Treatment Of Femoroacetabular Impingement Syndrome Research Articles

First-line treatment for femoroacetabular impingement syndrome and hip-related quality of life: study protocol for a multicentre randomised controlled trial comparing a 6-month supervised strength exercise intervention to usual care (the Better Hip Trial)

IntroductionFemoroacetabular impingement syndrome (FAIS) is a motion-related and position-related clinical condition of the hip associated with pain, reduced physical function and hip-related quality of life (QoL). Interestingly, higher maximal muscle...

Effect of Spinopelvic Parameters on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Spinopelvic parameters, including pelvic tilt (PT), sacral slope (SS), and pelvic incidence, have been developed to characterize the relationship between lumbar spine and hip motion, but a paucity of literature is available characterizing differences in spinopelvic parameters among patients with femoroacetabular impingement syndrome (FAIS) versus patients without FAIS, as well as the effect of these parameters on outcomes of arthroscopic treatment of FAIS. To (1) identify differences in spinopelvic parameters between patients with FAIS versus controls without FAIS; (2) identify associations between spinopelvic parameters and preoperative patient-reported outcomes (PROs); and (3) identify differences in PROs between patients with stiff spines (standing-sitting ΔSS ≤10°) versus those without. Cohort study; Level of evidence, 2. The study enrolled patients ≥18 years of age who underwent primary hip arthroscopy for treatment of FAIS with cam, pincer, or mixed (cam and pincer) morphology. Participants underwent preoperative standing-sitting imaging with a low-dose 3-dimensional radiography system and were matched on age and body mass index (BMI) to controls without FAIS who also underwent EOS imaging. Spinopelvic parameters measured on EOS films were compared between the FAIS and control groups. Patients with FAIS completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 1-year follow-up. Outcome scores were compared between patients with stiff spines versus those without. Associations between spinopelvic parameters and baseline outcome scores were assessed with Pearson correlations. Continuous variables were compared with Student t test and/or Mann-Whitney U test, and categorical variables were compared with Fisher exact test. A total of 50 patients with FAIS (26 men; 24 women; mean age, 36.1 ± 10.7 years; mean BMI, 25.6 ± 4.2) were matched to 30 controls without FAIS (13 men; 17 women; mean age, 36.6 ± 9.5 years; mean BMI, 26.7 ± 3.6). Age, sex, and BMI were not significantly different between the FAIS and control groups (P > .05). Standing PT was not significantly different between stiff and non-stiff cohorts (P = .73), but sitting PT in the FAIS group was more than double that of the control group (36.5° vs 15.0°; P < .001). Incidence of stiff spine was significantly higher in the FAIS group (62.0% vs 3.3%; P < .001). Among FAIS patients, those with stiff spines had a significantly higher prevalence of cam impingement, whereas those with non-stiff spines had a higher prevalence of mixed impingement (P = .04). No significant differences were seen in preoperative mHHS or NAHS scores or pre- to postoperative improvement in scores between FAIS patients with stiff spines versus those without (P > .05), but a greater sitting SS was found to be positively correlated with a higher baseline mHHS (r = 0.36; P = .02). Patients with FAIS were more likely to have a stiff spine (standing-sitting ΔSS ≤10°) compared with control participants without FAIS. FAIS patients with stiff spines were more likely to have isolated cam morphology than patient without stiff spines. Although sitting SS was positively correlated with baseline mHHS, no significant differences were seen in 1-year postoperative outcomes between FAIS patients with versus without stiff spine.

Pregnancy-Related Decision-Making and Perceptions of Risk among Reproductive-Age Females Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Single-Surgeon Cross-Sectional Study

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed “some” to “a lot of” concern that their hip pain could get worse during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes.

Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome

PurposeThe purpose of our study was to provide an updated assessment of hip arthroscopy utilization using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). MethodsAll patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology (CPT) coding in a multi-institutional, single health-system database. A longitudinal analysis was performed to identify trends in the utilization of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. ResultsDuring the study, a total of 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1490% (R2 =0.87, p=0.001). Capsular repair (R2=0.92, p<0.001), labral repair (R2=0.75, p=0.002), and femoroplasty (R2=0.70, p=0.004) were performed in an increasing proportion of cases over our study period while labral debridement (R2=-0.84, p<0.001) became less utilized. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in utilization (R2=0.02, p=0.73). ConclusionCapsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS while the use of labral debridement decreased significantly over our study period. Postless traction systems were utilized in the majority of cases each year. Clinical RelevanceAs comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.

