Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

Abstract

Background: Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. Purpose: To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. Study Design: Systematic review; Level of evidence, 4. Methods: The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. Results: Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement ( P < .0001), preoperative acetabular index ( P = .01), and BMI ( P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. Conclusion: Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.

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“…Overall, the rate of revision surgical procedures was 5.29% (351 of 6,641 patients) and the rate of progression to THA was 3.78% (263 of 6,966 patients). Concomitant labral debridement (compared with labral repair) and higher preoperative acetabular index showed a significant positive and strong association with an increased rate of progression to THA, and BMI at baseline showed a significant positive and moderate association with increased rates of THA 17 .…”

“…In the case of failed conservative treatment for femoroacetabular impingement, surgical treatment is often recommended, although risk factors for a revision surgical procedure and/or progression to total hip arthroplasty (THA) are unclear. Migliorini et al 17 completed a systematic review to assess potential risk factors associated with outcomes following surgical treatment of femoroacetabular impingement, including patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and preoperative and postoperative scores. A total of 99 studies consisting of 9,357 procedures and 8,897 patients, with a mean age 33.4 years and a mean body mass index (BMI) of 24.8 kg/m 2 , were included in the analysis; median follow-up time was 30.9 months.…”

Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis

“…Classified by pathology, there are three morphologies of FAI: (1) cam-type morphology with an aspherical femoral head; (2) pincer-type morphology with an over coverage of the femoral head; and (3) mixed-type morphology which has both pincer and cam type, is the most common morphology. Because of the abnormal contact between femur and acetabulum, it will cause focal cartilage defects, cartilage delamination, chondrolabral separation and labral tears, eventually leading to hip osteoarthritis [ 6 – 8 ].…”

Hyperlipidemia does not influence clinical outcome in arthroscopic treatment of femoroacetabular impingement syndrome

“…Though good clinical effects were achieved after surgery [8,9]. Many demographic factors can influence the clinical outcomes of hip arthroscopy, such as higher age, higher BMI, and female patients [10][11][12][13][14], of which obesity demonstrated a twofold increased risk of conversion to total hip arthroplasty [15].…”