Hip kinematics and kinetics in patients with femoroacetabular impingement syndrome before and 1 year after hip arthroscopic surgery. Results from the HAFAI cohort

2021 ◽  
Author(s):  
S. Kierkegaard ◽  
I. Mechlenburg ◽  
U. Dalgas ◽  
B. Lund ◽  
K. Søballe ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Impingement Syndrome ◽  
Femoroacetabular Impingement Syndrome ◽  
Hip Kinematics ◽  
Kinematics And Kinetics

scholarly journals No association between femoral or acetabular angles and patient-reported outcomes in patients with femoroacetabular impingement syndrome—results from the HAFAI cohort

2020 ◽  
Vol 7 (2) ◽  
pp. 242-248
Author(s):  
S Kierkegaard ◽  
L Rømer ◽  
B Lund ◽  
U Dalgas ◽  
K Søballe ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Patient Reported Outcomes ◽  
Morphological Changes ◽  
Arthroscopic Surgery ◽  
Alpha Angle ◽  
Clinical Findings ◽  
Impingement Syndrome ◽  
Acetabular Index ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Abstract Patients with femoroacetabular impingement syndrome (FAIS) are diagnosed using imaging, but detailed description especially the acetabular shape is lacking and may help give more insight to the pathogenesis of FAIS. Furthermore, associations between patient-reported outcomes (PROs) and the radiological angles might highlight which radiological angles affect outcomes experienced by the patients. Hence, the aims of this study were (i) to describe computer tomography (CT) acquired angles in patients with FAIS and (ii) to investigate the association between radiological angles and the Copenhagen Hip and Groin Outcome Score (HAGOS) in patients with FAIS. Patients scheduled for primary hip arthroscopic surgery for FAIS were included. Based on CT, following angles were measured before and 1 year after surgery; femoral anteversion, alpha, lateral centre edge, acetabular index, anterior sector, posterior sector and acetabular anteversion. All patients completed the HAGOS. Sixty patients (63% females) aged 36 ± 9 were included. One year after surgery, significant alterations in the alpha angle and the acetabular index angle were found. Neither baseline PROs nor changes in PROs were associated with the radiological angles or changes in angles. Since neither changes in CT angles nor baseline scores were associated with HAGOS, the improvements felt by patients must origin from somewhere else. These findings further underlines that morphological changes seen at imaging should not be treated arthroscopically without a patient history of symptoms and clinical findings.

scholarly journals Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Ida Lindman ◽  
Sarantos Nikou ◽  
Axel Öhlin ◽  
Eric Hamrin Senorski ◽  
Olufemi Ayeni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Continuous Increase ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Abstract Purpose The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. Methods This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. Results The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004–2008)—(2016–2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5–120 months). Between 1–10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). Conclusion There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.

scholarly journals Preoperative Performance of the PROMIS in Patients Undergoing Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711986007 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Reagan Chapman ◽  
Jorge Chahla ◽  
Kelechi Okoroha ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Linear Regression Analysis ◽  
Arthroscopic Surgery ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Poor Correlation ◽  
Multivariate Linear Regression Analysis ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Floor Effects

