompression is a demanding technique, as under- or over-resection of the anterior inferior iliac spine (AIIS) could lead to inferior outcomes. An anterior mini-open approach has also been used in the management of femoroacetabular impingement (FAI), and it could provide adequate visualization of the anterior hip joint without a long learning curve.Purpose/Hypothesis:The objective of the current study was to compare the outcomes of SSI patients with FAI who underwent arthroscopic subspine decompression and osteoplasty with a group undergoing subspine decompression and osteoplasty using a modified direct anterior mini-open approach. It was hypothesized that there would be no significant difference in outcomes between the groups.Study Design:Cohort study; Level of evidence, 3.Methods:We reviewed the records of SSI patients who underwent decompression surgery (arthroscopic or mini-open) at our institution from June 1, 2015 to December 31, 2016. Both groups underwent the same postoperative rehabilitation protocol. Preoperative and 2-year postoperative patient-reported outcomes were compared using the modified Harris Hip Score (mHHS), International Hip Outcome Tool–33 (iHOT–33), and Hip Outcome Score—Activities of Daily Living (HOS–ADL). Major and minor complications as well as reoperation rates were recorded.Results:Included were 47 patients (49 hips) who underwent subspine decompression using an anterior mini-open approach and 35 patients (35 hips) who underwent arthroscopic subspine decompression. There were no differences in demographic and radiological parameters between the groups, and patients in both groups showed significant improvement in all outcome scores at follow-up. The pre- to postoperative improvement in outcome scores was also similar between groups (mini-open vs arthroscopy: mHHS, 26.30 vs 27.04 [P = .783]; iHOT–33, 35.76 vs 31.77 [P = .064]; HOS–ADL, 26.09 vs 22.77 [P = .146]). In the mini-open group, 10 of the 47 patients had temporary meralgia paresthetica, and fat liquefaction was found in 1 female patient. There were no reoperations in the mini-open group.Conclusion:Subspine decompression using the anterior mini-open approach had similar outcomes to arthroscopic decompression in the management of SSI. The lateral femoral cutaneous nerve should be protected carefully during use of the anterior mini-open approach.

Arthroscopic Management of Femoroacetabular Impingement in Adolescents: A Systematic Review

Background: Femoroacetabular impingement (FAI) is highly prevalent in adolescent athletes. There has been an increasing trend for arthroscopic surgery for FAI, and the results of several clinical studies on outcome after arthroscopic surgery for FAI are available. Purpose: To conduct a systematic review to investigate the role of arthroscopic management for FAI in adolescents. Study Design: Systematic review. Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In August 2020, PubMed, Scopus, Google Scholar, and EMBASE were accessed. All clinical trials concerning the arthroscopic treatment for adolescents with FAI were identified. Only studies on patients aged less than 18 years at the time of surgery reporting data over a minimum follow-up of 12 months were considered. Results: Data from 406 adolescents (470 procedures; mean age at surgery, 15.9 years; mean follow-up, 30.4 months) with FAI were retrieved. At a mean of 28.0 months of follow-up, 94% of the adolescents had already returned to sport. All the scores of interest were improved at the final follow-up: visual analog scale (P = .01), modified Harris Hip Score (P < .0001), Non-Arthritic Hip Score (P = .03), Hip Outcome Score–Activities of Daily Living (P = .01), Hip Outcome Score–Sport-Specific Subscale (P < .0001), and Tegner score (P < .0001). Complications occurred in 1.1% (5/470) of procedures, and revision arthroscopy was performed in 4.7% (22/470) of procedures. Conclusion: Arthroscopic surgery in adolescents with FAI achieves excellent outcomes and a high rate of return to sport, with rates of complication and revision surgery of 1% and 5%, respectively.

Arthroscopic Treatment of Femoroacetabular Impingement: Rim Trim to Closed Capsule

Femoroacetabular impingement (FAI) has been the focus of much investigation, which has inherently led to an improvement in understanding of the pathophysiology, diagnosis, and surgical management of this condition. Over the last decade, hip arthroscopy has become the preferred form of surgical management for FAI with the advancement in arthroscopic technology. In this review, the arthroscopic surgical technique to address acetabular rim, labrum, and capsule are described. Furthermore, current evidence and recent advancements in the arthroscopic approach for FAI are evaluated.

Lower body mass index and age are predictive of improved pain and health utility scores following arthroscopic management of femoroacetabular impingement.

