Ten-year outcome following surgical treatment of femoroacetabular impingement

Abstract

Aims The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome. Methods Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome. Results At a mean follow-up of 7.5 years (SD 2.5), there were 43 failures in 38 hips (9.7%), with 35 hips (8.9%) having one failure mode, one hip (0.25%) having two failure modes, and two hips (0.5%) having three failure modes. The five- and ten-year hip joint preservation rates were 94.1% (SD 1.2%; 95% confidence interval (CI) 91.8 to 96.4) and 90.4% (SD 1.7%; 95% CI 87.1 to 93.7), respectively. Inferior survivorship was detected in the surgical dislocation group. Age at surgery, Tönnis grade, cartilage damage, and absence of rim-trimming were associated with improved preservation rates. Only Tönnis grade was an independent predictor of hip preservation. All PROMs improved postoperatively. Factors associated with improvement in PROMs included higher lateral centre-edge and α angles, and lower retroversion index and BMI. Conclusion FAI surgery provides lasting improvement in function and a joint preservation rate of 90.4% at ten years. The evolution of practice was not associated with inferior outcome. Since degree of arthritis is the primary predictor of outcome, improved awareness and screening may lead to prompt intervention and better outcomes. Cite this article: Bone Jt Open 2022;3(10):804–814.

Hip Arthroscopic Surgery With Chondrolabral Refixation, Osteochondroplasty, and Routine Capsular Closure for Femoroacetabular Impingement Syndrome: Clinical Outcomes at a Minimum 10-Year Follow-up

“…As techniques in hip arthroscopic surgery continue to evolve, it is important to evaluate whether such changes translate to improved outcomes. Grammatopoulos et al 25 reported 10-year outcomes including patients who underwent open treatment with surgical hip dislocation, combined open and arthroscopic treatment, arthroscopic labral debridement, and arthroscopic labral repair and did not find, in their case series, clear relationships between the technique and outcomes. However, it is known now that correction of bony morphology is critical, labral debridement is inferior to repair, and capsular closure is paramount to better clinical outcomes.…”

“…Although there are valuable longer-term studies on hip arthroscopic surgery in the literature, many that are currently available report on cases in which contemporary techniques were not employed. For example, previous long-term follow-up studies have described surgical techniques that approach the central compartment only, 8 perform debridement or resection of the labrum as opposed to repair as a major treatment method, 7,19,25,40,72 utilize open techniques, 25 and do not include or specify capsular closure/repair. 10,49,71,72 Moreover, many of these studies are limited by a low rate (<50%) of follow-up, which may bias results.…”

“…35,39,49 Previously published long-term clinical outcomes assessing the efficacy of hip arthroscopic surgery for the treatment of FAIS have necessarily included patients without capsular repair and/or labral repair when such procedures would be indicated in modern practice. [17][18][19][20][21][22][23][24][25] As a result, these investigations do not reflect the long-term findings associated with contemporary techniques for the treatment of FAIS, including surgical correction of pathomorphology, chondrolabral refixation, and capsular management. The current literature supports that hip arthroscopic surgery for FAIS has reliable short-and midterm patient-reported outcomes (PROs) and clinical success, 2,15,30,38,43,52,57,70 including in athletes 11,12,59 and adolescents, 31,42 among other unique populations.…”

Functional Outcome Scores and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients With Tönnis Grade 1 Versus Grade 0 Arthritis: A Propensity-Matched Study at Minimum 10-Year Follow-up

“…This study has numerous strengths. First, although long-term studies on hip arthroscopy for FAIS currently exist in the literature, many report on cases in which contemporary hip arthroscopy techniques were not used, and older techniques such as open techniques, 22 the majority of labral treatment was debridement, 6,20,22,38,64 and no capsular management were performed. 9,44,63,64 To our knowledge, this is the first 10-year investigation that uses contemporary approaches (ie, labral repair, capsular closure, femoral osteochondroplasty) specifically comparing patients with To ¨nnis grade 0 versus grade 1.…”

Revealing a Natural Model of Pre-Osteoarthritis of the Hip Through Study of Femoroacetabular Impingement

“…Surgical interventions for treating FAI are focused on labrum repair and osteochondroplasty to remove the impingement and alleviate symptoms. Femoroacetabular impingement surgery is reported to provide lasting improvements in function and a joint preservation rate of 90.4% at 10 years [14]. Nevertheless, some patients progress to hip OA after surgery.…”