No abstract

Background: Although femoral osteoplasty is common practice in treating cam-type femoroacetabular impingement (FAI), long-term data are lacking that support the ability of this procedure to optimize outcomes and alter natural history. Purpose: To compare long-term clinical outcomes and survivorship of treatment for symptomatic FAI via arthroscopic correction of labral or chondral pathology with and without femoral osteoplasty. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed across 2 consecutive cohorts of patients with isolated cam-type FAI who underwent hip arthroscopic treatment of labral or chondral pathology without femoral osteoplasty (HS group) or with femoral osteoplasty (HS-OST group). These unique cohorts were established at a distinct transition time in our practice before and after adoption of femoral osteoplasty for treatment of FAI. Clinical outcomes were measured using the modified Harris Hip Score (mHHS). Kaplan-Meier analysis was used to assess for total hip arthroplasty (THA)–free and reoperation-free survivorship. Results: The final HS group included 17 hips followed for 19.7 ± 1.2 years, and the final HS-OST group included 23 hips followed for 16.0 ± 0.6 years. No significant patient or morphological differences were found between groups. Compared with the HS group, the HS-OST group had significantly higher final mHHS (82.7 vs 64.7 for HS-OST vs HS, respectively; P = .002) and mHHS improvement (18.4 vs 6.1; P = .02). The HS-OST group also had significantly greater 15-year THA-free survivorship versus the HS group (78% vs 41%, respectively; P = .02) and reoperation-free survivorship (78% vs 29%; P = .003). Conclusion: This study demonstrated superior long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared with hip arthroscopy alone. These long-term data strongly support the practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI at long-term follow-up.

Background:The optimal surgical treatment (hip arthroscopy compared with periacetabular osteotomy [PAO]) for borderline acetabular dysplasia (lateral center-edge angle [LCEA], 18° to 25°) remains a topic of debate. To date, the literature has focused primarily on arthroscopy outcomes, with only a few small reports on PAO outcomes. The purpose of this study was to define PAO outcomes in a large cohort of borderline hips. In a secondary analysis, we assessed the effect of prior failed arthroscopy, concurrent hip arthroscopy, and concurrent femoral osteoplasty on PAO outcomes in this cohort.Methods:A prospective database was retrospectively reviewed for patients who underwent PAO for symptomatic instability in the setting of borderline dysplasia (LCEA, 18° to 25°). Of the 232 identified hips, 186 (80.2%) were assessed at a mean follow-up of 3.3 ± 2.0 years postoperatively. The mean patient age was 25.2 ± 8.5 years (range, 14 to 45 years), and 88.2% were female. Thirty hips (16.1%) had undergone a failed prior arthroscopy. Arthroscopy was performed concurrently with the PAO in 130 hips (69.9%), and femoral osteoplasty was performed concurrently in 120 hips (64.5%). The modified Harris hip score (mHHS) was assessed relative to the minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Clinical failure was defined as a reoperation for persistent symptoms or a failure to achieve either the mHHS MCID or PASS.Results:Of the 156 hips undergoing a primary surgical procedure, clinical success was achieved in 148 hips (94.9% [95% confidence interval (CI), 90.2% to 97.4%]). Two hips (1.3% [95% CI, 0.4% to 4.6%]) underwent reoperation (hip arthroscopy) for persistent symptoms and an additional 6 hips (3.8% [95% CI, 1.8% to 8.1%]) failed to achieve the mHHS MCID or PASS, for a clinical failure rate of 5.1% (95% CI, 2.6% to 9.8%); 8.8% reported dissatisfaction with the surgical procedure. Clinical failure was more frequent among the 30 hips (23.3% [95% CI, 11.8% to 40.9%]; p = 0.001) that had undergone a prior failed arthroscopy. There were no outcome differences between hips that had or had not undergone concurrent hip arthroscopy or femoral osteoplasty.Conclusions:This study demonstrates excellent early outcomes of PAO for borderline acetabular dysplasia, with significant clinical improvement in 94.9% of patients undergoing a primary surgical procedure; 91.2% were satisfied with the surgical procedure.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Femoroacetabular impingement (FAI) is one of the most common causes of hip osteoarthritis, yet the factors controlling disease progression are poorly understood. Purpose: To investigate rates of initial and subsequent symptoms in the contralateral hip of patients with FAI, and identify predictors of disease progression (symptom development and surgical intervention) in the contralateral hip. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective study included a minimum 5-year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) and surgical progression were monitored. Univariate and multivariate analyses compared patient-specific and imaging characteristics of symptomatic patients with those who remained asymptomatic to identify factors associated with disease progression. Results: A total of 150 patients (84% follow-up) were followed for a mean of 7.1 years (range, 5-11 years). Thirty-nine of these patients (26% [39/150]) had contralateral hip symptoms at initial evaluation. Of those without contralateral hip symptoms at initial evaluation, 32% (36/111) had developed contralateral hip symptoms by latest follow-up. Those who developed symptoms during the study period had a lower anteroposterior head-neck offset ratio (0.153 vs 0.165; P = .005), decreased total arc of rotation in 90° of flexion (39.9° vs 51.1°; P = .005), and decreased external rotation in 90° of flexion (28.6° vs 37.1°; P = .003) compared with those who never developed symptoms. Age, sex, body mass index, alpha angle, lateral center-edge angle, internal rotation in flexion, and University of California, Los Angeles (UCLA), activity score were similar between these groups. Those with contralateral symptoms at initial evaluation progressed to contralateral surgery at a rate of 41% (16/39) and those who developed contralateral symptoms during the study period progressed to contralateral surgery at a rate of 28% (10/36). Among those with contalateral hip symptoms (either present initially or developed during study period)), younger age (24.6 vs 34.1 years; P < .001) and baseline UCLA activity score ≥9 (P = .003) were associated with progression to surgery. By Kaplan-Meier analysis, 64%, 54%, and 48% of patients remained free of contralateral hip symptoms at 2, 5, and 10 years. Conclusion: At a mean follow-up of 7.1 years, significant symptoms in the contralateral hip of patients with FAI were present in approximately 50% of patients. FAI disease progression (symptom development and surgical intervention) was associated with decreased hip rotation arc, decreased external rotation, and decreased head-neck offset ratio. In symptomatic patients, younger age and UCLA activity score ≥9 were associated with progression to surgery. These findings represent important factors for patient counseling and risk modeling in FAI.

No abstract