Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: a systematic review

Fernandez, Claire E.; Sheth, Ujash; Tjong, Vehniah K.; Terry, Michael A.

doi:10.1093/jhps/hnaa013

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…In a recent systematic review, the timing of the second procedure ranged from 3 weeks to 58 months (mean, 7.7 months), with favorable results seen regardless of the timing of the second procedure. 10 However, Kuhns et al demonstrated that patients who underwent the second operation before 10 months after the index hip had greater HOS-Activities of Daily Living and HOS-SSS scores as well as lower VAS pain scores when compared with patients who underwent the contralateral surgery after the 10-month period.…”

Section: Discussionmentioning

confidence: 99%

Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain

et al. 2021

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Background: In patients with symptomatic femoroacetabular impingement syndrome, bilateral hip pain has been reported to occur in high frequency. However, not all patients require bilateral hip arthroscopy. Purpose: To determine the incidence, patient-specific variables, and postoperative outcomes in patients who presented with bilateral hip pain at the time of index hip arthroscopy and underwent subsequent contralateral arthroscopic hip surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who presented with bilateral hip pain, underwent primary hip arthroscopy between January 2012 and June 2018 for indication of femoroacetabular impingement syndrome, and had minimum 2-year follow-up were retrospectively analyzed. Baseline descriptive data, preoperative hip range of motion, and radiographic measurements were recorded with pre- and postoperative patient-reported outcomes (PROs). Independent samples t test was used to compare continuous variables, and chi-square test was used to compare categorical variables between patients undergoing unilateral and bilateral surgery. Bivariate correlations and a multivariable binary logistic regression were performed to determine factors predictive of the need for future contralateral hip arthroscopy. Results: In total, 108 patients were identified who reported bilateral hip pain during the index evaluation, underwent primary hip arthroscopy, and had 2-year follow-up. Among these, 42% (n = 45) elected to undergo hip arthroscopy on the contralateral hip at a mean of 6.0 months (range, 1-17 months) after the index surgery. Patients requiring bilateral surgery were significantly younger ( P = .004) and had a larger preoperative anterior center-edge angle (ACEA; P = .038) when compared with patients who had unilateral surgery. There were no significant differences in alpha angle measurements between patients who had unilateral and bilateral surgery. On bivariate analysis, younger age at the time of the index surgery ( r = −0.272; P = .005) and preoperative ACEA ( r = 0.249; P = .016) were significantly correlated with the need for bilateral surgery. On multivariate analysis, younger age remained a significant predictor for bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). Patients who underwent bilateral hip arthroscopy reported significant improvement in all PROs ( P < .001), with a significantly greater mean Hip Outcome Score− Sports Specific Subscale score when compared with patients undergoing unilateral surgery ( P = .037). Conclusion: Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. Younger age at the time of the index surgery and greater ACEA were predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significantly improvement in PROs at minimum 2-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain

et al. 2021

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“…Despite a lower return to soccer rate among these players (68.8 vs. 78.2% for unilaterals), this difference did not reach statistical significance. Two recent systematic reviews [7, 12] reported on improved outcomes after a simultaneous or staged bilateral hip arthroscopy for FAIS, with similar efficacy and safety when compared with unilateral surgeries. These studies, however, did not focus on athletic populations and did not report on return to play after bilateral surgeries.…”

