Identification of Factors Associated with Disease Progression in the Contralateral Hip of Patients with Symptomatic Femoroacetabular Impingement. (139)

Objectives: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. The purpose of this study was to (1) investigate rates of symptom development in the contralateral hip of patients with FAI at mid-term follow-up, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included 179 patients undergoing ipsilateral FAI surgery with no history of previous contralateral hip surgery. In the current study, the contralateral hip was assessed at minimum 5 year follow-up. Symptoms (defined as moderate pain) and the need for surgery were monitored over the study course. Statistical analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: A total of 146 hips (81.5%) were included at a mean 6.7 years of follow-up. Thirty-nine (26.7%) presented with symptoms in the contralateral hip, while an additional 35 (23.9%) developed symptoms during the follow-up period. Twenty-Six (17.8%) progressed to surgery for their contralateral hip. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.16 vs. 0.15 p=0.03). Maximum alpha angle (p=0.41), lateral center edge angle (p=0.70), and crossover sign (p=0.12) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in 90° of flexion (40.0° vs 50.8°, p=0.01) as well as external rotation at 900 of flexion (28.9° vs 36.6°, p=0.02) were decreased in hips developing symptoms. Internal rotation in flexion was not significantly decreased in symptomatic patients (11.1° vs 14.2°, p=0.11). Kaplan Meier survival analysis demonstrated 53% and 45% of patients remaining asymptomatic at 5 and 8 year time points (Figure). Conclusions: At a mean follow-up of 6.7 years, significant symptoms in the contralateral hip of patients with FAI are present in 50.7% of patients, while 49.3% remain asymptomatic or minimally symptomatic. We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.

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IDENTIFICATION OF FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN THE CONTRALATERAL HIP OF PATIENTS WITH SYMPTOMATIC FEMOROACETABULAR IMPINGEMENT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00145 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0014

Author(s):

Adam Khan ◽

Craig R. Louer ◽

Wahid Abu-Amer ◽

Gail Pashos ◽

Cecilia Pascual Garrido ◽

...

Keyword(s):

Disease Progression ◽

Femoroacetabular Impingement ◽

External Rotation ◽

Univariate Analysis ◽

Alpha Angle ◽

Hip Osteoarthritis ◽

Symptom Development ◽

Ucla Activity Score ◽

Center Edge ◽

Imaging Characteristics

Introduction: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. Hypothesis/Purpose: The purpose of this study was to (1) investigate rates of initial and subsequent symptom development in the contralateral hip of patients with FAI, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included a minimum 5 year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) were monitored over the study course. Univariate analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: 146 patients (146 hips, 81.5%) were included (min 5 year, mean 6.7 years). Thirty-nine (26%) presented with symptoms in the contralateral hip while 34 (23%) developed symptoms. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.164 vs. 0.153 p=0.025). Maximum alpha angle (p=0.413), lateral center edge angle (p=0.704), and crossover sign (p=0.115) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in extension (35.740 vs 45.140, p=0.012) and 900 of flexion (40.00 vs 50.800, p=0.009) as well as external rotation at 900 of flexion (28.940 vs 36.590, p=0.020) were decreased in hips developing symptoms. Internal Rotation in flexion was not significantly decreased in symptomatic patients (11.060 vs 14.20, p=0.113). Conclusions: We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.

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A Prospective Analysis of the Contralateral Hip Among Patients With Femoroacetabular Impingement: What Are the Risk Factors for Disease Progression?

The American Journal of Sports Medicine ◽

10.1177/0363546518786246 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2486-2491 ◽

Cited By ~ 3

Author(s):

Craig R. Louer ◽

Gail Pashos ◽

John C. Clohisy ◽

Jeffrey J. Nepple

Keyword(s):