Evaluating the Morphology of Unique Superficial Fissured Cartilage Lesions at the Femoral Head-Neck Junction in Patients with Femoroacetabular Impingement Syndrome.

While an association between femoroacetabular impingement (FAI) and osteoarthritis (OA) has been reported, the mechanistic differences and transition between the 2 conditions is not fully understood. In FAI, cartilage lesions at the femoral head-neck junction can sometimes be visualized during hip arthroscopy. The purpose of this study was to describe a unique dimpled pattern of superficial fissured cartilage lesions on the femoral head-neck junction at impingement site in patients with FAI syndrome (FAIS) and to evaluate the clinical, histological, and genetic phenotype of this cartilage. We hypothesized that the cartilage lesions may indicate risk for, or predict occurrence of, OA. Controlled laboratory study. Six hips (6 patients; mean age, 34.2 ± 12.9 years; range, 19-54 years) with dimpled or fissured cartilage were included among patients who underwent hip arthroscopy for treatment of FAIS from October 2020 through December 2021. This affected cartilage (dimple-pattern group) and normal cartilage (control group) on the femoral head-neck junction were collected from the same patients and evaluated for histological quantification by Mankin scores and expression of proteins related to cartilage degeneration (eg, matrix metalloproteinase [MMP]-1, MMP-2, MMP-3, MMP-10, and MMP-12, tissue inhibitor of metalloproteinase [TIMP]-1 and TMP-2, aggrecan neopepitope CS846, and hyaluronic acid [HA]) with the use of Milliplex Multiplex Assays. All 6 hips were of the mixed FAI subtype. Preoperatively, 4 of 6 hips had Tönnis grade 1 radiographic changes, which was associated with greater femoral head chondral damage visualized intraoperatively. Mankin scores for the normal cartilage group and the dimple-pattern group were 0.67 ± 0.82 and 3.3 ± 0.82, respectively. Dimple pattern fissured cartilage showed a significant increase in Mankin score (P = .031) and a significant increase in protein expression of CS846 (P = .031) compared with normal cartilage. There were no significant differences in MMPs, TIMPs, or HA levels between the 2 groups. The dimple pattern fissured cartilage, compared to normal cartilage, showed histologically significant cartilage degeneration and a significant increase in protein expression of CS846, a biomarker for early OA. This lesion serves as helpful visual indicator of early degeneration of the cartilage of femoral head-neck junction caused by FAIS.

Decision-making in borderline hip dysplasia and concomitant femoracetabular impingement syndrome: using a discrete choice experiment to explore patient preferences

ABSTRACT Decision-making regarding surgical treatment of patients showing radiographic evidence of femoroacetabular impingement syndrome (FAIS) in the setting of borderline hip dysplasia (BHD) remains a challenge as there is no consensus on treatment in current literature. When medical evidence is unclear, understanding patient preferences becomes particularly important in deciding the optimal treatment for each patient. The purpose of this study was to measure the patient-determined importance of factors surrounding surgical treatment of FAIS in BHD. Patients aged 18–65 with hip pain and BHD (defined as lateral center edge angle 18–25 or Tonnis angle 10–15) morphology were given a discrete-choice experiment (DCE) focusing on attributes that differ between treatment options: Length of Hospital Stay, Major Complication Rate, Chance of Needing Reoperation within 2 Years and Time to Return to Regular Exercise. This DCE was used to calculate treatment preferences, relative attribute importance and preference weights. A total of 101 patients fully completed the DCE. The most important attribute (average importance weight, 95% CI) was Chance of Reoperation (60.16, 56.99–63.34), while the least important was Hospital Stay (6.57, 5.73–7.41). Only 6 Months to Resume Regular Exercise and 2% Chance of Reoperation (P &amp;lt; 0.05) significantly impacted treatment choice. When presented with fixed choice parameters, 50.5% of subjects preferred PAO and arthroscopy while 49.5% opted for arthroscopy alone. When no clear surgical treatment is indicated, patient preferences have an amplified role in patient decision-making. Our results confirm variation in attribute importance within treatments as well as treatment choice, highlighting the importance in understanding patient preferences in decision-making for FAIS in BHD. More patient-specific generalizable outcomes of surgical treatment options are needed in the literature.