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is being increasingly evaluated for use in orthopaedic surgery. The performance of the PROMIS in patients undergoing hip preservation surgery is unknown. Purpose: To investigate the psychometric performance of the PROMIS compared with legacy patient-reported outcome measures (PROMs) in patients indicated for hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data from consecutive patients who underwent primary hip arthroscopic surgery between January and October 2018 for the treatment of FAIS were collected and analyzed. Baseline data, including preoperative PROM scores and demographics, were recorded. PROMs included the PROMIS Physical Function (PF), the Hip Outcome Score (HOS), the modified Harris Hip Score (mHHS), the International Hip Outcome Tool–12 (iHOT-12), and the Veterans RAND 12-item health survey (VR-12). Pearson and Spearman coefficient analyses were used to identify correlations between continuous and noncontinuous variables, respectively. Correlation was defined as excellent (>0.80), very good (0.71-0.80), good (0.61-0.70), fair (0.41-0.60), or poor (0.21-0.40). A multivariate linear regression analysis was used to identify preoperative predictors of having higher preoperative PROMIS scores. Results: A total of 197 patients with a mean age and body mass index (BMI) of 32.8 ± 12.6 years and 25.7 ± 5.6 kg/m2, respectively, were included in the final analysis. There were no ceiling or floor effects for the PROMIS PF score observed in the study group. With regard to hip-specific measures, PROMIS PF scores demonstrated excellent correlation with HOS–Activities of Daily Living ( r = 0.801; P < .001) scores, very good correlation with mHHS ( r = 0.721; P < .001) and iHOT-12 ( r = 0.722; P < .001) scores, and good correlation with HOS–Sports Specific ( r = 0.675; P < .001) scores. With regard to general health–related quality of life (HRQoL) measures, PROMIS PF scores demonstrated very good correlation with VR-12 mental ( r = 0.721; P < .001) scores, good correlation with VR-12 physical ( r = 0.618; P < .001) scores, and poor correlation with visual analog scale for pain ( r = –0.365; P < .001) scores. Patients who reported being physically active were more likely to have a higher preoperative PROMIS score (β = 3.216; P = .004). Lower PROMIS scores were found in patients with a higher BMI (β = –0.236; P = .005) and in female patients (β = –2.608; P = .014). Conclusion: In patients with FAIS, the preoperative PROMIS PF scores demonstrated excellent to good correlation with legacy hip-specific instruments as well as with HRQoL measures. No ceiling or floor effects were identified. Notably, of the hip-specific PROMs administered, the PROMIS PF demonstrated the weakest correlation with the HOS–Sports Specific subscale. Physical activity, BMI, and sex were predictors of preoperative PROMIS scores in our patient population.

Prevalence and Clinical Implications of Chondral Injuries After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome

2019 ◽  
Vol 47 (11) ◽  
pp. 2626-2635 ◽  
Author(s):  
Jorge Chahla ◽  
Edward C. Beck ◽  
Kelechi Okoroha ◽  
Jourdan M. Cancienne ◽  
Kyle N. Kunze ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Alpha Angle ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Full Thickness ◽  
Chondral Defects ◽  
Partial Thickness ◽  
Femoroacetabular Impingement Syndrome ◽  
Chondral Damage

Background: Studies on the effect of partial- and full-thickness chondral damage of the hip on outcomes and the ability to achieve meaningful clinical outcomes are limited. Purpose: To determine the effect of full- and partial-thickness chondral injuries on 2-year outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared with patients without chondral damage, and to identify significant predictors of achieving the patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID). Study Design: Case-control study; Level of evidence, 3. Methods: Data from consecutive patients with evidence of chondromalacia at the time of primary hip arthroscopic surgery with routine capsular closure for the treatment of FAIS by a single fellowship-trained surgeon between January 2012 and September 2016 were reviewed. Patients were divided into groups with partial-thickness (grade I-III) or full-thickness (grade IV) chondral defects and matched by age and body mass index (BMI) to patients without chondral injuries. Preoperative and postoperative outcomes were compared among the 3 groups, and a binary logistic regression analysis was utilized to identify significant predictors of achieving the MCID and PASS. Results: There were 634 patients included in the analysis, with a mean age of 34.5 ± 10.9 years and a mean BMI of 25.2 ± 4.7 kg/m2. A total of 493 (77.8%) patients had no evidence of chondral damage, 92 (14.5%) patients had partial-thickness chondral defects, and 49 (7.7%) patients had full-thickness chondral defects. There were statistically significant differences in the Hip Outcome Score (HOS)–Activities of Daily Living, HOS–Sports Subscale, modified Harris Hip Score, pain, and satisfaction ( P < .01) among the 3 groups. Patients with grade IV chondromalacia experienced the poorest outcomes and lowest percentage of achieving the PASS. Predictors for achieving any PASS threshold included preoperative alpha angle (odds ratio [OR], 0.96; P = .016), absence of preoperative limping (OR, 7.25; P = .002), absence of preoperative chronic pain (OR, 5.83; P = .019), primary hip arthroscopic surgery (OR, 0.17; P = .050), patients who self-identified as runners (OR, 2.27; P = .037), and Tönnis grade 0 (OR, 2.86; P = .032). Male sex (OR, 2.49; P = .015) was the only predictor of achieving any MCID threshold. Conclusion: Patients with grade IV chondral defects experienced worse functional outcomes, lower satisfaction, and increased pain when compared with both patients without chondral damage or grade I-III chondromalacia at 2-year follow-up. Several predictors were associated with achieving clinically significant function in patients undergoing hip arthroscopic surgery for FAIS.