Disease Progression ◽

Femoroacetabular Impingement ◽

Alpha Angle ◽

Activity Level ◽

Study Cohort ◽

Symptom Development ◽

Crossover Sign ◽

Kaplan Meier ◽

Head Neck

Background: The pathophysiology of femoroacetabular impingement (FAI) remains to be better understood, including factors affecting symptom development and disease progression. Purpose: (1) To determine rates of initial and subsequent symptom development in the contralateral hip of patients with symptomatic FAI and (2) to identify predictors of the development of symptomatic contralateral FAI. Study Design: Case-control study; Level of evidence, 3. Methods: This prospective study cohort included the contralateral hip of 179 consecutive patients undergoing primary surgical treatment of FAI. At presentation and follow-up time points, patients recorded the presence of symptoms in the contralateral hip. Patients with a minimum 1-year follow-up were included in the final cohort. Univariate analysis compared the patient characteristics and FAI imaging characteristics (cam and pincer) of initially asymptomatic patients who developed symptoms and those who remained asymptomatic. Kaplan-Meier survival curves were calculated to demonstrate symptom development over time. Results: A total of 148 patients (83%) were followed for at least 1 year (mean, 2.9 years). Thirty-four (23%) patients had symptoms in the contralateral hip at the time of the initial presentation. An additional 27 hips (24% of the initially asymptomatic) developed symptoms during the follow-up period at a mean 2.0 years from presentation. Head-neck offset ratio on the anteroposterior pelvis radiograph was significantly lower among hips that developed symptoms (0.153 vs 0.163 asymptomatic group, P = .027). Maximum alpha angle ( P = .503), lateral center edge angle ( P = .975), and crossover sign ( P = .865) were not predictive of the development of symptoms. Patients developing contralateral hip symptoms were less likely to have a UCLA (University of California, Los Angeles) activity score of 9 or 10 at presentation (18.2% vs 43.8%, P = .032). The total arc of rotation in flexion (internal rotation in 90° of flexion + external rotation in flexion) was significantly decreased in hips developing symptoms (39.4º vs 50.4º, P = .012). Kaplan-Meier survival analysis demonstrated that 72%, 67%, 56%, and 48% of all patients remained asymptomatic at 1, 2, 3, and 4 years, respectively. Conclusion: Approximately 1 in 4 patients with FAI presents with symptoms in the contralateral hip, and an additional 1 in 4 patients develops significant symptoms in the following 4 years. Several factors, including low activity level, less hip rotational motion, and decreased head-neck offset ratio, were significantly associated with the development of symptoms, while the alpha angle and crossover sign were not.

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Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977892 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712097789

Author(s):

Rodolfo Morales-Avalos ◽

Adriana Tapia-Náñez ◽

Mario Simental-Mendía ◽

Guillermo Elizondo-Riojas ◽

Michelle Morcos-Sandino ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Alpha Angle ◽

Cross Sectional Study ◽

Level Of Evidence ◽

Crossover Sign ◽

Cross Sectional ◽

Radiographic Findings ◽

Morphological Variations ◽

Pelvic Radiographs ◽

Center Edge

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

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The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients With Hip Pain

The American Journal of Sports Medicine ◽

10.1177/0363546519896355 ◽

2020 ◽

Vol 48 (3) ◽

pp. 647-653 ◽

Cited By ~ 1

Author(s):

Jun Zhou ◽

Heath P. Melugin ◽

Rena F. Hale ◽

Devin P. Leland ◽

Christopher D. Bernard ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Mixed Type ◽