Predicting Outcomes in Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) continues to rise in incidence, and thus there is an increased focus on factors that predict patient outcomes. The factors that impact the outcomes of arthroscopic FAIS treatment are complex. The purpose of this review is to outline the current literature concerning predictors of patient outcomes for arthroscopic treatment of FAIS. Multiple studies have shown that various patient demographics, joint parameters, and surgical techniques are all correlated with postoperative outcomes after arthroscopic FAIS surgery, as measured by both validated patient-reported outcome (PRO) scores and rates of revision surgery including hip arthroplasty. To accurately predict patient outcomes for arthroscopic FAIS surgery, consideration should be directed toward preoperative patient-specific factors and intraoperative technical factors. The future of accurately selecting patient predictors for outcomes will only improve with increased data, improved techniques, and technological advancement.

Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: An Updated Review

Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: An Updated Review

Functional Outcome Scores and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients With Tönnis Grade 1 Versus Grade 0 Arthritis: A Propensity-Matched Study at Minimum 10-Year Follow-up

Background: Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. Purpose: To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. Results: A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P = .805; BMI, 26.1 ± 3.9, P = .117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P < .05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P = .066) in the Tönnis grade 1 cohort. No significant difference (P > .05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P = .021), Hip Outcome Score Sports-Specific subscale (P = .016), and modified Harris Hip Score (P = .026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P = .006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P = .04). Conclusion: Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery.

Decreased Hip Labral Width Measured on Preoperative Magnetic Resonance Imaging Is Associated With Greater Revision Rate After Primary Arthroscopic Labral Repair for Femoroacetabular Impingement Syndrome at 5-Year Follow-Up

To examine the associations between hip labral width and patient-reported outcomes, clinical threshold achievement rates, and rate of reoperation among patients with femoroacetabular impingement syndrome (FAIS) who underwent hip arthroscopy and labral repair at minimum 5-year follow-up. Patients were identified from a prospective database who underwent primary hip arthroscopy for treatment of labral tears and FAIS. Modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 5-year follow-up. Achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) was determined using previously established values. Labral width magnetic resonance imaging measurements were performed by 2 independent readers at standardized "clockface" locations. Patients were stratified into 3 groups at each position: lower-width (<½ SD below mean), middle-width (within ½ SD of mean), and upper-width (>½ SD above mean). Multivariable regression was used to evaluate associations of labral width with patient-reported outcomes and reoperation rate. Seventy-three patients (age: 41.0 ± 12.0 years; 68.5% female) were included. Inter-rater reliability for labral width measurements was high at all positions (intraclass correlation coefficient 0.94-0.96). There were no significant intergroup differences in mHHS/NAHS improvement (P > .05) or in achievement rates of MCID/SCB/PASS at each clockface position (P > .05). Eleven patients (15.1%) underwent arthroscopic revision and 4 patients (5.5%) converted to total hip arthroplasty. Multivariable analysis found lower-width groups at 11:30 (odds ratio 1.75, P= .02) and 3:00 (odds ratio 1.59, P= .04) positions to have increased odds of revision within 5 years; however, labral width was not associated with 5-year improvement in mHHS/NAHS, achievement of MCID/PASS/SCB, or conversion to total hip arthroplasty (P > .05). Hip labral width <½ SD below the mean measured on preoperative magnetic resonance imaging at 11:30- and 3:00-clockface positions was associated with increased odds of reoperation after arthroscopic labral repair and treatment of FAIS. Labral width was not associated with 5-year improvement of mHHS, NAHS, achievement of clinical thresholds, or conversion to arthroplasty. Level IV, case series.

Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell-based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions-a systematic review.

To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up. The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM. Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score-Activities of Daily Living (p < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting. Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations. IV.

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery.

