Patient outcomes, pathology may predict failure after femoroacetabular impingement surgery
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Certain patient demographics and outcomes, as well as pathology, may independently predict risk of total hip arthroplasty, reoperation and persistent symptoms after femoroacetabular impingement surgery, according to results.
“Identification of these at-risk subgroups allows us to target optimal interventions, as well as patient selection, in this group to hopefully improve the treatment of [femoroacetabular impingement] FAI surgery in the future,” Jeffrey J. Nepple, MD, said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Nepple and his colleagues recorded patient characteristics, baseline patient-reported outcomes, imaging findings, intraoperative pathology and surgical treatments of 621 hips that underwent primary treatment of FAI.
“We looked at continuous but also dichotomous outcomes,” Nepple said. “So, the dichotomous outcomes included total hip arthroplasty, rates of reoperation, as well as rates of persistent symptoms, that can [lead to] reoperation in symptomatic hips, those failing to reach either [minimally clinically important difference] MCID or [patient-acceptable symptom state] PASS for the modified Harris Hip Score.”
Nepple noted patients improved about 20 points on average on the modified Harris Hip Score. He added patients had a 4% rate of THA, a 11% rate of reoperation and a 25.9% rate of overall persistent symptoms.
“Deformity was somewhat predictive of persistent symptoms,” Nepple said. “Lower alpha angles and a lateral center edge about 40°, indicating over coverage, were associated with higher rates of persistent symptoms.”
Labral pathology in treatment was not predictive of outcomes, while cartilage pathology was predictive of the rate of THA when in the setting of a full-thickness defect, according to Nepple. He noted age, acetabular microfracture and femoral head chondroplasty were predictors of THA.
“When we combine these, you can see the risks in the setting of microfracture or femoral head chondroplasty. The risk is above 10%,” Nepple said. “If we combine these, having two or more of those risk factors, the risk of total hip was more than 20%.”
Low preoperative patient outcome score at baseline was the most predictive of reoperation, with the Kaplan Meier curve showing a 30% rate of reoperation among patients with a modified Harris Hip Score below 40, according to Nepple.
“When we move on to the overall persistent symptoms, so again 25.9%, predictors included the lack of competitive athletics, a higher BMI and then, female sex,” Nepple said.
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Nepple JJ, et al. Paper 49. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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