Imaging Modality ◽

Alpha Angle ◽

Young Patients ◽

Radiographic Finding ◽

Hip Pain ◽

Radiographic Findings ◽

Protrusio Acetabuli ◽

Center Edge

Background: Radiography is the initial imaging modality used to evaluate femoroacetabular impingement (FAI), and diagnostic radiographic findings are well-established. However, the prevalence of these radiographic findings in patients with hip pain is unknown. Purpose: The purpose was 3-fold: (1) to determine the overall prevalence of radiographic FAI deformities in young patients presenting with hip pain, (2) to identify the most common radiographic findings in patients with cam-type FAI, and (3) to identify the most common radiographic findings in patients with pincer-type FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A geographic database was used to identify patients aged 14 to 50 years with hip pain between the years 2000 to 2016. The following were evaluated on radiographs: cam type: typical pistol grip deformity, alpha angle >55°; pincer type: crossover sign (COS), coxa profunda or protrusio acetabuli, lateral center edge angle (LCEA) ≥40°, Tönnis angle <0°; and mixed type: both cam- and pincer-type features. Posterior wall sign (PWS) and ischial spine sign (ISS) were also evaluated. The prevalence of each was determined. Descriptive statistics were performed on all radiographic variables. Results: There were 1893 patients evaluated, and 1145 patients (60.5%; 1371 hips; 374 male and 771 female; mean age, 28.8 ± 8.4 years) had radiographic findings consistent with FAI. Of these hips, 139 (10.1%) had cam type, 245 (17.9%) had pincer type, and 987 (72.0%) had mixed type. The prevalence of a pistol grip deformity and an alpha angle >55° was 577 (42.1%) and 1069 (78.0%), respectively. The mean alpha angle was 66.9°± 10.5°. The prevalence of pincer-type radiographic findings was the following: COS, 1062 (77.5%); coxa profunda, 844 (61.6%); ISS, 765 (55.8%); PWS, 764 (55.7%); Tönnis angle <0°, 312 (22.8%); LCEA ≥40°, 170 (12.4%); and protrusio acetabuli, 7 (0.5%). Conclusion: The overall prevalence of radiographic findings consistent with FAI in young patients with hip pain was 60.5%. Radiographic findings for mixed-type FAI were the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°. The most common radiographic finding for pincer-type FAI was the COS.

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Treatment of cam-type femoroacetabular impingement

Joints ◽

10.11138/jts/2015.3.2.067 ◽

2015 ◽

Vol 03 (02) ◽

pp. 67-71 ◽

Cited By ~ 5

Author(s):

Gennaro Fiorentino ◽

Alberto Fontanarosa ◽

Riccardo Cepparulo ◽

Alberto Guardoli ◽

Luca Berni ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Case Series ◽

Arthroscopic Treatment ◽

Correct Selection ◽

Harris Hip Score ◽

Radiographic Examination ◽

Level Of Evidence

Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

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Long-term follow-up of patients undergoing the modified Dunn procedure for slipped capital femoral epiphysis

Bone & Joint Open ◽

10.1302/2046-3758.14.bjo-2020-0010.r1 ◽

2020 ◽

Vol 1 (4) ◽

pp. 80-87

Author(s):

Caroline Passaplan ◽

Lucienne Gautier ◽

Emanuel Gautier

Keyword(s):

Avascular Necrosis ◽

Femoroacetabular Impingement ◽

Revision Surgery ◽

Slipped Capital Femoral Epiphysis ◽

Implant Removal ◽

Long Term Results ◽

Harris Hip Score ◽

Ucla Activity Score

Aims Our retrospective analysis reports the outcome of patients operated for slipped capital femoral epiphysis using the modified Dunn procedure. Results, complications, and the need for revision surgery are compared with the recent literature. Methods We retrospectively evaluated 17 patients (18 hips) who underwent the modified Dunn procedure for the treatment of slipped capital femoral epiphysis. Outcome measurement included standardized scores. Clinical assessment included ambulation, leg length discrepancy, and hip mobility. Radiographically, the quality of epiphyseal reduction was evaluated using the Southwick and Alpha-angles. Avascular necrosis, heterotopic ossifications, and osteoarthritis were documented at follow-up. Results At a mean follow-up of more than nine years, the mean modified Harris Hip score was 88.7 points, the Hip Disability and Osteoarthritis Outcome Score (HOOS) 87.4 , the Merle d’Aubigné Score 16.5 points, and the UCLA Activity Score 8.4. One patient developed a partial avascular necrosis of the femoral head, and one patient already had an avascular necrosis at the time of delayed diagnosis. Two hips developed osteoarthritic signs at 14 and 16 years after the index operation. Six patients needed a total of nine revision surgeries. One operation was needed for postoperative hip subluxation, one for secondary displacement and implant failure, two for late femoroacetabular impingement, one for femoroacetabular impingement of the opposite hip, and four for implant removal. Conclusion Our series shows good results and is comparable to previous published studies. The modified Dunn procedure allows the anatomic repositioning of the slipped epiphysis. Long-term results with subjective and objective hip function are superior, avascular necrosis and development of osteoarthritis inferior to other reported treatment modalities. Nevertheless, the procedure is technically demanding and revision surgery for secondary femoroacetabular impingement and implant removal are frequent. Cite this article: 2020;1-4:80–87.

