Hip arthroscopy for femoroacetabular impingement is associated with significant improvement in early patient reported outcomes: analysis of 4963 cases from the UK non-arthroplasty registry (NAHR) dataset

Abstract

Purpose Results from recent randomised controlled trials demonstrate the superiority of surgery over physiotherapy in patients with femoroacetabular impingement (FAI) of the hip in early follow-up. However, there is paucity of evidence regarding which factors influence outcomes of FAI surgery, particularly notable is the lack of information on the effect of impingement subtype (cam or pincer or mixed) on patient reported outcomes measures (PROMs). This study aims to evaluate the early outcomes of hip arthroscopy for FAI, and their determinants. Methods This is a retrospective analysis of prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) of patients undergoing arthroscopic intervention for FAI between 2012 and 2019. The null hypothesis was that there is no difference in PROMs, based on morphological subtype of FAI treated or patient characteristics, at each follow-up timepoint. The outcome measures used for the study were the iHOT-12 score and the EQ5D Index and VAS 6- and 12-month follow-up. Results A cohort of 4963 patients who underwent arthroscopic treatment of FAI were identified on the NAHR database. For all FAI pathology groups, there was significant improvement from pre-operative PROMs when compared to those at 6 and 12 months. Overall, two-thirds of patients achieved the minimum clinically important difference (MCID), and almost half achieved substantial clinical benefit (SCB) for iHOT-12 by 12 months. Pre-operatively, and at 12-month follow-up, iHOT-12 scores were significantly poorer in the pincer group compared to the cam and mixed pathology groups (p < 0.01). Multivariable analysis revealed PROMS improvement in the setting of a higher-grade cartilage lesion. Conclusion This registry study demonstrates that hip arthroscopy is an effective surgical treatment for patients with symptomatic FAI and results in a statistically significant improvement in PROMs which are maintained through 12 months follow-up. Level of evidence III.

The growth of hip preservation as a speciality

“…Concomitant with these increases in the use of hip preservation surgery, there has been a rapid increase in the volume of related data and literature. A hip arthroscopy registry was commenced by a Scandinavian expert group in 2011 [25], and the following year the NAHR was founded in the United Kingdom (UK) [11]. There has been a dramatic increase in the number of publications on topics related to hip preservation surgery, though the quality of these studies continues to be low, with the majority of studies providing Level IV evidence [16].…”

“…Amongst patients undergoing hip arthroscopy for FAI, there is significant improvement of patient‐reported outcomes (PROMs) at 6 and 12 months post‐operatively compared to baseline. Pre‐operatively, and at 12 months post‐operatively, PROMs were significantly lower in patients with pincer morphology compared to cam and mixed types [11].…”

PREHAB FAI- Prehabilitation for patients undergoing arthroscopic hip surgery for Femoroacetabular Impingement Syndrome -Protocol for an assessor blinded randomised controlled feasibility study

“…Excision of the impingement lesion (Cam, pincer or mixed) and addressing chondro-labral pathology through surgical procedures like hip arthroscopy may be necessary to provide better medium to long term outcomes [ 8 ]. Innovations in diagnosis and surgical technique have resulted in an exponential growth of hip arthroscopy procedures in the past decade [ 9 ].…”

Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

“…The Non-Arthroplasty Hip Registry from the UK also showed that only 67% of patients achieved the minimal clinically important difference (MCID) on the iHOT-12 scale in the short term following arthroscopic treatment for FAI. 13 However, there is contradictory evidence on the outcomes of HA in patients with moderate-to-severe OA. 14 It is also not clear how the location and degree of chondral damage affects the outcome.…”

“…The Non-Arthroplasty Hip Registry from the UK also showed that only 67% of patients achieved the minimal clinically important difference (MCID) on the iHOT-12 scale in the short term following arthroscopic treatment for FAI. 13…”