Outcomes of Hip Arthroscopy in Patients with Systemic Inflammatory Diseases: A Matched Cohort 5-Year Follow-Up Study

The purpose of this study was to determine if there is a difference in hip survivorship rates and patient-reported outcomes (PROs) at a 5-year follow-up after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) between patients with versus without systemic inflammatory diseases (SIDs). A retrospective single-surgeon matched cohort study of FAIS patients who underwent hip arthroscopy and had a minimum of a 5-year follow-up was conducted. Subjects with SIDs were matched at a ratio of 2:3 of age and body mass index (BMI) with respect to controls without SIDs. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) prior to surgery and at a 2-year and 5-year follow-up. Survival distributions for time to reoperation and to total hip arthroplasty (THA) were compared between groups using the log-rank test. Fifteen subjects with SIDs (mean age 41.5 years) were matched with twenty-five controls (41.8 years). There were no significant differences in reoperation rates (SIDs 27% vs. controls 20%, p = 0.71) or THA conversion rates (SIDs 7% vs. controls 12%, p = 1.00) at the 5-year follow-up, nor were there differences in survival distributions for reoperations (p = 0.72) or THAs (p = 0.55). There were no significant differences in postoperative mHHS (SIDs 79.3 vs. controls 88.5, p = 0.09) or NAHS (SIDs 82.7 vs. controls 89.3, p = 0.77) by the 5-year follow-up. At the 5-year follow-up, FAIS patients with comorbid SIDs experienced a significant clinical improvement from hip arthroscopy that is comparable to that of FAIS patients without SIDs.

Physiotherapist-led treatment for Femoroacetabular Impingement Syndrome (The PhysioFIRST study): A participant and assessor-blinded randomised controlled trial.

Physiotherapist-led treatment for Femoroacetabular Impingement Syndrome (The PhysioFIRST study): A participant and assessor-blinded randomised controlled trial.

Concomitant Ipsilateral Knee Pain Is Associated With Worse Preoperative Functional Status and Short-Term Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome

Purpose(1) To determine the effect of concomitant IKP (ipsilateral knee pain) on short-term outcomes after hip arthroscopic treatment of FAIS (femoroacetabular impingement syndrome), and (2) to determine whether IKP would improve with surgery. MethodsData between September 2021 and May 2022 was reviewed. Patients diagnosed with FAIS and underwent hip arthroscopy with minimum of 1-year follow-up were included. Exclusion criteria were prior ipsilateral hip or knee surgery, hip Tönnis grade > 1, knee Kellgren-Lawrence grade > 2, hip conditions (avascular necrosis, Legg-Calve-Perthes disease, pigmented villonodular synovitis, osteoid osteoma, synovial chondromatosis and developmental dysplasia of the hip), and spine diseases. A knee MRI was performed on all patients preoperatively. Preoperative and short-term (1 year) patient-reported outcome (PRO) scores were collected for Hip Sports Activity Scale (HSAS), weekly sports participation, modified Harris Hip Score (mHHS), international Hip Outcome Tool, 12-component form (iHOT-12), visual analog pain scale (VAS) of the hip and ipsilateral knee. The percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS and iHOT-12 were calculated. Multivariate regression analysis was performed to determine the effect of IKP severity on postoperative outcomes. Subgroup analysis was performed between patients with and without IKP alleviation. ResultsAmong the 107 patients included, 47 presented preoperative IKP. Compared to patients without IKP, the IKP cohort had comparable knee structural abnormalities (all with P > 0.05). Still, it showed inferior preoperative mHHS (P = .003), iHOT-12 (P = .016), hip VAS (P = .001), and weekly sports participation (P = .039). Postoperatively, the IKP cohort had lower mHHS (P = .046), iHOT-12 (P = .037), and hip VAS (P = .003), and were less likely to achieve PASS of mHHS (P = .021) and iHOT-12 (P = .049). Patients with higher knee VAS were less likely to achieve PASS of mHHS (OR = 0.61; P = .023). Within the IKP group, knee VAS improved from 2.3 to 1.0 (P < .001). Those with alleviated IKP showed superior postoperative iHOT-12 (P = .038) compared to those with persistent IKP. ConclusionConcomitant IKP at baseline negatively affected preoperative status and short-term PROs after arthroscopic treatment of FAIS. Patients with IKP were less likely to meet clinical thresholds. Most patients achieved IKP alleviation postoperatively, which was associated with superior clinical outcomes. Level of evidenceIII, retrospective cohort study.

