Factors Associated With the Failure of Surgical Treatment for Femoroacetabular Impingement

Abstract

Context With the recent increased recognition of femoroacetabular impingement (FAI) as a cause of hip pain and early osteoarthritis, surgical treatment has proliferated. A growing body of literature reports on outcomes of surgical intervention for FAI, but factors associated with inferior surgical outcomes have not been reviewed systematically. Objective To review available literature and identify factors associated with failure of open or arthroscopic surgery for FAI. Data Sources Using the PubMed database, we searched for relevant English-language articles published from January 1966 through August 2012. Study Selection Inclusion criteria were primary focus on surgical treatment of FAI, measurement of functional or pain outcomes, identification of treatment failures and statistical analysis of factors leading to failure. Exclusion criteria were review articles, technique-only articles and studies of nonoperative management. Data Extraction Two definitions of failure were considered: 1) lack of statistically signigicant improvement in validated measures of pain, function or satisfaction postoperatively, and 2) revision surgery or conversion to hip arthroplasty because of persistent symptoms. The consistency of association between preoperative variables and clinical outcomes was reported across all studies. Results Thirteen studies were included. Three were retrospective. There were no randomized controlled trials. Many studies had important methodological limitations. Preoperative cartilage damage or osteoarthritis had the strongest and most consistent relationship with conversion to hip arthroplasty and with lack of improvement in pain or function. Greater age at index operation, worse preoperative modified Harris Hip Score and longer duration of symptoms preoperatively (> 1.5 years) were associated with conversion to hip arthroplasty. Conclusions Older age, the presence of arthritic changes, longer duration of symptoms and worse preoperative pain and functional scores are associated with poor outcomes of surgery for FAI. Incorporation of these data into discussions with patients may facilitate informed shared decision-making about surgical treatment of FAI.

Arthroscopic Versus Open Treatment of Femoroacetabular Impingement

“…Study authorship and study patient populations were crosschecked to prevent patient data duplication, with longer term studies preferentially included in such a situation. To ensure that no studies were omitted, the references for each included study were also reviewed and prior similar systematic reviews 9,24,33,38 were assessed for eligible studies. This extended search did not produce additional studies.…”

A Less-Invasive Technique for Capsular Management During Hip Arthroscopy for Femoroacetabular Impingement

“…16 For correct treatment of FAI, it is necessary to have a broad vision of the joint, particularly in patients with cam-type FAI. The surgical dislocation technique described by Ganz et al 1 in 2001 allows maximum vision of the femoral head, which gives an accurate correction of the bony deformity with excellent clinical results.…”

Arthroscopic Approach to Femoroacetabular Impingement

“…Arthroscopic techniques may have fewer major complications and might allow for faster rehabilitation and sooner return to activity as compared with open surgery. Among various studies, negative predictors of clinical outcome include preoperative radiographic joint-space narrowing, higher grade of articular cartilage damage seen intraoperatively or on MRI, and longer duration of preoperative symptoms [41,93,94,[98][99][100][101]. Complications from hip arthroscopy are uncommon but may include iatrogenic injury to the articular cartilage or labrum, adhesions, heterotopic ossification, hip instability or dislocation, femoral neck fracture, avascular necrosis, gluteal vascular injury, symptomatic intra-abdominal fluid extravasation, or traction-related neurapraxia [102,103].…”