Association Between Orientation and Magnitude of Femoral Torsion and Propensity for Clinically Meaningful Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Computed Tomography Analysis

2021 ◽  
pp. 036354652110216
Author(s):  
Kyle N. Kunze ◽  
Thomas D. Alter ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
Joel C. Williams ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Body Mass Index ◽  
Body Mass ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Femoral Torsion ◽  
Femoroacetabular Impingement Syndrome ◽  
Outcome Improvement ◽  
The Mean

Background: Femoral torsion imaging measurements and classifications are heterogeneous throughout the literature, and the influence of femoral torsion on clinically meaningful outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well studied. Purpose: To (1) perform a computed tomography (CT)–based analysis to quantify femoral torsion in patients with FAIS and (2) explore the relationship between the orientation and magnitude of femoral torsion and the propensity for clinically meaningful outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients who underwent hip arthroscopy for FAIS between January 2012 and April 2018 were identified. Inclusion criteria were the presence of preoperative CT imaging with transcondylar slices of the knee and minimum 2-year outcome measures. Exclusion criteria were revision hip arthroscopy, Tönnis grade >1, congenital hip condition, hip dysplasia (lateral center-edge angle <20°), and concomitant gluteus medius or minimus repair. Torsion groups were defined as severe retrotorsion (SR; <0°), moderate retrotorsion (MR; 0°-5°), normal torsion (N; 5°-20°), moderate antetorsion (MA; 20°-25°), and severe antetorsion of antetorsion (SA; >25°). Treatment did not differ based on femoral torsion. Patient characteristics and clinical outcomes were analyzed, including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) by torsion stratification was analyzed using the chi-square test. Inter- and intrarater reliabilities for CT measurements were 0.980 ( P < .001) and 0.974 ( P < .001), respectively. Results: The study included 573 patients with a mean ± SD age and body mass index of 32.6 ± 11.8 years and 25.6 ± 10.6, respectively. The mean ± SD femoral torsion for the study population was 12.3°± 9.3°. After stratification, the number of patients within each group and the mean ± SD torsion for each group were as follows: SR (n = 36; –6.5°± 7.1°), MR (n = 80; 2.8°± 1.4°), N (n = 346; 12.3°± 4.1°), MA (n = 64; 22.2°± 1.4°), and SA (n = 47; 30.3°± 3.7°). No significant differences in age, body mass index, sex, tobacco use, workers’ compensation status, or participation in physical activity were observed at baseline. No significant differences were seen in pre- and postoperative VAS pain, mHHS, HOS-ADL, HOS-SS, iHOT-12, or postoperative VAS satisfaction among the cohorts. Furthermore, no statistically significant differences were found in the proportion of patients who achieved the MCID or the PASS for any outcome among the groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS did not influence the propensity for clinically significant outcome improvement.

scholarly journals Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110345
Author(s):  
Steven F. DeFroda ◽  
Thomas D. Alter ◽  
Blake M. Bodendorfer ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoral Torsion ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

Hip Arthroscopy for Femoroacetabular Impingement: 1-Year Outcomes Predict 5-Year Outcomes

2020 ◽  
Vol 49 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Berkcan Akpinar ◽  
Lawrence J. Lin ◽  
David A. Bloom ◽  
Thomas Youm
Keyword(s):  
Body Mass Index ◽  
Survival Rate ◽  
Body Mass ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Survival Rates ◽  
Cox Proportional Hazards Model ◽  
Harris Hip Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Limited evidence exists comparing short- and long-term patient-reported outcomes (PROs) and overall survival rates after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Hypothesis: Patients with high improvement (HI) versus low improvement (LI) at 1 year postoperatively would achieve higher PROs and better index procedure survival rates at 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between September 2012 and March 2014 with minimum 5-year outcome data were identified. Using the median 1-year change in modified Harris Hip Score (mHHS) as a threshold, HI and LI subcohorts were determined. Analysis of variance was used to compare PROs. Failure rates were determined using Kaplan-Meier and Cox proportional hazards model analyses. Regression analysis was used to identify factors associated with increasing 5-year change in mHHS and Nonarthritic Hip Score (NAHS). Results: Out of 108 eligible consecutive patients, 89 (82.4%) were included (mean [SD]: age, 43.3 [14.6] years; body mass index, 25.4 [4.5]). As compared with the LI group (n = 45), the HI group (n = 44) had a longer 5-year index surgery survival rate (mean ± SEM: 83.7 ± 3.3 months vs 68.5 ± 4.6 months; P = .012) and 5-year estimated survival rate (89% vs 71%). The HI group had a decreased risk of failure versus the LI group (hazard ratio, 0.15; P = .002). The HI group also had greater PROs than did the LI group at 1 year (mHHS: 94.8 ± 1.2 vs 72.6 ± 2.7, P < .001; NAHS: 94.0 ± 1.3 vs 75.6 ± 2.2, P < .001) and 5 years (mHHS: 86.9 ± 2.0 vs 77.6 ± 3.4, P = .017; NAHS: 92.6 ± 1.8 vs 82.7 ± 4.1, P = .020). As compared with the LI group, the HI group achieved higher rates of the Patient Acceptable Symptomatic State (PASS) and minimal clinically important difference (MCID) at 1 year (PASS: 95% vs 42%, P < .001; MCID: 100% vs 89%, P = .056) and 5 years (PASS: 77% vs 45%, P = .002; MCID: 86% vs 64%, P = .014). Linear regression demonstrated that being in the HI group (ΔmHHS, P = .041; ΔNAHS, P = .017) and decreasing body mass index (ΔmHHS, P = .055; ΔNAHS, P = .023) were associated with higher 5-year ΔPROs. Conclusion: Patients with FAIS and significant improvement in the first year after hip arthroscopy had superior 5-year outcomes versus patients with persistent symptom severity. Survival rates and PROs were significantly better in patients who achieved high early outcomes at the 1-year mark.