High Rate of Return to High-Intensity Interval Training After Arthroscopic Management of Femoroacetabular Impingement Syndrome

2018 ◽  
Vol 46 (11) ◽  
pp. 2594-2600 ◽  
Author(s):  
Andrew J. Riff ◽  
Gift Ukwuani ◽  
Ian Clapp ◽  
Kamran Movassaghi ◽  
D. Michael Kelly ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
High Intensity ◽  
Arthroscopic Surgery ◽  
Interval Training ◽  
Impingement Syndrome ◽  
Preoperative Imaging ◽  
High Intensity Interval Training ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
High Intensity Interval

Background: Since the inception of CrossFit in 2000, the popularity of high-intensity interval training (HIIT) in the United States has risen dramatically. While HIIT is a highly efficient exercise for weight loss and improved conditioning, some literature reports injuries in up to 34% of HIIT participants. We sought to evaluate the functional and sports-specific results of hip arthroscopic surgery in recreational HIIT participants. Purpose: To evaluate patients’ ability to return to HIIT after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with FAIS who had identified themselves as participating in HIIT and had undergone hip arthroscopic surgery for the treatment of FAIS by a single fellowship-trained surgeon between 2012 and 2015 were reviewed. Demographic data; preoperative physical examination findings; preoperative imaging results; preoperative patient-reported outcome (PRO) scores including the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and postoperative examination and PRO scores at a minimum 2 years after surgery, including a HIIT-specific questionnaire, were assessed for all patients. Results: Thirty-two patients (13 male, 19 female) with a mean age of 34.7 ± 6.9 years (range, 21-49 years) were identified with a minimum 24-month follow-up. Among these, 22 participated in CrossFit, 4 in Shred415, 3 in Orangetheory, and 3 in self-directed cross-training including plyometrics. Preoperatively, 14 patients had discontinued HIIT because of activity-related hip complaints, 17 patients had scaled back involvement in HIIT, and 1 patient maintained her baseline routine. Postoperatively, 28 of 32 patients (88%) returned to HIIT at a mean of 9.8 ± 5.7 months after surgery (range, 3-24 months); 96% returned to HIIT at the same level as or better than before the injury. Fear of reinjury was the most common reason for cessation (3/4). Preinjury and postoperative involvement in HIIT were comparable (5.3 vs 5.1 h/wk, respectively; P = .8). All patients had significant improvements in the HOS-ADL score (69.7 ± 17.3 to 94.2 ± 8.4; P < .001), HOS-SSS score (49.2 ± 21.2 to 83.3 ± 21.4; P < .001), mHHS score (59.9 ± 14.2 to 85.4 ± 11.6; P < .001), and VAS for pain score (7.5 ± 1.8 to 1.1 ± 1.3; P < .001) from preoperatively to postoperatively. Conclusion: Arthroscopic treatment of FAIS in recreational HIIT participants resulted in significant improvements in hip function and predictably high rates of patient satisfaction. Postoperatively, 88% of patients returned to HIIT, 44% noted improvement from preinjury HIIT performance, and the mean weekly participation was comparable with before the injury.

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