Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty

Dukas, Alex G.; Gupta, Andrew; Peters, Christopher L.; Aoki, Stephen K.

doi:10.1007/s12178-019-09572-4

Cited by 13 publications

(8 citation statements)

References 59 publications

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“…In the past decade, hip arthroscopy has shown a drastic rise in utilization and has become one of the fastest growing orthopaedic procedures in the United States [8, 38]. The procedure is indicated for a number of hip pathologies such as femoroacetabular impingement (FAI) and labral tears [8, 13, 15, 27]. High patient satisfaction and return to activity rates have been reported for patients with FAI following hip arthroscopy [11, 13, 16, 25, 33].…”

Section: Introductionmentioning

confidence: 99%

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

Bovonratwet

Boddapati

Nwachukwu

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to determine the association between operative duration and short‐term complications as well as overnight hospital admission following hip arthroscopy. MethodsHip arthroscopy cases from 2006 to 2016 were retrieved from the National Surgical Quality Improvement Program registry, which prospectively collects 30‐day postoperative complications. Patients were stratified into the following groups based on procedure length: group 1 (< 60 min), group 2 (60–120 min), and group 3 (> 120 min). Preoperative characteristics were compared across the cohorts. Multivariate regressions were used to compare complication rates and overnight hospital admission between the three groups. Independent risk factors for overnight hospital admission were characterized. ResultsA total of 2129 hip arthroscopy cases were identified. Average operative duration was 99.3 ± 55.7 min. As operative time increased, patients were more likely to be younger, male, and had lower American Society of Anesthesiologists (ASA) class (p < 0.001). Body mass index and comorbidity profiles were similar across the patient cohorts, with the exception of hypertension being more prevalent in the shorter operative time cohort (p < 0.001). Patients in group 3 were more likely to stay overnight in the hospital (26.0%) compared to patients in groups 1 (7.7%) and 2 (10.9%), p < 0.001). All postoperative complication rates were otherwise similar between the cohorts. Independent risk factors for overnight hospital admission included increasing operative time (most notably > 120 min relative to < 60 min, relative risk [RR] = 3.53, 95% CI 2.50–5.00, p < 0.001) and increasing ASA classification (most notably ASA III or IV relative to ASA I, RR = 1.64, 95% CI 1.18–2.27; p = 0.013). ConclusionsIncreasing operative duration was not associated with increased postoperative complications following hip arthroscopy. However, patients were more than three times likely to stay in the hospital overnight if their surgery was longer than 120 min, relative to cases that were less than 60 min. Level of evidenceIII.

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Section: Introductionmentioning

confidence: 99%

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

Bovonratwet

Boddapati

Nwachukwu

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Along with the findings of the present study, we propose that patients with low PI may in fact be the most likely candidates to benefit from hip arthroscopy, as targeted decompression osteoplasties may effectively alleviate osseous impingement and restore native hip biomechanics to reconstitute compensatory range of motion without pain. 8 Conversely, patients with high PI have been previously labeled as ''spine users.'' This subset of patients has been hypothesized to possess more baseline lumbopelvic mobility, making them less dependent on hip motion and less prone to impingement-specific symptoms even with radiographic evidence of FAI.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears

Torabian,

Cherian,

Eberlin

et al. 2024

Am J Sports Med

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Background: In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. Purpose: To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. Results: A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT ( P = .001), SS ( P < .001), acetabular version ( P < .001), and acetabular inclination ( P = .049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI.

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“…The concept of FAIS is not new 1. Indeed, the understanding of FAIS has enormously increased,2 thus surgical management has progressed rapidly with a transition from open (surgical dislocation/mini-open) to arthroscopic surgery of the hip 3. In that context, evolution of hip arthroscopy in the last decade has been formidable,4 representing an unique microcosm within sports medicine 5…”

Section: Femoroacetabular Impingement Syndrome (Fais) and Hip Arthros...mentioning

confidence: 99%

Efficacy and Economics of Arthroscopic Surgical Treatment of Femoroacetabular Impingement Syndrome

Maldonado

Domb

2020

Techniques in Orthopaedics

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Hip arthroscopy has emerged as a highly popular and minimally invasive treatment of femoroacetabular impingement syndrome and labral tears by correcting the femoral and acetabular morphology and addressing the chondrolabral pathology. It has been reported to lead to significant improvements of patient-reported outcomes with minimal complications at short-term, mid-term, and longterm follow-up in addition to having low rates of secondary surgeries. As a result, rates of hip arthroscopy have increased dramatically, both in the United States and worldwide. Albeit these favorable outcomes of hip arthroscopy have been well-established, its cost-effectiveness has not yet been as well defined. However, even in the scenario of limited resources of today's health care, new data has shown that this procedure is truly cost-effective.

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Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty

Cited by 13 publications

References 59 publications

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears

Efficacy and Economics of Arthroscopic Surgical Treatment of Femoroacetabular Impingement Syndrome

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