To identify patient factors associated with improved pain scores, functional hip scores, health-related quality of life, and re-operation rates after arthroscopic management of femoroacetabular impingement (FAI). Using the comprehensive dataset from the multinational Femoroacetabular Impingement Randomized Controlled Trial (FIRST), a total of 13 prognostic factors that were chosen a priori were identified that would be expected to predict post-surgical outcomes. The primary outcome was pain assessed using a Visual Analogue Scale (VAS) and secondary outcomes included hip function (Hip Outcome Score [HOS] and International Hip Outcome Tool [iHOT-12]), health-related quality of life (Short Form-12 [SF-12] and Euro-Qol 5 Dimensions [EQ-5D]), and re-operation rate. A multivariable linear regression was used to analyse the change questionnaire scores from baseline to 12months post-surgery including all 13 prognostic factors as independent variables. A total of 27 re-operation events were analysed at 24months using a multivariable logistic regression including only the treatment group variable. Of the 154 patients that had VAS scores completed at 12months, a lower BMI (adjusted mean difference [aMD], 4.48 for a 5-unit decrease in BMI; 95% confidence interval [CI] 0.33-8.63; p = 0.035) was significantly associated with less pain. There was a significant negative association between increasing age and 1-year EQ-5D scores (aMD, - 0.04 for every 10-year increase in age; 95% CI - 0.07 to - 0.006; p = 0.020). The degree of impingement, severity of osteoarthritis, type of procedure, and adjudicated quality of surgery were not significantly associated with improvement across all outcomes at 12months. Furthermore, there was no significant association between the treatment variable and the incidence of re-operation at 24months. This study identified that lower BMI and age are predictive of improved pain and health utility scores, respectively, following arthroscopic management of FAI at 12months post-surgery. These results may be a helpful adjunct in clinical decisions for this patient population when determining candidacy for surgical intervention. I.

Nonsurgical Versus Surgical Management of Femoroacetabular Impingement: What Does the Current Best Evidence Tell Us.

Controversy exists as to the management of femoroacetabular impingement (FAI). When nonsurgical management of symptomatic FAI fails, surgical management is generally indicated. However, many groups with a stake in patient care (particularly payors) have insisted on higher levels of evidence. Recently, there have been several Level I studies published, comparing physical therapy (PT) with hip arthroscopy in the management of symptomatic FAI. All of these studies have used outcomes tools developed and validated for patients with nonarthritic hip pain (the International Hip Outcome Tool). Most highest level evidence confirms that although patients with FAI do benefit from PT, patients who undergo surgical management for FAI with hip arthroscopy benefit more than those who undergo PT (mean difference in the International Hip Outcome Tool 6.8 [minimal clinically important difference 6.1], P = 0.0093). Future large prospective studies are needed to evaluate the effect on the outcomes when there is a delay in surgical management in symptomatic individuals, assess whether FAI surgery prevents or delays osteoarthritis, and determine the role of other advanced surgical techniques.

Historical analysis of the diagnosis and management of femoroacetabular impingement prior to the year 2000: a systematic review.

This systematic review aims to assess the diagnosis, indications and treatment of femoroacetabular impingement (FAI) prior to the year 2000 and to determine if historical concepts remain applicable today. PUBMED, MEDLINE and EMBASE were searched for literature evaluating the diagnosis/treatment of FAI prior to 2000. Cadaver/non-human, non-English and review studies were excluded. Quality assessment was performed using the Methodological Index for Non-Randomized Studies. Nine studies comprising 307 patients [315 hips; mean age of 32.6 ± 2.4 years (range, 12–58)] were included. Patients reported groin pain. Magnetic resonance arthrography (MRA; n = 76) and the anterior impingement test (AIT) (n = 88) were used to diagnose impingement. Surgical dislocation with a trochanteric flip osteotomy (n = 237) and Bernese periacetabular osteotomy (n = 40) were common treatments. Pain and range of motion improved for patients. Overall complication rate was 35% (n = 99), with heterotopic ossification (n = 79) most commonly reported. Prior to 2000, there was low quantity and quality of research on the diagnosis/management of FAI. Diagnostic evaluation was primarily through clinical examination (i.e. groin pain and AIT). MRA was occasionally used to detect labral degeneration; however, utilization of computed tomography (CT) and diagnostic injections were not reported. Surgical dislocation and osteotomies of the acetabulum yielded desirable short-term clinical outcomes with a moderate complication rate. No study reported using arthroscopy for FAI management prior to 2000. Clinicians today can learn from historical principles (i.e. clinical diagnosis of FAI, management with surgical correction of femoral head–neck offset) while applying novel techniques (i.e. CT, injections, arthroscopic surgical techniques and rehabilitation) to improve patient outcomes.Level of EvidenceIV (systematic review of III and IV evidence).