Concordant history, exam and radiographs critical to manage young patients with FAI
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COLORADO SPRINGS, Colo. — MRI prior to primary hip arthroscopy may not be as clinically useful as concordant history, physical exam and radiographs alone among young patients with femoroacetabular impingement, according to study data.
“Surgeon history, exam and radiographic evaluation were sufficient to diagnose this [FAI] and indicate young, primary patients for hip arthroscopy,” Prem N. Ramkumar, MD, MBA, said at the American Orthopaedic Society for Sports Medicine Annual Meeting.
In the retrospective study, Ramkumar and colleagues reviewed 1,391 patients aged 40 years or younger who were indicated for and underwent primary hip arthroscopy for femoroacetabular impingement (FAI) between August 2015 and December 2020. Researchers excluded patients who had a previous MRI, contraindications for MRI, reattempted conservative management or patients with concomitant periacetabular osteotomy. Overall, researchers studied 322 patients who presented without a preoperative MRI and eventually had an MRI prior to hip arthroscopy and 1,069 patients who presented with a preoperative MRI. There were no demographic differences between the groups, with 63% of all patients having a mean BMI of 25.6 kg/m2 and mean age of 25.8 years. Surgeons were from four different centers, Ramkumar said.
Researchers compared preoperative MRI to the in-office evaluation, which consisted of concordant history and physical exam, plain radiographs and intraoperative findings found during hip arthroscopy. They recorded time from initial evaluation to MRI and time from MRI to hip arthroscopy.
They found 198 patients with MRI findings of anterosuperior labral tears, which were also shown and repaired during hip arthroscopy. Three patients had questionable articular cartilage pathology noted on preoperative MRI, but none required surgical treatment or reoperation. No patients underwent primary labral reconstruction.
“Preoperative MRI did not alter the decision to operate or the actual surgical plan for the 322 indicated patients without an MRI. For this group, this wasted about 3 weeks of these patients’ time in their lives,” Ramkumar said.
He said although referrals to the hip arthroscopist with a MRI saved a month, this study did not follow patients who never received surgery or had a non-FAI diagnosis.
“The take-home message is that the hip MRI should be left to the discretion of the surgeon,” he said.
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Ramkumar PN, et al. Paper 45. Presented at: American Orthopaedic Society for Sports Medicine; July 13-17, 2022; Colorado Springs, Colo.
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