scholarly journals Effect of Capsular Closure After Hip Arthroscopy for Femoroacetabular Impingement Syndrome on Achieving Clinically Meaningful Outcomes: A Meta-analysis of Prospective and Comparative Studies

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110174
Author(s):  
Kyle N. Kunze ◽  
Amar Vadhera ◽  
Annie Devinney ◽  
Benedict U. Nwachukwu ◽  
Bryan T. Kelly ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Comparative Studies ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Outcome Improvement ◽  
Clinically Significant

Background: Recent literature has demonstrated conflicting evidence as to whether capsular closure after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) results in superior outcomes compared with capsulotomy without repair. Additionally, these studies have not explored the effect of capsular management on clinically significant outcome improvement. Purpose: To perform a meta-analysis of prospective and comparative studies to determine whether capsular management influences the rate of clinically significant outcome improvement after hip arthroscopy for FAIS. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, OVID/Medline, EMBASE, and Cochrane databases were queried in September 2020 for studies with evidence levels 1 to 3 that directly compared capsular management cohorts and reported rates of achieving the minimal clinically important difference (MCID) at a minimum follow-up of 2 years. Studies of level 4 evidence, those not describing or directly comparing capsular management techniques as well as those not reporting the MCID were excluded. Methodological quality was assessed using the methodological index for nonrandomized studies tool. Mantel-Haenszel fixed-effects models were constructed to quantitatively evaluate the association between capsular management and achievement of the MCID by generating effect estimates in the form of relative risk (RR) with 95% CIs. Results: A total of 6 studies with 1611 patients were included. The overall pooled rate of MCID achievement for the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and HOS Sports Subscale (HOS-SS) were 84.4%, 80.3%, and 82.5%, respectively, at a mean follow-up of 40.8 months (range, 24-87.6 months). Capsular closure was associated with a significantly higher rate of MCID achievement for the mHHS (RR, 1.06; 95% CI, 1.01-1.10; P = .001) and trended toward statistical significance for the HOS-ADL (RR, 1.11; 95% CI, 1.0-1.24; P = .055) and the HOS-SS (RR, 1.09; 95% CI, 0.99-1.21; P = .094). Conclusion: Although capsular closure appeared to result in higher rates of clinically significant outcome improvement in hip function, there was no definitively increased likelihood of achieving clinically significant improvement in relevant hip outcome scores with capsular closure.

Acetabular Labral Tear Dimensions and Number of Suture Anchors Used to Repair in Patients with Femoroacetabular Impingement Syndrome

2021 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Matthew J. Pacana ◽  
Adam J. Money ◽  
Thomas J. Ergen ◽  
Allen J. Barnes ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Impingement Syndrome ◽  
Labral Tear ◽  
Labral Repair ◽  
Suture Anchors ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
The Mean ◽  
Tear Size ◽  
Anterior Extent

AbstractFemoroacetabular impingement syndrome (FAIS) is commonly associated with acetabular labral tears. Correction of impingement morphology and suture anchor repair of labral tears have demonstrated successful early and midterm patient-reported outcomes. The purpose of this study was to evaluate the posterior and anterior extent and size of labral tears in patients with FAIS undergoing arthroscopic labral repair, and to evaluate the number of suture anchors required to repair these tears. The design of this study was retrospective case series (Level 4). A single surgeon's operative database was retrospectively reviewed to identify patients undergoing primary arthroscopic hip labral repair between November 2014 and September 2019. Patient-specific factors and radiographic measurements were recorded. Arthroscopic findings including labral tear posterior and anterior extents, and the number of suture anchors utilized for the repair were recorded. Linear regression was performed to identify factors associated with labral tear size. The number of suture anchors used relative to labral tear size was calculated. Three-hundred and thirteen patients were included in the study. The mean posterior and anterior extent for labral tears were 11:22 ± 52 and 2:20 ± 34 minutes, respectively. Mean tear size was 2 hours, 58 minutes ± 45 minutes. The mean number of suture anchors utilized for labral repair was 3.1 ± 0.7. The mean number of anchors per hour of labral tear was 1.1 ± 0.3. Increased age, lateral center edge angle, and α angle were associated with larger labral tears. Our study found that acetabular labral tears associated with FAIS are, on average, 3 hours in size and centered in the anterosuperior quadrant of the acetabulum. Arthroscopic labral repair required 1.1 anchors per hour of tear size, resulting in a mean of 3.1 anchors per repair. Level of Evidence IV

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