Immediate Versus Delayed Hip Arthroscopy for Femoroacetabular Impingement: An Expected Value Decision Analysis

Mehta, Manisha; Hoffer-Hawlik, Michael A.; O’Connor, Michaela; Lynch, T. Sean

doi:10.5435/jaaosglobal-d-20-00206

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…Ouyang et al 25 reported that younger age at surgery results in earlier achievement of clinically meaningful improvement after hip arthroscopy. Similarly, Mehta et al 22 reported that immediate hip arthroscopy results in significantly better outcomes due to immediate restoration of good function when compared with delayed hip arthroscopy. Delayed hip arthroscopy may result in rapidly progressive arthritis in some patients, and earlier evaluation may be key in limiting chondral damage from large cam lesions in FAIS.…”

Section: Discussionmentioning

confidence: 95%

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis

Ramkumar

Berrier

Helm

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources. Purpose: To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated. Results: Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient. Conclusion: Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.

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Section: Discussionmentioning

confidence: 95%

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis

Ramkumar

Berrier

Helm

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…In a recent study, Mehta et al 24 showed that immediate hip arthroscopy is preferred over delayed arthroscopy for FAI, with restoration of good function postoperatively being the most notable contributor to this difference. A cutoff with which to optimize outcomes for patients, and particularly athletes with bilateral symptoms requiring surgical intervention, is unavailable.…”

Section: Discussionmentioning

confidence: 99%

Accelerated Bilateral Hip Arthroscopy (1 Week Apart): Outcomes Compared With Delayed Bilateral Procedure (4-12 Weeks) and Case-Control Matched Unilateral Arthroscopy

2023

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Background: Staged bilateral hip arthroscopy is an option for athletes who have symptomatic bilateral femoroacetabular impingement; however, the optimal timing of the second procedure is unknown. Purpose: To evaluate minimum 2-year outcomes for patients undergoing accelerated bilateral arthroscopy against those undergoing (1) delayed bilateral and (2) unilateral arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of prospectively collected data from patients undergoing bilateral primary hip arthroscopy for femoroacetabular impingement between 2009 and 2022. Inclusion criteria entailed competitive athletes with concurrent bilateral symptoms at initial presentation. Exclusion criteria (either hip) were Tönnis grade >1, dysplasia (lateral center-edge angle <25°), Perthes disease, protrusio acetabuli, and avascular necrosis. Two groups were established based on the duration between procedures: within 7 days (accelerated group) and within 4 to 12 weeks (delayed group). Patients from the accelerated group were matched in a 1:2 ratio with patients undergoing unilateral surgery based on age ±2 years, sex, and athletic status. Minimum 2-year postoperative patient-reported outcomes (PROs) (including modified Harris Hip Score, University of California Los Angeles activity scale, 36-Item Short Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index), rates of achieving the minimal clinically important difference, rates of continuing to play main sport, and satisfaction were compared between groups. Results: A total of 131 athletes (262 hips) with bilateral femoroacetabular impingement were included: 91 in the accelerated group and 40 in the delayed group. Duration between surgeries was 0.99 ± 0.02 and 6.35 ± 2.18 weeks, respectively. All accelerated athletes were each successfully matched to 2 athletes with unilateral procedures (N = 182). All 3 groups demonstrated significant improvement from baseline across all PROs ( P < .001 for all). Acquired change in PROs was similar and not significantly different between groups ( P > .05). Satisfaction with relief from pain was achieved by 85.9% of patients in the accelerated group compared with 83.1% in the delayed group ( P = .053) and 87.3% in the unilateral group ( P = .933). The minimal clinically important difference for the modified Harris Hip Score was achieved by 84.9% of patients in the accelerated group compared with 91.5% in the delayed group ( P = .212) and 87.6% in the unilateral group ( P = .456). At 2 years postoperatively, the continue-to-play rate was 73.6% for the accelerated group compared with 77.1% for the delayed group ( P = .577) and 73.0% for the unilateral group ( P = .903). There were no increased complications associated with the accelerated group. Conclusion: Accelerated bilateral hip arthroscopy 1 week apart was a safe and effective treatment option for athletes with bilateral symptoms. Improvement in PROs and continue-to-play rates were comparable with those after a delayed duration between procedures and with those case-control matched athletes undergoing unilateral arthroscopy.

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“…Labral reconstruction should be considered for patients with symptomatic labral pathology that is not amenable to repair (Table 1). Prompt surgical treatment has been shown to lead to better hip functionality and decreased risk of revision procedures when compared to conservative and delayed operative management [25,26]. However, a trial of conservative management is often wise depending on the duration or severity of symptoms and other factors such as urgency of need for return to sport, work, or activities of daily living.…”

Section: Indicationsmentioning

confidence: 99%

Hip Labral Reconstruction: Techniques and Outcomes

Green

Salfiti²,

Wolff³

2021

Curr Rev Musculoskelet Med

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Purpose of Review With increased understanding of the biomechanical function of the acetabular labrum, more attention has been directed towards surgical techniques that preserve or restore normal joint anatomy. While labral repair has been shown to produce superior outcomes to labral debridement, repair is not always possible in the setting of severe labral intrasubstance tearing or deficiency. These patients were previously left without suitable arthroscopic treatment options. Recent Findings Labral reconstruction is an emerging procedure that has been shown to offer promising outcomes for traditionally difficult-to-treat hip pathology. Short-and mid-term follow-up studies have consistently demonstrated significant improvement in patient-reported outcomes, function, and patient satisfaction postoperatively, often despite less favorable preoperative characteristics. Summary Labral reconstruction is a viable arthroscopic treatment option that has been shown to reliably produce clinically meaningful results in patients with severe labral pathology that is not amenable to repair/refixation or augmentation.

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Immediate Versus Delayed Hip Arthroscopy for Femoroacetabular Impingement: An Expected Value Decision Analysis

Cited by 4 publications

References 31 publications

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis

Accelerated Bilateral Hip Arthroscopy (1 Week Apart): Outcomes Compared With Delayed Bilateral Procedure (4-12 Weeks) and Case-Control Matched Unilateral Arthroscopy

Hip Labral Reconstruction: Techniques and Outcomes

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