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Several patient-reported outcomes predict failure after femoroacetabular impingement surgery
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BOSTON — A multicenter, prospective study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting highlighted the predictors of persistent symptoms and reoperation after surgical treatment for femoroacetabular impingement.
Jeffrey J. Nepple , MD, and colleagues recorded patient characteristics, baseline patient-reported outcomes, imaging findings, intraoperative pathology and surgical treatments among 760 hips undergoing primary surgical treatment of femoroacetabular impingement across nine institutions. The modified Harris Hip Score was used to identify patients who failed to reach the minimally clinically important difference and patient acceptable symptom state, according to Nepple.
Overall, 81.6% of hips with a mean 4.3-year follow-up were included in the study. Nepple noted 4% of patients underwent total hip arthroplasty, 11% of patients underwent reoperation overall and 25.9% of patients had persistent symptoms. He added deformity severity predicted persistent symptoms, but not reoperation.
“Lower preoperative alpha angle was associated with higher rates of persistent symptoms,” Nepple said. “Similarly, elevations in lateral center edge above 40° were predictive of higher rates of persistent symptoms.”
Patients younger than 18 years experienced lower rates of persistent symptoms, according to Nepple, while women, non-athletes and alpha angle smaller than 55° predicted higher rates of persistent symptoms.
“When we go into the multivariate analysis for total hip, things you would expect — age, acetabular microfracture, femoral head chondroplasty — all independently predicted this outcome,” Nepple said.
He added preoperative Harris Hip Score strongly predicted reoperation, especially among female patients, non-athletes or patients with a higher BMI.
“So these patients get better [and] have some level of persistent symptoms that leads to higher likelihood of reoperation,” Nepple said. – by Casey Tingle
Reference:
Nepple JJ, et al. Abstract 77. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Nepple reports he is a paid consultant for Responsive Arthroscopy and Smith & Nephew, is a paid presenter or speaker for Smith & Nephew and receives research support from Smith & Nephew and Zimmer.
Perspective
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Shane J. Nho, MD, MS
Surgical treatment of femoroacetabular impingement syndrome (FAIS) has been reported to decrease pain and improve daily life activities, as well as improve hip function. Understanding the reasons for failure is important to help establish indications for surgery, assist with shared decision-making and set appropriate expectations.
In their study, Jeffrey J. Nepple, MD, and colleagues attempted to determine predictors of failure after surgical management of FAIS. The multicenter prospective cohort included 621 patients with a mean follow-up of 4.3 years. Of this cohort, 4% underwent conversion to total hip arthroplasty, 6.9% had revision surgery and 14.8% had clinical failure based on patient-reported outcomes. Conversion to THA was predicted by increasing age, acetabular microfracture and femoral head chondroplasty. Revision surgery was predicted by low modified Harris Hip Score. The authors also reported on clinical failure, which was predicted by participation in competitive athletics and male gender.
While the revision rate and conversion to THA rate is variable in the literature, the current paper appears to be consistent with prior published papers. Historically, athletic males with FAIS were thought to be positive predictors of outcome; however, these patients may also have advanced chondral damage or unrealistic preoperative expectations.
Head, Section of Young Adult Hip Surgery
Department of orthopedic surgery
Chicago
Division of sports medicine
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