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CT Imaging Features During Disease Progression of 2019 Novel Coronavirus (COVID-19) Pneumonia

Iranian Journal of Radiology ◽

10.5812/iranjradiol.102925 ◽

2020 ◽

Vol 17 (4) ◽

Author(s):

Nan Yu ◽

Yong Yu ◽

Shubo Cai ◽

Cong Shen ◽

Youmin Guo

Keyword(s):

Disease Progression ◽

Symptom Onset ◽

Early Stage ◽

Ground Glass Opacity ◽

Ct Imaging ◽

Imaging Features ◽

Imaging Characteristics ◽

Novel Coronavirus ◽

Stage 1

Objectives: To describe the characteristics of computed tomography (CT) in patients with 2019 novel coronavirus (COVID-19) pneumonia and their changes during disease progression. Patients and Methods: A total of 96 chest CT scans of 61 pneumonia patients associated with COVID-19 were reviewed to identify CT features associated with the time of symptom onset and the evolution of disease. Results: The initial CTs of 61 patients were obtained during 1 to 11 days after the onset. The main CT pattern of initial CT obtained during 1 - 3 days after the symptom onset was single (7/23, 35%) or multiple ground-glass opacity (GGO, 8/23, 35%). At 4 - 7 days after the symptom onset, the main imaging features were crazy paving GGO mixed with partial consolidation pattern (15/32, 47%). At 8 - 11 days after the symptom onset, the CT images showed consolidation pattern (3/6, 50%). A total of 35 follow up CTs were collected. The mean interval time between each follow up CT was 3 ± 2 days. The CT patterns also changed with the evolution of the disease: the features of GGO manifested at the early stage (1 - 3d). The crazy paving GGO pattern, consolidation pattern and mixed with partial consolidation pattern were found 4 to 14 days after the onset. In the absorption stage (15 - 24d), both density and extent of lesions were reduced. Conclusion: The CT imaging features are associated with the time of symptom onset and evolution of disease. Understanding the imaging characteristics of each stage is very helpful for understanding the development of disease.

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Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention

The American Journal of Sports Medicine ◽

10.1177/0363546520949179 ◽

2020 ◽

Vol 48 (12) ◽

pp. 2881-2886

Author(s):

Heath P. Melugin ◽

Rena F. Hale ◽

Jun Zhou ◽

Matthew LaPrade ◽

Christopher Bernard ◽

...

Keyword(s):

Risk Factors ◽

Femoroacetabular Impingement ◽

Mixed Type ◽

Surgical Intervention ◽

Significant Risk ◽

Hip Osteoarthritis ◽

Hip Pain ◽

Male Sex ◽

Time Of Presentation

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and total hip arthroplasty (THA) at a young age. Unfortunately, little is known about the specific factors associated with an increased risk of OA. Purpose: To (1) report the overall rate of symptomatic hip OA and/or THA in patients with FAI without surgical intervention and (2) identify radiographic features and patient characteristics associated with hip OA. Study Design: Case-control study; Level of evidence, 3. Methods: A geographic database was used to identify all patients with hip pain and radiographs between 2000 and 2016. Chart review was performed to identify patients with FAI. Patient medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Kaplan-Meier analysis was used to determine the rate of hip OA. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. Results: The study included 952 patients (649 female; 303 male; 1104 total hips) with FAI. The majority of hips had mixed type (n = 785; 71.1%), 211 (19.1%) had pincer type, and 108 (9.8%) had cam type. Mean age at time of presentation was 27.6 ± 8.7 years. Mean follow-up time was 24.7 ± 12.5 years. The rate of OA was 13.5%. THA was performed in 4% of patients. Male sex, body mass index (BMI) greater than 29, and increased age were risk factors for OA (male sex: hazard ratio [HR], 2.28; P < .01; BMI >29: HR, 2.11; P < .01; per year of increased age: HR, 1.11; P < .01.). Smoking and diabetes mellitus were not significant risk factors. No radiographic morphological features were found to be significant risk factors for OA. Conclusion: At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. BMI greater than 29, male sex, and increased age at the time of presentation with hip pain were risk factors for hip OA. The cohort consisted of a large percentage of mixed-type FAI morphologies, and no specific radiographic risk factors for OA were identified.

