Hip arthroscopy, a burgeoning surgical technique for addressing symptomatic femoroacetabular impingement (FAI), has seen a surge in utilization. A comprehensive study scrutinizing radiological indicators to forecast surgical success was conducted, with intriguing findings that may influence both patient selection and surgical strategy.
A prognostic cross-sectional cohort study was carried out at a single institution, examining patients who underwent hip arthroscopy between January 2013 and April 2021. The researchers meticulously evaluated radiological parameters from conventional radiographs and magnetic resonance arthrography to determine their correlation with post-surgical outcomes. The study aimed to identify radiological features and their combinations that predict the outcome of hip arthroscopy for FAI.
Study Findings
From a pool of 810 hip arthroscopies, 359 cases were included for detailed analysis. Specific radiological risk factors such as a dysplastic posterior wall, a Tönnis grade of 2 or higher, and excessive correction of the α angle were associated with suboptimal results following cam resection. Additionally, acetabular retroversion and dysplasia emerged as significant predictors of unfavorable surgical outcomes. The study highlighted that over-correction of both cam and pincer deformities led to poorer outcomes compared to under-correction, emphasizing the need for precision in surgical intervention.
Clinical Implications
The results suggest that caution is warranted when considering hip arthroscopy for patients displaying multiple signs of acetabular retroversion. Furthermore, individuals with acetabular dysplasia and a lateral center-edge angle of less than 20° should not be subjected to isolated hip arthroscopy, as it might not yield the desired results. The findings also advise against acetabular rim-trimming in patients with borderline dysplasia and stress the importance of avoiding over-correction of deformities.
From a market access perspective, these insights are vital for informing clinical guidelines and patient selection criteria. They have the potential to streamline surgical outcomes and minimize complications, ultimately enhancing the value proposition of hip arthroscopy as a viable treatment option. Moreover, these findings can assist healthcare providers in optimizing resource allocation and improving patient satisfaction through tailored interventions.
Key Inferences
The study’s concrete inferences can be summarized as follows:
- Patients with multiple acetabular retroversion signs should be cautiously considered for hip arthroscopy.
- A lateral center-edge angle of less than 20° in acetabular dysplasia patients is a contraindication for isolated hip arthroscopy.
- Avoidance of acetabular rim-trimming in borderline dysplasia is recommended.
- Precision in correcting deformities is crucial to avoid over-correction and its associated poor outcomes.
In conclusion, these findings underscore the importance of meticulous preoperative radiological assessment in predicting the success of hip arthroscopy for FAI. By adhering to these recommendations, clinicians can enhance surgical outcomes, thereby improving patient care and optimizing therapeutic efficacy.
Original Article:
Bone Joint J. 2024 Aug 1;106-B(8):775-782. doi: 10.1302/0301-620X.106B8.BJJ-2023-1478.R2.
ABSTRACT
AIMS: Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI.
METHODS: A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes.
RESULTS: Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction.
CONCLUSION: We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.
PMID:39084659 | DOI:10.1302/0301-620X.106B8.BJJ-2023-1478.R2
This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.
