Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations

Abstract

To describe the recovery trajectory in a group of relatively older borderline dysplastic female femoroacetabular impingement syndrome (FAIS) patients following arthroscopic surgery, to determine if outcomes in this group differs from females with different age and bony morphology characteristics. Four subgroups were created to define (i) older females (>35 years), borderline dysplastic (lateral center edge angle [LCEA] ≤ 25 degrees) and anterior wall index (AWI) deficient (AWI ≤ 0.40) (older, borderline dysplastic, anterior wall deficient [ODD, reference]); (ii) younger (≤35 years), borderline dysplastic (LCEA ≤ 25 degrees) and deficient anterior wall (AWI ≤ 0.40) (younger, borderline dysplastic, anterior wall deficient [YDD]); (iii) older (>35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (older, non-dysplastic, non-deficient anterior wall [ONN]); and (iv) younger (≤35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (younger, non-dysplastic, non-deficient anterior wall [YNN]). One hundred and seventy-three female patients were included. Comparing mean scores, the ODD group reported significantly lower International Hip Outcome Tool (iHOT-12) change scores compared with the ONN group [23.58 ± 9.73; P = 0.03] at 12 months. ODD group also demonstrated significantly lower iHOT-12 change scores compared with the ONN (27.62 ± 8.22; P < 0.01) and YNN (25.39 ± 7.68; P < 0.01) groups at 24 months. Relatively older females with borderline dysplasia and anterior acetabular wall deficiencies had poorer iHOT-12 outcomes at both 12 and 24 months post-operatively compared with other female subgroups. In the absence of hip dysplasia and anterior wall deficiencies, superior iHOT-12 outcomes were observed in both older and younger females post-operatively.

The Natural Course of Recovery After Hip Arthroscopy for Femoroacetabular Impingement According to the International Hip Outcome Tool–12 and Hip Outcome Score Sports Subscale

“…Previous studies have examined recovery after hip arthroscopy using pain and validated PROs and found significant improvement occurring in the first 3 months, with a majority of patients achieving a clinically significant outcome at 1- and 2-year follow-up. 8,34 Patient factors such as older age, female sex, and elevated body mass index (BMI) have been associated with worse postoperative outcomes. 16 Similarly, preoperative factors such as preoperative narcotic use, workers’ compensation status, higher lateral center-edge angle, and osteoarthritic changes have been shown to predict negative outcomes, and response to intra-articular injections has been shown to be a predictor of positive outcomes.…”

Validation of the Dutch version of the Hip Outcome Score; validity, reliability, and responsiveness in patients with femoroacetabular impingement syndrome

“…Study population consisted of all consecutive patients with FAIS, derived from the orthopedic outpatient department from the two participating hospitals. Inclusion criteria were age between 18–65 years, a physical and radiological examination that confirms FAIS without severe osteoarthritis (≥Tönnis grade 3) [ 9 ], conservative treatment of FAIS of at least 6 months and physical activity. Exclusion criteria were patients with prior surgery to the hip for FAIS, a pathological fracture of the hip or other metastatic pathology and patients not speaking the Dutch language or refusing to participate.…”

Borderline Dysplastic Hips Undergoing Hip Arthroscopy Achieve Equivalent Patient Reported Outcomes When Compared With Hips With Normal Acetabular Coverage: A Systematic Review and Meta-Analysis

“…15,[18][19][20][21][22] Seven additional studies presenting associations between LCEA and PRO measures were identified but provided insufficient data to be included in a meta-analysis. [23][24][25][26][27][28][29] All associations for which there was insufficient data to perform meta-analysis are listed in Supplemental Table 4 (http://links.lww.com/JAAOS/A849). These studies were excluded as, for each PRO, there were fewer than the minimum three studies required for quantitative synthesis reporting data in the same format-such as odds ratios or mean 6 SD-thus prohibiting meta-analysis.…”