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THREE-DIMENSIONAL PREDICTORS OF FAI DISEASE PROGRESSION IN THE CONTRALATERAL HIP

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00137 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0013

Author(s):

Lucas M. Fowler ◽

John C. Clohisy ◽

Wahid Abu-Amer ◽

Cecilia Pascual Garrido ◽

Jeffrey J. Nepple

Keyword(s):

Surgical Treatment ◽

Alpha Angle ◽

Three Dimensional ◽

Symptom Development ◽

Acetabular Version ◽

Femoral Version ◽

Experienced Pain ◽

Bony Morphology

Background: Bony morphologies contributing to femoroacetabular impingement (FAI) are relatively common in the general population, but drivers of symptom development are not well understood. Hypothesis/Purpose: The purpose of this study was to determine the role of three-dimensional bony morphology in symptom development in the contralateral hip in patients undergoing ipsilateral surgical treatment for FAI. Methods: The study included a prospective cohort of 161 consecutive patients (101 females, 60 males) who presented for ipsilateral FAI surgical treatment from 2013-2018. The average age was 29.1 years. Minimum follow-up was 1 year (mean, 2.3 years; range, 1-6 years). Low-dose CT scans were obtained prior to surgical treatment. Three-dimensional hip analysis of the contralateral hip was performed relative to normative data and allowed measurements of 15 key parameters. Prior to surgery and at routine follow-up, patients completed standardized questionnaires that included pain in the contralateral hip. Univariate and multivariate analyses were performed to identify independent predictors. Results: There were 133 patients (83%) with follow-up. Significant levels of pain in the contralateral hip were reported in 25 (18.8%) patients at presentation and 50 (35.3%) patients at follow-up. Twenty-six (19.5%) patients progressed to surgery at an average of 1.12 years. Significant predictors of symptom development were alpha angle >55° at 1:00 (p=0.037), femoral version <0° or > 20° (p=0.027), and decreased central acetabular version at 3:00 (p=0.048). Significant predictors of surgery were age <30 years (p=0.023) and alpha angle >55° at 1:00 (p=0.005). Conclusion: We found that roughly 1 in 5 patients undergoing surgical treatment for ipsilateral FAI experienced pain in the contralateral hip at presentation, over one third reported pain at follow-up, and 1 in 5 progressed to surgery. Higher alpha angle, abnormal femoral version, and decreased acetabular version were correlated with symptom development, while higher alpha angle and age under 30 were associated with progression to surgery.

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The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab080 ◽

2021 ◽

Author(s):

Jeong-Kil Lee ◽

Deuk-Soo Hwang ◽

Sang-Bum Kim ◽

Chan Kang ◽

Jung-Mo Hwang ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Hip Osteoarthritis ◽

Ligamentum Teres ◽

Thermal Shrinkage ◽

Radiologic Evaluation ◽

Chondral Damage ◽

Group A ◽

Tönnis Grade

ABSTRACT We aimed to compare clinical and radiologic outcomes in patients with cam-type femoroacetabular impingement (FAI), with and without a partial ligamentum teres (LT) tear, who underwent hip arthroscopy (HA) with ≥10 years of follow-up. Among the patients who underwent HA for a cam-type FAI diagnosis with a labral tear, 28 patients (28 hips) with a partial LT tear and 87 patients (99 hips) with an intact LT were assigned to Groups A and B, respectively. All patients underwent partial labral debridement and femoroplasty. Debridement and thermal shrinkage were performed for LT tears. The grade of chondral damage was measured intraoperatively. Clinical items were assessed preoperatively and at the last follow-up. Patients’ satisfaction with the surgery and changes in postoperative sports ability in those who had previously been active in sports were assessed at the last follow-up. The Tönnis grade was assessed preoperatively and at the last follow-up for radiologic evaluation. Chondral damage to the acetabular and femoral head detected intraoperatively was significantly different between the groups (P = 0.005 and P < 0.001). At the last follow-up, Group A patients experienced more difficulty performing sports activities than Group B patients (P = 0.056), and significantly, more Group A patients had stopped exercising despite their active participation in sports preoperatively (P = 0.002). Regarding the Tönnis grade, significant differences were found only at the final follow-up (P = 0.020). Patients with partial LT tear showed a higher grade of chondral damage, experienced decreased exercise capacity and had significantly worsened Tönnis grades, suggesting hip osteoarthritis progression compared to those with an intact LT.

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