Global Acetabular Retroversion Is Not Associated With Differences in Outcomes After Primary Hip Arthroscopy Among Patients With Femoroacetabular Impingement Syndrome: A Matched Cohort Study With Minimum 5-Year Follow-Up

To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy at 5-year follow-up between patients with femoroacetabular impingement syndrome (FAIS) with radiographic signs of global acetabular retroversion and those without. A retrospective matched-cohort study was conducted using a single-surgeon hip arthroscopy database. Patients were included if they underwent primary hip arthroscopy for treatment of FAIS, had preoperative hip x-rays, and had a minimum 5-year follow-up. Global retroversion was defined as the presence of ischial spine sign, posterior wall sign, and crossover sign on anteroposterior view. Patients with FAIS with global retroversion were matched 1:1 on age, sex, and body mass index to FAIS controls. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were administered preoperatively and at follow-up. Hip survivorship and PROMs were compared between the 2 groups using the paired t test, Wilcoxon signed rank test, and/or Cochran-Mantel-Haenszel test as appropriate. P values <.05 were considered significant. Thirty-eight patients with global retroversion (mean age 40.6 ± 10.8 years, 60.5% female) were matched to 38 controls (mean age 41.3 ± 13.6 years, 60.5% female). Reoperation rates were the same in both groups (5.3%). On average, both groups reported significant pre- to postoperative improvement in mHHS (P < .001) and NAHS (P < .001), and there was no significant intergroup differences in the change in mHHS (P= .86) or NAHS (P= .90). Achievement rates for the patient acceptable symptom state on the mHHS were higher among males compared to females (P= .04) in both the global retroversion group (93.3% vs 73.9%) and the control group (93.3% vs 73.9%). Patients with FAIS with and without global acetabular retroversion had no significant difference in outcomes after primary hip arthroscopy at a minimum 5-year minimum follow-up. Level III, retrospective comparative prognostic trial.

Reprint of: Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but Not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P= .006) and at 2-year follow-up (P= .008). There were no significant intergroup differences in time to achievement for MCID (P= .92) or SCB (P= .69), but obese patients had longer time to PASS than normal BMI patients (P= .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR= .55; P= .007) but not MCID (HR= 0.91; P= .68) or SCB (HR= 1.06; P= .30). Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. Level III, retrospective comparative study.

Return to Work Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Case Series

The expected rate and timing of return to work (RTW) following hip arthroscopy is an important consideration for patients. The purpose of this study was to evaluate the rates of RTW following hip arthroscopy, the time required to RTW, and factors correlated with successful RTW. A retrospective review was performed of patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) from 2018–2021. Data were collected regarding pre-injury employment, work activity level, workers’ compensation (WC) status, ability to return to work, the pre- and postoperative pain visual analog score (VAS), and the Nonarthritic Hip Score (NAHS). Overall, 76 patients (90.5%) returned to their pre-surgical occupation at an average of 9.3 weeks (range: 0.14–56 weeks) postoperatively. Of those who returned, 62 patients (81.6%) returned to full work duties. The NAHSs improved significantly from the preoperative period to follow-up at 1 year (64.7 vs. 83.7, p &lt; 0.001). A linear regression found elevated BMI to be associated with an increased time to return (β = 0.757, p = 0.012). On average, patients with WC status returned to work 9 weeks later than non-WC patients, though this difference did not reach statistical significance (18.4 vs. 9.9 weeks, p = 0.130). There is a high rate of return to full work duties at an average of 9.3 weeks following hip arthroscopy for FAIS.

