Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery

Wong, Stephanie E.; Newhouse, Alexander C.; Wichman, Daniel M.; Bessa, Felipe S.; Williams, Joel C.; Nho, Shane J.

doi:10.1016/j.arthro.2021.10.012

Cited by 9 publications

(11 citation statements)

References 23 publications

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confidence: 53%

“…Ó 9 Postoperative mHHS was 80 in the stable and 79 in the unstable group; similar scores were obtained for Hip Outcome Score (HOS)-Activities of Daily Living and HOS-Sport Scale. 9 MCID was achieved in 73% to 79% in the stable group and in 71% to 91% in the unstable group; PASS ranged from 59% to 65% in the stable and 55% to 63% in the unstable group. 9 The between-group differences were not statistically different, suggesting that patients with borderline dysplasia have very similar outcomes when compared with patients with a normal hip.…”

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confidence: 53%

“…9 MCID was achieved in 73% to 79% in the stable group and in 71% to 91% in the unstable group; PASS ranged from 59% to 65% in the stable and 55% to 63% in the unstable group. 9 The between-group differences were not statistically different, suggesting that patients with borderline dysplasia have very similar outcomes when compared with patients with a normal hip. Good news.…”

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confidence: 90%

“…In their series of 220 patients, 90% of patients with values above 1.3 were dysplastic. 8 Wong, Newhouse, Wichman, Bessa, Willialms, and Nho 9 have now reported clinical outcomes in patients with borderline dysplasia undergoing hip arthroscopy for femoroacetabular impingement. In their study titled…”

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confidence: 99%

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Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement in Patients With Borderline Dysplasia Does Not Result in Inferior Outcomes Compared With Outcomes in Patients Without Dysplasia: Do Not Fear

Hohmann¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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confidence: 53%

Section: See Related Article On Page 1509supporting

confidence: 53%

Section: See Related Article On Page 1509mentioning

confidence: 90%

Section: See Related Article On Page 1509mentioning

confidence: 99%

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Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement in Patients With Borderline Dysplasia Does Not Result in Inferior Outcomes Compared With Outcomes in Patients Without Dysplasia: Do Not Fear

Hohmann¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The Femoro-Epiphyseal Acetabular Roof (FEAR) index has been proposed as a useful tool in identifying hips with instability in the setting of borderline acetabular dysplasia and is becoming increasingly used in multiple settings. 24 , 27 – 29 Wyatt et al 29 defined the FEAR index as the angle between a line connecting the most medial and lateral parts of the sourcil and a line connecting the most medial and lateral parts of the straight central third of the femoral head physeal scar. In the original study, FEAR was internally validated in a mixed cohort (mean LCEA, 13.7°) of classic acetabular dysplasia (LCEA, <20°) and borderline acetabular dysplasia (LCEA, 20°-25°), which may increase its sensitivity and specificity and not reflect performance in the setting of borderline dysplasia alone.…”

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confidence: 99%

External Validation of the FEAR Index in Borderline Acetabular Dysplasia

Schwabe

Clohisy

Graesser

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Given the lack of established, externally validated criteria for the diagnosis of unstable hips, the Femoro-Epiphyseal Acetabular Roof (FEAR) index has been proposed as a useful tool for identifying hips with instability in the setting of borderline acetabular dysplasia. Purposes: To (1) determine the external performance of the FEAR index in identifying hips with a clinical diagnosis of instability in the setting of borderline dysplasia and (2) assess the performance of the FEAR index compared with acetabular inclination or physeal scar angle alone. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors reviewed 176 patients with borderline acetabular dysplasia (lateral center-edge angle, 20°-25°). A positive FEAR index was defined as ≥5°. An alternative threshold ≥2° was also assessed. Significant instability was determined by the senior surgeon based on the combination of patient and radiographic features; unstable hips were treated with periacetabular osteotomy (with or without hip arthroscopy), and stable hips were treated with isolated hip arthroscopy. Results: Only 18% of borderline hips had a positive FEAR index. The ≥5° positive FEAR index threshold had a sensitivity of 33% (23/70) and specificity of 92% (98/106) in predicting the clinical diagnosis of instability. The ≥2° FEAR index threshold had a sensitivity of 39% (27/70) and specificity of 89% (94/106) in predicting the clinical diagnosis of instability. No alternative threshold for the FEAR index resulted in high levels of sensitivity and specificity. A threshold of –5° was required to reach an adequate sensitivity of 74%. The FEAR index remained a significant predictor of hip instability even after controlling for acetabular inclination (odds ratio, 1.12; P < .001) or physeal scar angle (odds ratio, 1.6; P < .001). Conclusion: In the current study, a positive FEAR index was generally indicative of the presence of clinical instability, but the FEAR index alone remained inadequate to fully define the instability of a given hip, as it demonstrated low sensitivity (only 33%) in the external validation. The FEAR index is best used in the context of other clinical and radiographic features.

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The Radiographic Femoroepiphyseal Acetabular Roof Index Is a Reliable and Reproducible Diagnostic Tool in Patients Undergoing Hip-Preservation Surgery: A Systematic Review

Cohen

Ifabiyi

Mathewson

et al. 2023

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery

Cited by 9 publications

References 23 publications

Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement in Patients With Borderline Dysplasia Does Not Result in Inferior Outcomes Compared With Outcomes in Patients Without Dysplasia: Do Not Fear

Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement in Patients With Borderline Dysplasia Does Not Result in Inferior Outcomes Compared With Outcomes in Patients Without Dysplasia: Do Not Fear

External Validation of the FEAR Index in Borderline Acetabular Dysplasia

The Radiographic Femoroepiphyseal Acetabular Roof Index Is a Reliable and Reproducible Diagnostic Tool in Patients Undergoing Hip-Preservation Surgery: A Systematic Review

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