Section: Discussionmentioning

confidence: 99%

Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer

Marom

Olsen

Burger

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose To determine return to soccer rates and soccer performance in a large cohort of competitive soccer players after hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) and to identify possible risk factors associated with not returning to soccer. Methods An institutional hip preservation registry was retrospectively reviewed for patients identiied as competitive soccer players who underwent primary hip arthroscopy for FAI performed between 2010 and 2017. Patient demographics and injury characteristics as well as clinical and radiographic indings were recorded. All patients were contacted for return to soccer information using a soccer-speciic return to play questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to soccer. Results Eighty-seven competitive soccer players (119 hips) were included. 32 players (37%) underwent simultaneous or staged bilateral hip arthroscopy. The mean age at surgery was 21.6 ± 7.0 years. Overall, 65 players (74.7%) returned to soccer, of which 43 players (49% of all included players) returned to pre-injury level of play or better. Most common reasons for not returning to soccer were pain or discomfort (50%) followed by fear of re-injury (31.8%). The mean time to return to soccer was 33.1 ± 26.3 weeks. Among 22 players who did not return to soccer, 14 (63.6%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female players (odds ratio [OR] = 0.27; conidence interval [CI] = 0.083 to 0.872; p = 0.029) and older aged players (OR = 0.895; 95% CI = 0.832 to 0.963; p = 0.003) were less likely to return to soccer. Bilateral surgery was not found to be a risk factor. Conclusion Hip arthroscopic treatment for FAI in symptomatic competitive soccer players allowed three-quarters of them to return to soccer. Despite not returning to soccer, two-thirds of players who did not return to soccer were satisied with their outcome. Female and older aged players were less likely to return to soccer. These data can better guide clinicians and soccer players with realistic expectations related to the arthroscopic management of symptomatic FAI. Level of evidence III.

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“…However, the incidence of radiological deformities does not always coincide with symptomatic FAI 3 , 4 . A common phenomenon is that most patients with FAI complain of unilateral hip pain only, and only a quarter of FAI patients have bilateral hips involved 5 . What causes the difference in symptoms of bilateral hips in patients with FAI has not been well‐studied.…”

Section: Introductionmentioning

confidence: 99%

Subspine Hypertrophy: Higher Incidence of Symptomatic versus Asymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement

Bai

Zhao

et al. 2021

Orthopaedic Surgery

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Objective: To compare the difference of anterior inferior iliac spine (AIIS) and subspine hypertrophic deformity between symptomatic and asymptomatic hips in patients traditionally diagnosed with femoroacetabular impingement (FAI), and investigate the correlation of subspine decompression with AIIS variation and subspine hypertrophic deformity. Methods:We retrospectively reviewed 70 patients with unilateral symptomatic FAI who underwent hip arthroscopy. The operative hips and contralateral hips naturally formed the symptomatic groups and asymptomatic control groups, respectively. The morphometric comparison of the hip joint was performed between the operative and contralateral sides of each patient. Radiological assessment was performed by two observers (an experienced musculoskeletal radiologist and an experienced surgeon). Three-dimensional (3D)-CT images of each patient were blindly reviewed to determine the AIIS variation and subspine hypertrophic deformity. Reformatted two-dimensional (2D)-CT images and anterior-posterior (AP) pelvic plain radiographs were blindly reviewed to determine FAI-related morphological measurements. Moreover, the surgical assessment was reviewed by one experienced surgeon to interpret whether subspine decompression was performed. The correlation of subspine decompression with AIIS variation and subspine hypertrophy was analyzed.Results: Out of 70 patients with unilateral symptomatic FAI, 37 were males (52.9%) and 23 (32.9%) had symptoms involving the left hip. The mean age was 39.3 AE 10.4 years and the mean BMI was 24.3 AE 3.6. The distribution of AIIS variants in symptomatic hips did not differ significantly from that in asymptomatic hips (χ 2 = 3.092, P = 0.213). Twenty-nine hips in the symptomatic group (41.4%) and 12 hips in the asymptomatic group (17.1%) were identified as positive for subspine hypertrophy. The incidence of positive subspine hypertrophy was significantly higher in the symptomatic hips compared to the asymptomatic hips (χ 2 = 9.968, P = 0.002). FAI-related morphological parameters including α angle, lateral center-edge angle, acetabular anteversion, crossover sign, and Tonnis grade were highly symmetrical and did not show significant differences between symptomatic and asymptomatic hips. Fifty-four of 70 hips (77.1%) had labral tears extended to the acetabular rim corresponding to the AIIS. Forty-seven hips of 70 hips (67.1%) underwent subspine decompression, which was significantly correlated with AIIS variation and subspine hypertrophic deformity (P = 0.019 and 0.001, respectively). Conclusion:Subspine hypertrophic deformity was found to be more common in symptomatic side vs asymptomatic side in patients with unilateral symptomatic femoroacetabular impingement. Subspine hypertrophy may be considered as an underlying indication for subspine decompression besides low-lying AIIS.

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Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: a systematic review

Cited by 8 publications

References 25 publications

Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain

Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain

Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer

Subspine Hypertrophy: Higher Incidence of Symptomatic versus Asymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement

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