Surgical Advancements in Hip Arthroscopy and FAI Syndrome: Indications and Technique for Labral Reconstruction of the Hip

The Hip Joint ◽  
2021 ◽  
pp. 569-593
Author(s):  
Michael Scheidt ◽  
Michael B. Ellman ◽  
Sanjeev Bhatia
Keyword(s):  
Hip Arthroscopy ◽  
Fai Syndrome

scholarly journals Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

2021 ◽  
pp. bjsports-2021-104060
Author(s):  
Lasse Ishøi ◽  
Mathias Fabricius Nielsen ◽  
Kasper Krommes ◽  
Rasmus Skov Husted ◽  
Per Hölmich ◽  
...  
Keyword(s):  
Effect Size ◽  
Hip Arthroscopy ◽  
Clinical Information ◽  
Quality Of Evidence ◽  
Post Test ◽  
Fai Syndrome ◽  
Post Test Probability ◽  
Test Probability ◽  
Evidence Interpretation

This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.

Effects of Arthroscopy for Femoroacetabular Impingement Syndrome on Quality of Life and Economic Outcomes

2018 ◽  
Vol 46 (5) ◽  
pp. 1205-1213 ◽  
Author(s):  
Richard C. Mather ◽  
Shane J. Nho ◽  
Andrew Federer ◽  
Berna Demiralp ◽  
Jennifer Nguyen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Indirect Cost ◽  
Functional Status ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Nonoperative Treatment ◽  
Economic Benefits ◽  
The Mean ◽  
Mean Cost ◽  
Fai Syndrome

Background: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. Purpose: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Results: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. Conclusion: FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.

scholarly journals Arthroscopy for Management of Femoroacetabular Impingement Syndrome in the Military Health System: A 10-Year Epidemiological Overview of Cases with 2-year Follow-up

2019 ◽  
Vol 184 (11-12) ◽  
pp. 788-796
Author(s):  
Daniel Rhon ◽  
Matthew Schmitz ◽  
Rachel Mayhew ◽  
Katie Dry ◽  
Tina Greenlee
Keyword(s):  
Physical Therapy ◽  
Health System ◽  
Healthcare Utilization ◽  
Hip Arthroscopy ◽  
Complication Rates ◽  
Military Health System ◽  
Military Health ◽  
The Military ◽  
Fai Syndrome

Abstract Introduction With the rapid rise in arthroscopy rates for the management of Femoroacetabular Impingement (FAI) Syndrome, it is important to understand current surgical rates and the impact of these surgeries within the Military Health System (MHS). The purpose of this study was to provide an epidemiological descriptive summary of hip arthroscopy for FAI Syndrome in the MHS and describe perioperative healthcare utilization variables. Methods Eligible beneficiaries ages 18–50, undergoing hip arthroscopy with 2-year follow-up after surgery were included. Healthcare utilization data were abstracted from the MHS Data Repository (MDR) from June 2003 to July 2015, and included all visits, costs, procedures, and prescriptions taking place in both military and civilian hospitals worldwide. Results 1870 patients were included (mean age 32.2 years; 55.5% male). 51.7% of the procedures took place in military versus 48.3% in civilian hospitals. Mean hip-related healthcare costs in the 2-year following surgery were $15,434 per patient. Patients had a median of 3 opioid prescriptions and 72% had a comorbidity present after surgery. Generally, rates of surgery grew annually from 66 cases in 2004 to 422 cases in 2013. Overall complication rates were comparable to other published reports. Procedures in both military and civilian hospitals had the same rates of femoroplasty and labral repairs, however acetabuloplasty procedures occurred at a higher rate in military (18.9%) vs civilian (14.7%) hospitals. Only 58.8% of patients had physical therapy in the year prior to surgery, while 82.7% had it after surgery. Additionally, 50% of patients had received opioid prescriptions in the 1 year prior to surgery, while 38.9% had 3 or greater opioid prescriptions beyond the initial perioperative fill within the 2-year follow-up. Conclusion Rates of arthroscopy have grown in the MHS over the last decade. Complication rates are similar to those reported in other populations and settings. Utilization of physical therapy was much more likely after surgery than prior to it. Opioid use was high prior to surgery and many individuals continued to receive opioid prescriptions beyond the initial perioperative period.

