Osteoarthrosis, Advanced Age, and Female Sex Are Risk Factors for Inferior Outcomes After Hip Arthroscopy and Labral Debridement for Femoroacetabular Impingement Syndrome: Case Series With Minimum 10-Year Follow-Up

Zimmerer, Alexander; Ramoser, Annalena; Streit, Marcus R.; Janz, Viktor; Sobau, Christian; Wassilew, Georgi I.; Miehlke, Wolfgang

doi:10.1016/j.arthro.2021.01.024

Cited by 38 publications

(33 citation statements)

References 43 publications

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“…This survivorship rate is comparable with an 86.3% survivorship in patients undergoing arthroscopy for FAI with To ¨nnis grade \2 reported in a recent study. 54 The indications for hip arthroscopy as a treatment intervention for FAI have evolved over the years. Certain morphologic and patient predictors of increased risk of conversion to THR or reoperation are now well established.…”

Section: Discussionmentioning

confidence: 99%

Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

Carton

Filan²,

Mullins³

2021

Am J Sports Med

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Background: Femoroacetabular impingement (FAI) is a common mechanical hip condition, prevalent in both the athletic and the general population. Surgical intervention is an effective treatment option that improves both symptoms and function in short- to medium-term follow-up. Few studies within the literature have reported the longer-term success of arthroscopic surgery. Purpose: The aim of this study was to quantify the 10-year survivorship and clinical outcome for patients treated arthroscopically for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Patients from our hip registry (n = 119) completed patient-reported outcome measures (PROMs) including the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity scale, 36-Item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at a minimum of 10 years after arthroscopy (range, 10-12 years). Results were compared with baseline scores using the Wilcoxon signed rank test. The associations among several prognostic factors, which included age, sex, Tönnis grade, and labral treatment, and subsequent conversion to total hip replacement (THR) or repeat hip arthroscopy (RHA) were analyzed using the chi-square analysis. Relationships between range of motion and radiological findings with clinical outcome were also examined using Pearson correlation analysis. Minimal clinically important difference (MCID) was calculated using a distribution method (0.5 standard deviation of the change score), and substantial clinical benefit (SCB) was determined using an anchor method. Finally, receiver operating characteristic curves with subsequent Youden index were used to determine cutoffs for PROMs, which equated to a Patient Acceptable Symptom State (PASS). Results: A total of 8.4% of cases required conversion to THR, and 5.9% required RHA. Statistically significant improvements in mHHS, SF-36, and WOMAC scores, with high satisfaction (90%), were observed 10 years after surgery. No significant change was seen in activity level (UCLA score) despite patients being 10 years older. A high percentage of patients achieved MCID for mHHS (88%), SF-36 (84%), and WOMAC (60%). The majority of patients also achieved PASS (62% for mHHS, 85% for UCLA, 78% for SF-36, and 84% for WOMAC) and SCB (74% for mHHS, 58% for UCLA, 52% for SF-36, and 56% for WOMAC). Conclusion: Arthroscopic intervention is a safe and viable treatment option for patients with symptomatic FAI, and patients can expect long-term improvements and high satisfaction. Results indicated a high satisfaction (90%) and survivorship rate (91.6%), with excellent clinical outcome, 10 years after the initial procedure.

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Section: Discussionmentioning

confidence: 99%

Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

Carton

Filan²,

Mullins³

2021

Am J Sports Med

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“…A recent retrospective comparative study, reported that 46 % of the patients with Tönnis grade 2 or 3 hip osteoarthritis treated with labral debridement and impingement survived at the end of 11 years of follow-up, and still advocated hip arthroscopy for younger (<40 years) and male patients even in the presence of osteoarthrosis (19) .…”

Section: Discussionmentioning

confidence: 99%

Kalça Osteoartritinde Artroskopik Debridman Sonrası Hasta Memnuniyeti ve Hastanın Beklentisi

Yanık¹,

Ali²,

Hapa³

2021

HIP

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Objective: The purpose of the present study was to evaluate the expectation and satisfaction of patients treated with hip arthroscopy for moderate to advanced hip osteoarthritis. Method: Eighteen patients with Tönnis grade 2 or 3 hip osteoarthritis who were treated with hip arthroscopy and followed up for at least one year, were included in the study. All patients received partial labrum debridement with limited rim excision (3-5mm), chondroplasty and excision of osteophytes/cam lesion. Demographic data, education level, VAS scores, time to the last follow-up, expectation and satisfaction levels were evaluated. Results: There was not any correlation between any parameters tested except a negative correlation between time to follow up and satisfaction level, time to follow-up and satisfaction point. When short-term follow-up patients were compared with longer term follow-up groups, patient satisfaction levels, and scores were higher. Conclusion: Satisfaction levels of patients, treated with arthroscopic debridement for advanced hip osteoarthritis, is dependent on the follow-up time. Patients are satisfied up to 2 years postoperatively.

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“…Likewise, another recent study found that hips with a Tönnis grade of more than 1 had as much as a 133% increased risk of converting to THA [51]. The role of age, as well as increased Tönnis grade, has called into question the appropriateness of arthroscopic hip surgery in an older population [4,[49][50][51][52][53]. While we support the contraindication of arthroscopic hip surgery in patients with advanced hip arthritis, as it is not amenable to hip preservation, we believe age may be less of a determinant than is generally argued.…”

Section: The Issue Of Agementioning

confidence: 95%

“…Two recent systematic reviews focused on hip arthroscopy outcomes in patients ages 40 years and older found that while there was an improvement in PROs the conversion to THA was as high as 30% 49,50 . Likewise, another recent study found that hips with a Tönnis grade of more than 1 had as much as a 133% increased risk of converting to THA [51]. The role of age, as well as increased Tönnis grade, has called into question the appropriateness of arthroscopic hip surgery in an older population [4,[49][50][51][52][53].…”

Section: The Issue Of Agementioning

confidence: 99%

Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy

White

Constantinides²

2022

Curr Rev Musculoskelet Med

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Purpose of Review The current review investigates outcomes and failure rates associated with arthroscopic circumferential allograft labral reconstruction of the hip, both as a revision and primary procedure in treating femoroacetabular hip impingement and labral-related pathology. Recent Findings Numerous studies within the last decade have demonstrated excellent patient-reported outcomes, high rates of return-to-play in athletes, and low failure rates in patients having undergone arthroscopic circumferential allograft labral reconstruction of the hip. Removal of chronically diseased and injured labral tissue can eliminate a significant pain-generator from the hip joint. Additionally, circumferential reconstruction of the labrum restores the hoop fiber strength and fluid seal akin to what would be seen with native, healthy labral tissue. Recent research has shown that arthroscopic circumferential allograft labral reconstruction may be used not only in the revision setting, but as a primary procedure. Circumferential labral reconstruction should be considered when a surgeon feels that the labrum is irreparable or has failed previous repair. Summary Arthroscopic circumferential allograft labral reconstruction of the hip can be utilized as treatment option not only in revision settings, but also in primary treatment for femoroacetabular impingement and labral pathology

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Osteoarthrosis, Advanced Age, and Female Sex Are Risk Factors for Inferior Outcomes After Hip Arthroscopy and Labral Debridement for Femoroacetabular Impingement Syndrome: Case Series With Minimum 10-Year Follow-Up

Cited by 38 publications

References 43 publications

Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

Kalça Osteoartritinde Artroskopik Debridman Sonrası Hasta Memnuniyeti ve Hastanın Beklentisi

Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy

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