Osteoarthritic changes rather than age predict outcome following arthroscopic treatment of femoroacetabular impingement in middle-aged patients

Abstract

BackgroundOur purpose was to evaluate outcome following arthroscopic treatment of femoroacetabular impingement (FAI) in middle-aged patients and to define risk factors for conversion to total hip arthroplasty (THA).MethodsThis was a retrospective case series of 79 consecutive patients (40 to 65 years) undergoing arthroscopic treatment of FAI (follow-up ≥12 months). Outcome at follow-up was assessed using Hip outcome score (HOS). Alpha angle, Kellgren Lawrence grade (K-L grade), joint space width (JS), lateral center edge (LCE) angle, caput-collum-diaphysis (CCD) angle and acetabular index (AI) were analysed retrospectively. THA group and Non-THA group were compared.ResultsSeventy-nine patients (mean age 48.6 years, mean follow-up 32 months) were included. 18 patients (22.8 %) were converted to THA. Mean HOS score in the Non-THA group at time point of follow-up was 80.2. Non-THA group and THA group showed no significant differences for mean age (48.2 years vs. 49.9 years, p = 0.278), alpha angel (p = 0.541), LCE (p = 0.294), CCD (p = 0.101) and AI (p = 0.661) in contrast to differences for JS (p = <0.001) and K-L grade (p = <0.001). Risk of conversion to THA was higher for patients with K-L grade 3 (p = 0.003) or joint space less or equal 2 mm (p = 0.001).ConclusionsOne fifth of the middle-aged patients required early conversion to THA. Advanced JS narrowing and K-L grade rather than age alone can be considered as risk factor for conversion to THA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1108-6) contains supplementary material, which is available to authorized users.

Risk Factors for Conversion of Hip Arthroscopy to Total Hip Arthroplasty: A Large Closed-Cohort Study

“…Although age is commonly cited as an association with conversion to THA, Herrmann et al. 23 suggested from their retrospective series of middle-aged patients that age as a sole factor should not be prohibitive of hip arthroscopy, but rather osteoarthritic changes as documented by Kellgren Lawrence grade 3 or joint space width <2 mm. The likely independent influence of degenerative changes is confirmed by a statewide study of hospitals in New York that found both age >60 years and the presence of pre-existing arthritis to be independent risk factors for THA conversion.…”

“…Other studies have also shown that prior hip arthroscopy or surgeries have been associated with predictors of clinical outcomes, 14 , 31 whereas the present study did not note prior hip arthroscopy as a significant predictor of conversion, despite it being statistically significant. Additional factors previously associated with conversion have been worsening preoperative evidence of arthritic changes or chondral damage 20 , 22 , 23 , 25 , 26 , 28 , 33 , 34 , 35 or acetabular morphology. 36 Contralateral THA has also been associated with increased conversion to THA after hip arthroscopy.…”

Editorial Commentary: Hip Radiographic Measurement: It Takes More Than One

“…R educed hip joint space measurements have been shown to predict early conversion to total joint arthroplasty after hip arthroscopy. [1][2][3][4] In the article titled "Standardizing the Pre-Arthritic Hip Joint Space Width: An Analysis of 994 Hips," the authors Kraeutler, Garabekyan, Goodrich, Fioravanti, Chadayammuri, and Mei-Dan 5 analyzed the radiographs in a large population. Joint space and lateral center edge angle were measured on standing anteroposterior radiographs in both symptomatic and asymptomatic individuals.…”

Postoperative Imaging after Impingement Surgery

“…10 However, the early conversion rate to total hip arthroplasty may increase in more disadvantageous study cohorts, for example, up to 23% in middle-age patients between 40 and 65 years of age. 50 Patients with preoperative radiographic findings of moderate or advanced osteoarthritis, a radiologic joint space < 2 mm, advanced cartilage defects, presence of a subchondral acetabular edema with cystic changes on MRI, and hip dysplasia with a lateral center-edge angle < 20 degrees revealed poorer outcomes and were associated with a higher likelihood of early Fig. 7 (a-c) Ongoing hip joint degeneration with consecutive osteoarthritis on a (a) 3.5-year postoperative anteroposterior conventional radiograph in a 36-year-old male patient compared with (b) intraoperative and (c) preoperative conventional radiographs.…”

“…26,[51][52][53][54] Thus arthroscopic and open hip joint preservation surgery should be considered as a relative contraindication in these patients. 26,50,51…”