Author Reply to “Regarding ‘Does Femoral Retroversion Adversely Affect Outcomes After Hip Arthroscopy for FAI Syndrome? A Midterm Analysis’”

2020 ◽  
Vol 36 (4) ◽  
pp. 936-937
Author(s):  
Ajay C. Lall ◽  
Muriel R. Battaglia ◽  
David R. Maldonado ◽  
Itay Perets ◽  
Joseph R. Laseter ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Author Reply ◽  
Fai Syndrome

scholarly journals The Key Parts of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Implications for the Learning Curve

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110187
Author(s):  
Austin E. Wininger ◽  
Sherif Dabash ◽  
Thomas J. Ellis ◽  
Shane J. Nho ◽  
Joshua D. Harris
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Expert Opinion ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Delphi Technique ◽  
High Volume ◽  
Reduce Risk ◽  
Fai Syndrome

Background: Hip arthroscopy is a rapidly growing surgical approach to treat femoroacetabular impingement (FAI) syndrome with a significant learning curve pertaining to complication risk, reoperation rate, and total hip arthroplasty conversion. Hip arthroscopy is more frequently being taught in residency and fellowship training. The key, or critical, parts of the technique have not yet been defined. Purpose: To identify the key components required to perform arthroscopic treatment of FAI syndrome. Study Design: Consensus statement. Methods: A 3-question survey comprising questions on hip arthroscopy for FAI was sent to a convenience sample of 101 high-volume arthroscopic hip surgeons in the United States. Surgeon career length (years) and maintenance volume (cases per year) were queried. Hip arthroscopy was divided into 10 steps using a Delphi technique to achieve a convergence of expert opinion. A step was considered “key” if it could (1) avoid complications, (2) reduce risk of revision arthroscopy, (3) reduce risk of total hip arthroplasty conversion, or (4) optimize patient-reported outcomes. Based on previous literature, steps with >90% of participants were defined as key. Descriptive and correlation statistics were calculated. Results: A total of 64 surgeons (63% response rate) reported 5.6 ± 2.1 steps as key (median, 6; range, 1-9). Most surgeons (56.3%) had been performing hip arthroscopy for >5 years. Most surgeons (71.9%) had performed >100 hip arthroscopy procedures per year. Labral treatment (97% agreement) and cam correction (91% agreement) were the 2 key steps of hip arthroscopy for FAI. Pincer/subspine correction (86% agreement), dynamic examination before capsular closure (63% agreement), and capsular management/closure (63% agreement) were selected by a majority of respondents but did not meet the study definition of key. There was no significant correlation between surgeon experience and designation of certain steps as key. Conclusion: Based on a Delphi technique and expert opinion survey of high-volume surgeons, labral treatment and cam correction are the 2 key parts of hip arthroscopy for FAI syndrome.

scholarly journals Para-acetabular Radiopaque Densities in Patients With Femoroacetabular Impingement: A Retrospective Assessment of Prevalence and Characteristics

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989233
Author(s):  
Guillaume D. Dumont ◽  
Travis J. Menge ◽  
Adam J. Money ◽  
Philip Carmon
Keyword(s):  
Computed Tomography ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Labral Tear ◽  
Labral Repair ◽  
Patient Specific ◽  
Treatment Technique ◽  
Systemic Inflammatory Disease ◽  
Fai Syndrome

Background: Femoroacetabular impingement (FAI) syndrome is a common source of hip pain associated with chondrolabral injury. There is a subset of patients with FAI syndrome who present with radiopaque densities (RODs) adjacent to the acetabular rim. Purpose: To evaluate the prevalence, characteristics, and patient-specific factors associated with RODs adjacent to the acetabulum in patients treated with hip arthroscopy for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Between November 2014 and March 2018, a total of 296 patients who underwent hip arthroscopy for FAI with a labral tear were reviewed retrospectively. Patient-specific variables were collected, including age, sex, lateral center-edge angle (LCEA), and alpha angle. Imaging (computed tomography) and surgical reports were reviewed for the location and characteristics of RODs, as well as subsequent labral treatment technique. Patients were excluded if they were treated for extra-articular hip pathology, had a revision procedure, or had a diagnosis other than FAI with a labral tear. No patient was excluded for any history of systemic inflammatory disease. Binary logistic regression was used to compare age, LCEA, and alpha angle for patients with or without radiopaque fragments. An alpha level of 0.05 was used to indicate statistical significance. Results: A total of 204 patients met inclusion criteria; 33 patients (16.2%; 16 males, 17 females) had para-acetabular RODs. There were no statistically significant differences in age ( P = .82), sex ( P = .92), LCEA ( P = .24), or alpha angle ( P = .10) among patients with or without an ROD. Of the 33 patients, 29 (87.9%) had fragments in the anterosuperior quadrant. Overall, 31 patients (93.9%) were treated with labral repair in addition to correction of the underlying bony impingement, while 2 patients (6.1%) underwent focal labral debridement owing to poor labral tissue quality around the RODs. Twenty-five patients (76%) had identifiable RODs, which were excised at the time of surgery. The mean (± SD) ROD size measured on axial and coronal computed tomography imaging was 6.3 ± 5.5 mm and 4 ± 4.5 mm, respectively. Conclusion: Age, sex, LCEA, and alpha angle were not predictive of the presence of para-acetabular RODs. Approximately one-sixth of all patients with FAI had RODs identified on computed tomography, which were typically located at the anterosuperior acetabulum. The majority of hips with para-acetabular RODs were amenable to labral repair. The relative prevalence and lack of predictive patient-specific indicators for these fragments suggest that a high degree of suspicion is necessary when evaluating patients with FAI.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

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