Poster 213: Outcomes of High-Level Competitive Athletes Undergoing Hip Arthroscopy as Compared to Non-Competitive Athletes at 5-Year Follow-Up: A Propensity Matched Analysis

Objectives: Hip arthroscopy has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes and non-competitive athletes, with favorable patient reported outcomes (PROs), and low rates of complications. Previous data demonstrates a high return to sport (RTS) rate, reported up to 88% to 92%. Although PROs and RTS have previously been evaluated, many studies are limited to short-term follow-up and do not differentiate between competitive and non-competitive athletes. The objectives of this study were to (1) determine differences in mid-term clinical outcomes at 5-years follow-up between patients who are high-level competitive athletes (CA) versus propensity matched, non-competitive athletes (NCA) undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), (2) determine whether achievement rates of minimal clinically important differences (MCID) and patient acceptable symptomatic states (PASS) differ between the two groups, and (3) determine return to sport (RTS) rate in CA. Methods: Patients who were collegiate, semi-professional, or professional athletes and underwent primary hip arthroscopy for FAIS from January 2012 to April 2017 were identified. Patients were propensity matched on a 1:4 basis to NCA controls by age, sex, and body mass index (BMI). Preoperative and postoperative radiographs were assessed. Patient reported outcomes (PROs) collected preoperatively and at 5-years included international Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), and Visual Analog Scale (VAS) for Pain and Satisfaction. MCID and PASS rates were determined using previously-published thresholds for iHOT-12, mHHS, HOS-ADL, HOS-SS, and VAS Pain. RTS rate and duration was collected retrospectively. Results: A total of 57 high-level CA who underwent primary hip arthroscopy for FAIS (33 female, age: 21.7 ± 4.2 years, BMI: 23.1 ± 2.8kg/m2) were propensity matched to 228 NCA controls (132 female, p &gt; 0.999; age: 23.3 ± 5.8 years, p = 0.022; BMI: 23.8 ± 4.3 kg/m2, p = 0.239). There were no statistically significant differences between any radiographic parameters in any of the pre- or postoperative radiographic parameters between groups. Of note, competitive athletes had higher outcome scores prior to surgery in HOS-ADL (CA: 74.9 ± 13.7 vs NCA: 66.4 ± 18.4, p = 0.001) and mHHS (CA: 64.7 ± 12.9 vs NCA: 59.7 ± 14.3, p = 0.040). Both groups demonstrated significant postoperative improvements in all outcome scores measured (p ≤ 0.001). At 5-years postoperatively, CA had lower VAS pain than NCA (CA: 17.3 ± 17.6 vs NCA: 24.7 ± 25.9, p=0.017). There were no significant differences in achieving MCID or PASS for HOS-ADL, HOS-SS, mHHS, or iHOT-12 at final follow-up. CA returned to sport (RTS) at a median of 25.2 weeks (Q1 22.4 – Q3 30.7) with an overall RTS rate of 90%. The CA participated in a multitude of sports (Figure 1) however, there was no significant differences in comparing RTS between individual sports (p = 0.163) (Figure 2). Conclusions: CA patients demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates following primary hip arthroscopy, which were comparable to non- competitive controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than controls and achieve lower average self-reported pain at 5-years postoperatively. CA patients demonstrate high rate of RTS (˜90%) at a median of ˜25 weeks post- operatively.

Poster 115: Patients who Underwent Primary Hip Arthroscopy for Femoroacetabular Impingement with Acetabular Microfracture Show 77% Survivorship at 10-Year Follow-Up

Objectives: The purpose is to report minimum 10-year follow-up survivorship, defined as non- conversion to total hip arthroplasty (THA), and patient-reported outcome scores (PROS) following primary hip arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement syndrome (FAIS) and acetabular chondral lesions, respectively. Methods: Data was prospectively collected and retrospectively analyzed on all patients who underwent a primary hip arthroscopy and received an acetabular microfracture between June 2009 and January 2011 and included in this study. Patients with a minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain were included. If available, the minimum 10-year follow-up for the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) was reported. The demographics, intraoperative findings, surgical procedures, PROS, rate of achieving the minimal clinical important difference (MCID), and secondary surgeries were analyzed and reported. Results: Twenty-two hips (20 patients) were included in the study, and the mean follow-up time was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from females. The average patient age at the time of surgery was 42.3 years ± 9.6. All patients on average experienced statistically significant improvement (P &lt; 0.05) between preoperative and minimum 10-year follow-up scores for all PROs. In total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3% of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain. Conclusions: At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients that underwent primary hip arthroscopy with acetabular microfracture for the treatment of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients that did not require THA conversion, significant improvement in all PROS was demonstrated.