Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

Abstract

Background:Validated patient-reported outcome measures (PROMs) of hip pain and function at the time of arthroscopy could be predictors of the final outcome. Little is known about how patient factors or pathologic intra-articular findings relate to hip pain or function at the time of surgery for those presenting with femoroacetabular impingement (FAI).Purpose:To evaluate all patient and operative factors that contribute to hip pain and dysfunction in patients with FAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective cohort of patients undergoing hip arthroscopy for FAI were electronically enrolled between February 2015 and September 2016. Baseline PROMs were collected, including Hip disability and Osteoarthritis Outcome Score (HOOS) for pain, HOOS–Physical Function Shortform (HOOS-PS), Veterans RAND 12-Item Health Survey (VR-12), and University of California–Los Angeles (UCLA) Activity Score. Surgeons documented intra-articular operative findings and treatment. Multivariable linear regression models were created for continuous scores of HOOS pain, HOOS-PS, and VR-12 Physical Component Score as outcome measures. Risk factors included patient characteristics and intraoperative anatomic and pathologic findings.Results:During the study period, 396 patients underwent arthroscopic hip procedures, and 373 (94%) completed preoperative PROMs; 331 patients were undergoing arthroscopic surgery for FAI. The mean patient age was 32.91 ± 12.49 years, mean body mass index was 26.22 ± 4.92 kg/m2, and 71% were female. Multivariate analyses demonstrated female sex, lower education levels, smoking, lower mental health scores, and lower activity-level scores predicted HOOS pain preoperatively. According to multivariate analysis, patient factors associated with worse baseline HOOS-PS include smoking, additional years of education, lower mental health, and activity scores. Lower baseline VR-12 functional scores were predicted by female sex, elevated body mass index, smoking, and lower activity levels. For all baseline PROMs, there was no instance where an arthroscopic variable or pathologic finding proved statistically significant after the important patient covariates were controlled for.Conclusion:Patient factors, including mental health, activity level, sex, and smoking, are more predictive of baseline hip pain (as measured by HOOS) and function than are intra-articular findings (eg, status of the labrum or articular cartilage) during hip arthroscopy for FAI. Future studies evaluating patient outcomes after surgery for FAI should consider adjusting for these identified patient factors to accurately interpret the effect of treatment on patient-reported outcomes after surgery.

No Evidence of Systemic Inflammation in Symptomatic Patients With Femoroacetabular Impingement

“…), further supporting the lack of correlation between sFLCs and markers of disease severity. An important consideration when using PROMs is the importance of patient characteristics, such as mental health, activity level, smoking status, and sex in determining outcomes, rather than just underlying pathophysiology . Interestingly, although sFLCs did not correlate with FAI symptoms in this study, CRP has previously been shown to correlate with symptoms in osteoarthritis .…”

“…An important consideration when using PROMs is the importance of patient characteristics, such as mental health, activity level, smoking status, and sex in determining outcomes, rather than just underlying pathophysiology. 38 Interestingly, although sFLCs did not correlate with FAI symptoms in this study, CRP has previously been shown to correlate with symptoms in osteoarthritis. 10 This could be explained by systemic inflammation playing less of a role in FAI than osteoarthritis, or perhaps due to the different inflammatory pathways stimulating CRP and sFLC production.…”

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

“…35 Psychological distress and mental health disease are increasingly recognized as significant influences on pain and function associated with orthopedic conditions. 21,[36][37][38][39][40] In a previous study, preoperative predictors of increased baseline (preoperative) pain and decreased baseline function included mental health, activity level, sex, and smoking. 21 Psychological distress was reported to negatively affect both baseline hip pain and function scores at the time of hip arthroscopy.…”

“…21,[36][37][38][39][40] In a previous study, preoperative predictors of increased baseline (preoperative) pain and decreased baseline function included mental health, activity level, sex, and smoking. 21 Psychological distress was reported to negatively affect both baseline hip pain and function scores at the time of hip arthroscopy. 41 Poor mental health scores were subsequently identified as independent risk factors for increased baseline pain prior to hip arthroscopy.…”

“…[15][16][17][18][19][20] Preoperative predictors of clinically significant sport function level at 2 years after hip arthroscopy are unclear. Westermann and colleagues 21 identified that mental health, activity level, sex, and smoking predict greater baseline pain and decreased baseline function before hip arthroscopy; however, the authors did not evaluate the efficacy of the intervention or predictors of postoperative pain and function. Furthermore, as with other previous studies, the authors did not identify preoperative variables predictive of achieving high sportsspecific functional status after undergoing hip arthroscopy for FAIS in athletic patients.…”