10-13 Year Prospective Study of Patients with FAI undergoing Hip Arthroscopy Alex Chang
1 BS ,
1Donald
Chelsea Matzko
We present prospective outcome data collected from a cohort that followed a standard, postoperative PT protocol. We aim to: 1) Describe long-term patient-reported outcomes (>10 years) for hip arthroscopy 2) Describe survivorship and secondary hip procedures in our cohort 3) Identify pre-operative, intra-operative, and post-rehab strength deficits and correlate them with long-term outcomes for hip arthroscopy.
Methods
Enrollment
Excluded from cohort: - Failed to record preoperative strength measurements with rehab physical therapist (n= 78) Allocation
A. Hip Flexion
B. Hip Extension
Follow-Up
C. Hip Abduction
D. Hip Adduction
B.
C.
• The survivorship of hip arthroscopy was 96% (1 revision hip arthroscopy at 2 years post-arthroscopy). 2 out of 25 patients experienced recurrent labral tears in the ipsilateral hip, but both patients were managed conservatively without the need for revision. The labral tears occurred at 6- and 10-years postarthroscopy, respectively. 3 patients experienced contralateral symptomatic FAI with labral tear. None of the patients in our cohort required a total hip arthroplasty (THA).
D.
E.
F.
Results Cohort Characteristics
Intraoperative Findings
Sex:
Labral Treatment Labral debridement Labral repair Chondral wear Grade 0 Grade I Grade II Grade III Grade IV
Male Female
Left Right
n = 10 n = 15
n = 16 n=9
Age at Surgery (SD)
38 (13)
BMI (SD)
24 (4)
Alpha Angle (SD)
61 (4)
Degrees Flexion (SD)
111 (13)
Degrees Internal Rotation (SD)
26 (11)
Symptom Onset to Surgery (SD)
8 (6)
Follow-up, months (SD)
132 (13)
LT Villar Class 0: No Tear 1: Full Tear 2: Partial Tear Femoral neck osteoplasty Acetabuloplasty Acetabular Microfracture Iliopsoas Tendon Release LT debridement
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• HOS-ADL scores collected 10-13 years after hip arthroscopy (mean = 93 ± 9) were significantly improved in comparison to preoperative HOS-ADL scores (mean = 57 ± 9) (p < 0.01). Secondary hip outcome measures collected 10-13 years post-arthroscopy also included HOSSS (mean = 80 ± 22) and mHHS (92 ± 12).
Completed a HOS-ADL Questionnaire at 10-13 years follow-up (n = 25) Excluded: -Lost to follow-up (n = 16) -Declined to participate (n = 3)
G. AP radiograph depicting a CAM impingement on the left hip (elevated alpha angle > 55 degrees)
• Preoperative vs postoperative muscle strength measurements revealed statistically significant improvements in strength of hip extension and external rotation (p<0.05). Strength deficits measured at the end of the PT protocol did not have a statistically significant correlation to the 10-13 year post-operative HOS-ADL.
Enrolled in standard postoperative rehab protocol (n= 47)
Excluded from cohort: - Prospective strength measurements not collected during rehab with a physical therapist (n = 3)
A.
E. Hip Internal Rotation F. Hip External Rotation
2 MD
• Using previously published minimal patient acceptable symptomatic state (PASS) values for the HOS-ADL scale (87), we found that at 10-13 years post-hip arthroscopy, 20 patients (80%) achieved the PASS threshold
A. Burring of the femoral neck to remove the bony CAM impingement B. Completed femoral neck osteoplasty C. Labral tear on arthroscopy D-F. Labral repair utilizing a suture anchor method
Hips Included:
Patients with symptomatic FAI (Positive FADIR and FABER, alpha angle > 55), labral tear (confirmed by MRI), Osteoarthritis Tonnis Grade 1 or 0, and set to undergo hip arthroscopy with S.B. from 2007-2010 (n= 125)
and Srino Bharam
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Lenox Hill Hospital Department of Orthopedic Surgery
Introduction/Objectives Femoroacetabular impingement (FAI) is estimated to affect 1015% of the adult population. Hip arthroscopy is commonly performed to manage symptomatic FAI with labral tear. Until now, long-term patient-reported outcomes (>10 years) of hip arthroscopy for femoroacetabular impingement (FAI) have been scarcely reported. Accordingly, the influence of post-operative rehab for hip arthroscopy on long-term outcomes has not been described well.
2 BA ,
n (%) 15 (67) 10 (33) 3 (12) 10(40) 5 (20) 5 (20) 2 (8) 13 (52) 1 (4) 11(44) 25 (100) 5 (20) 2 (8) 4 (16) 12 (48)
• BMI, age, and pre-operative alpha angle did not have a significant correlation with improvement in HOS-ADL scores (p > 0.05). There also was no significant difference in outcomes of labral repair vs labral debridement (p > 0.05). Patients who presented with intraoperative findings of Grade 1 chondral wear sustained statistically significant improvement in HOS-ADL in comparison to patients with intraoperative findings of Grade 3 chondral wear (p<0.05).
Conclusions • Our study provides evidence of long-term survivorship for patients who undergo hip arthroscopy. 100% of the patients in our cohort survived 10-13 years without any revisions or THA. • Patient-reported outcome scores 10-13 years postoperatively remained significantly improved in comparison to pre-operative outcome scores. • We acknowledge possible compliance bias as our inclusion criteria included adherence to a 12-week post-op PT protocol. We also acknowledge that the young mean age of our sample and low BMI may possibly be influential. • Chondral wear grading, assessed intraoperatively, may influence long-term outcomes and may be useful for surgeons for assessing long-term prognosis.