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Radiographic outcomes following femoroacetabular impingement correction with open surgical management: a systematic review.

ABSTRACT: Femoroacetabular impingement (FAI) is a common cause of hip pain, and open surgical approaches remain an important treatment option for FAI. This systematic review of the literature sought to determine what post-operative radiographic outcomes have been reported following open surgical correction of FAI. After screening and full-text review, 18 studies involving 1192 hips in 1084 patients were included for analysis. In total, 24 radiological outcomes were reported. CAM-type FAI was most frequently assessed using the alpha angle (61.1 %) and head-neck offset/head-neck offset ratio (33.3 %). Lateral center edge angle (27.8 %) and the acetabular index (22.2 %) were the most commonly reported outcomes for pincer-type FAI. The results of this review suggest that reporting of post-operative radiographic outcomes is variable, that no single radiographic parameter is optimal, and that the clinician must use a combination of reproducible measurements, together with their clinical examination, to confirm adequate restoration of normal hip morphology.

SUBMITTER: Martin RK

PROVIDER: S-EPMC5127945 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Radiographic outcomes following femoroacetabular impingement correction with open surgical management: a systematic review.

Martin R Kyle RK Dzaja Ivan I Kay Jeffrey J Memon Muzammil M Duong Andrew A Simunovic Nicole N Ayeni Olufemi R OR

Current reviews in musculoskeletal medicine 20161201 4

Femoroacetabular impingement (FAI) is a common cause of hip pain, and open surgical approaches remain an important treatment option for FAI. This systematic review of the literature sought to determine what post-operative radiographic outcomes have been reported following open surgical correction of FAI. After screening and full-text review, 18 studies involving 1192 hips in 1084 patients were included for analysis. In total, 24 radiological outcomes were reported. CAM-type FAI was most frequent ...[more]

PMID: 27581791

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Project description:BackgroundFemoroacetabular 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.PurposeTo 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 designSystematic review; Level of evidence, 4.MethodsThe 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.ResultsData 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.ConclusionAlthough 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.

Project description:Purpose To evaluate the influence of spinopelvic parameters on short-term postoperative patient-reported outcomes (PROs) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS). Methods Patients undergoing primary hip arthroscopy between January 2012 and December 2015 were retrospectively reviewed. Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sports-Specific Subscale, modified Harris Hip Score, International Hip Outcome Tool-12, and visual analog scale pain were recorded preoperatively and at final follow-up. Lumbar lordosis (LL), pelvic tilt (PT), sacral slope, and pelvic incidence (PI) were measured on lateral radiographs in standing position. Patients were split into subgroups for individual analyses based on previous literature cutoffs: |PI-LL|> or <10°, PT> or <20°, and PI <40°, 40° < PI < 65°, and PI >65°. PROs and rate of achievement of patient acceptable symptom state (PASS) were compared between subgroups at final follow-up. Results Sixty-one patients who underwent unilateral hip arthroscopy were included in the analysis, and 66% of patients were female. Mean patient age was 37.6 ± 11.3 years, whereas mean body mass index was 25.0 ± 5.7. Mean follow-up time was 27.6 ± 9.0 months. No significant difference in preoperative nor postoperative PROs were appreciated in patients with spinopelvic mismatch (|PI-LL| >10°) versus those without, whereas patients with mismatch achieved PASS according to the modified Harris Hip Score (P = .037) and International Hip Outcome Tool-12 (P = .030) at greater rates. When we compared patients with a PT ≥20° versus PT <20°, no significant differences in postoperative PROs were present. When we compared patients in the following pelvic incidence groups: PI <40°, 40° < PI <65°, and PI >65°, no significant differences in 2-year PROs or rates of PASS achievement for any PRO were appreciated (P > .05 for all). Conclusions In this study, spinopelvic parameters and traditional measures of sagittal imbalance did not influence PROs in patients undergoing primary hip arthroscopy for FAIS. Patients with sagittal imbalance (|PI-LL|> 10° or PT >20°) achieved a greater rate of PASS. Level of Evidence IV; Prognostic case series.

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Radiographic outcomes following femoroacetabular impingement correction with open surgical management: a systematic review.

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Radiographic outcomes following femoroacetabular impingement correction with open surgical management: a systematic review.

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