Good Outcome Scores and Low Conversion Rate to THA 10 Years After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement

Abstract

Background Arthroscopic treatment of symptomatic femoroacetabular impingement (FAI) has promising short-term to mid-term results. In addition to treating acute pain or impaired function, the goal of hip-preserving surgery is to achieve a lasting improvement of hip function and to prevent the development of osteoarthritis. Long-term results are necessary to evaluate the effectiveness of surgical treatment and to further improve results by identifying factors associated with conversion to THA. Questions/purposes (1) How do the Merle d’Aubigné-Postel scores change from before surgery to follow-up of at least 10 years in patients undergoing hip arthroscopy for the treatment of FAI? (2) What is the cumulative 10-year survival rate of hips with the endpoints of conversion to THA or a Merle d’Aubigné-Postel score less than 15? (3) Which factors are associated with conversion to THA? Methods Between 2003 and 2008, we treated 63 patients (65 hips) for symptomatic FAI with hip arthroscopy at our institution. During that period, the indications for using arthroscopy were correction of anterior cam morphology and anterolateral rim trimming with debridement or reattachment of the labrum. We excluded patients who were younger than 16 years and those who had previous trauma or surgery of the hip. Based on that, 60 patients (62 hips) were eligible. A further 17% (10 of 60) of patients were excluded because the treatment was purely symptomatic without treatment of cam- and/or pincer-type morphology. Of the 50 patients (52 hips) included in the study, 2% (1) of patients were lost before the minimum study follow-up of 10 years, leaving 49 patients (51 hips) for analysis. The median (range) follow-up was 11 years (10 to 17). The median age at surgery was 33 years (16 to 63). Ninety percent (45 of 50) of patients were women. Of the 52 hips, 75% (39 of 52) underwent cam resection (femoral offset correction), 8% (4 of 52) underwent acetabular rim trimming, and 17% (9 of 52) had both procedures. Additionally, in 35% (18 of 52) of hips the labrum was debrided, in 31% (16 of 52) it was resected, and in 10% (5 of 52) of hips the labrum was reattached. The primary clinical outcome measurements were conversion to THA and the Merle d’Aubigné-Postel score. Kaplan-Meier survivorship and Cox regression analyses were performed with endpoints being conversion to THA or Merle d’Aubigné-Postel score less than 15 points. Results The clinical result at 10 years of follow-up was good. The median improvement of the Merle d’Aubigné-Postel score was 3 points (interquartile range 2 to 4), to a median score at last follow-up of 17 points (range 10 to 18). The cumulative 10-year survival rate was 92% (95% CI 85% to 99%) with the endpoints of conversion to THA or Merle d’Aubigné-Postel score less than 15. Factors associated with conversion to THA were each year of advancing age at the time of surgery (hazard ratio 1.1 [95% CI 1.0 to 1.3]; p = 0.01) and preoperative Tönnis Grade 1 compared with Tönnis Grade 0 (no sign of arthritis; HR 17 [95% CI 1.8 to 166]; p = 0.01). Conclusion In this series, more than 90% of patients retained their native hips and reported good patient-reported outcome scores at least 10 years after arthroscopic treatment of symptomatic FAI. Younger patients fared better in this series, as did hips without signs of osteoarthritis. Future studies with prospective comparisons of treatment groups are needed to determine how best to treat complex impingement morphologies. Level of Evidence Level IV, therapeutic study.

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

“…This is short term in the context of young adults with most of their life still to live with the affected hip or hips. Observational studies have demonstrated good outcomes from HA at 5 and 10 years [ 28 , 34 ], but we look forward to the long-term results of the randomized trials in this review.…”

Limited External Rotation and Hip Extension Due to Posterior Extra-articular Ischiofemoral Hip Impingement in Female Patients With Increased Femoral Anteversion: Implications for Sports, Sexual, and Daily Activities

“…In comparison to previous studies 6,28,46 that reported clinical measurements of ROM in hips with FAI or hip dysplasia, 27 the method in the current study had the following advantages: It provided more accurate and anatomically based quantification of ROM because clinical assessment is subject to error, 9 it identified motion patterns (posterior impingement in 20°of extension combined with 20°of ER) (Figure 3) instead of isolated amplitudes of ROM, and it detected the corresponding acetabular and femoral impingement location.…”

Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: A systematic review and meta-analysis

“…In patients undergoing arthroscopy and osteochondroplasty, one out of six patients over 40 years old opted for total hip arthroplasty at two years 28 . Meanwhile, in younger patients, the prognosis was better 29 . Some risk factors for conversion to arthroplasty were age, level of chondral damage, femoral osteoplasty, smoking, and in ammatory joint diseases, among others 30,31 .…”