Combined Borderline Acetabular Dysplasia and Increased Femoral Anteversion Is Associated With Worse Outcomes in Female Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Marland, Jennifer D.; Horton, Brandy S.; Smythe, Jason; West, Hugh S.; Wylie, James D.

doi:10.1016/j.arthro.2022.10.028

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…One avenue for future studies to consider is how retrotorsion or antetorsion may affect outcomes in the setting of different acetabular versions. As demonstrated by Chaharbakhshi et al 9 and Marland et al, 39 femoral antetorsion was an important risk factor but just in the setting of an abnormal acetabulum (borderline dysplastic). This may point to a negative effect of femoral torsion but one that is significant only when combined with deviations in acetabular version or acetabular coverage.…”

Section: Discussionmentioning

confidence: 90%

“…33 In combination with the complex interplay between torsion and other abnormal bony morphologies of the hip (ie, acetabular version, dysplasia), torsion may have an important effect on outcomes. 9,39 Whether femoral torsion abnormalities hold prognostic value remains poorly understood. In the literature, variability ranges from more favorable outcomes in patients with femoral retrotorsion 11 and femoral antetorsion 11 to no difference in outcomes based on torsion classification.…”

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confidence: 99%

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Effect of Differing Orientation and Magnitude of Femoral Torsion on Outcomes and Achievement of the MCID and PASS at 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

et al. 2023

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Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers’ compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively ( P < .01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs ( P≥ .515) and PRO values at 5-year follow-up ( P≥ .098). There were no significant differences in the achievement of the minimal clinically important difference ( P≥ .422) or Patient Acceptable Symptom State ( P≥ .161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study’s cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up.

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Section: Discussionmentioning

confidence: 90%