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Significant improvement after hip arthroscopy for femoroacetabular impingement in women

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study was designed to evaluate outcomes in women after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) and compare these results with men.

Methods

Retrospective study of a prospective database of patients undergoing hip arthroscopy between 2015 and 2018. Inclusion criteria were patients between 18 and 50 years of age, diagnosis of FAIS, complete clinical patient-reported outcomes (PROs), radiographic measurements, and underwent at least a 2-year HA follow-up. For each woman, two men underwent HA were matched in a 1:2 ratio based on age within 5 years, and date of surgery within 6 months. Diagnostic arthroscopy was performed to evaluate labral and chondral status. Radiographic evaluation, a self-administered Hip Outcome Score (HOS) questionnaire, with activity of daily living (ADL) and sports subscale (SSS), and a self-administered short version of the International Hip Outcome Tool (iHOT-12) were assessed at 6 months, 12 months, and then yearly. Clinical relevance was measured with the minimal clinical important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for HOS-ADL, HOS-SSS, and iHOT-12.

Results

One hundred and eighty-five patients met the inclusion criteria. Fifty-two women were matched with 104 men. Significant differences in terms of demographics, radiographic results, intraoperative findings and arthroscopic procedures were found between women and men. Mean follow-up was 48.4 months in women and 50.2 months in men. Both groups showed significant improvement from preoperative PROs to the latest follow-up. There were no significant differences between groups in preoperative PROs, latest follow-up PROs and PROs improvements. The difference in frequency of patients achieving MCID, PASS, and SCB was only significant greater for iHOT-12 PASS in women compared with men.

Conclusion

Significant improvements in PROs in women after HA for FAIS at 4-year follow-up were found. Differences between women and men in PROs and rates of achieving MCID, SCB and PASS were only significant for iHOT-12 PASS.

Level of evidence

IV.

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References

  1. Kyin C, Maldonado DR, Go CC, Shapira J, Lall AC, Domb BG (2021) Mid- to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy 37(3):1011–1025. https://doi.org/10.1016/j.arthro.2020.10.001

    Article  PubMed  Google Scholar 

  2. Minkara AA, Westermann RW, Rosneck J, Lynch TS (2019) Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med 47(2):488–500

    Article  Google Scholar 

  3. Zusmanovich M, Haselman W, Serrano B, Banffy M (2021) The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States. Arthroscopy S0749–8063(21):00441–00442. https://doi.org/10.1016/j.arthro.2021.04.049

    Article  Google Scholar 

  4. Jauregui JJ, Salmons HI, Meredith SJ, Oster B, Gopinath R, Adib F (2020) Prevalence of femoro-acetabular impingement in non-arthritic patients with hip pain: a meta-analysis. Int Orthop 44(12):2559–2566

    Article  Google Scholar 

  5. Nepple JJ, Riggs CN, Ross JR, Clohisy JC (2014) Clinical presentation and disease characteristics of femoroacetabular impingement are sex-dependent. J Bone Jt Surg Am 96(20):1683–1689

    Article  Google Scholar 

  6. Salvo JP, Nho SJ, Wolff AB, Christoforetti JJ, Van Thiel GS, Ellis TJ, Matsuda DK, Kivlan BR, Chaudhry ZS, Carreira DS (2018) Sex-dependent differences in preoperative, radiographic, and intraoperative characteristics of patients undergoing hip arthroscopy: results from the multicenter arthroscopic study of the hip group. Arthroscopy 34(3):844–852

    Article  Google Scholar 

  7. Frank RM, Lee S, Bush-Joseph CA, Salata MJ, Mather RC 3rd, Nho SJ (2016) Outcomes for hip arthroscopy according to sex and age: a comparative matched-group analysis. J Bone Jt Surg Am 98(10):797–804

    Article  Google Scholar 

  8. Mygind-Klavsen B, Lund B, Nielsen TG, Maagaard N, Kraemer O, Hölmich P, Winge S, Lind M (2019) Danish Hip Arthroscopy Registry: predictors of outcome in patients with femoroacetabular impingement (FAI). Knee Surg Sports Traumatol Arthrosc 27(10):3110–3120

    Article  Google Scholar 

  9. Sogbein OA, Shah A, Kay J, Memon M, Simunovic N, Belzile EL, Ayeni OR (2019) Predictors of outcomes after hip arthroscopic surgery for femoroacetabular impingement: a systematic review. Orthop J Sports Med 7(6):2325967119848982

    Article  Google Scholar 

  10. Nwachukwu BU, Beck EC, Kunze KN, Chahla J, Rasio J, Nho SJ (2020) Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up. Am J Sports Med 48(4):901–907

    Article  Google Scholar 

  11. Beck EC, Drager J, Nwachukwu BU, Jan K, Rasio J, Nho SJ (2021) Gender and age-specific differences observed in rates of achieving meaningful clinical outcomes 5-years after hip arthroscopy for femoroacetabular impingement syndrome. Arthroscopy 37(8):2488-2496.e1

    Article  Google Scholar 

  12. Flores SE, Chambers CC, Borak KR, Zhang AL (2020) Is There a gender gap in outcomes after hip arthroscopy for femoroacetabular impingement? Assessment of clinically meaningful improvements in a prospective cohort. Orthop J Sports Med 8(7):2325967119900561

    Article  Google Scholar 

  13. Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50(19):1169–1176

    Article  CAS  Google Scholar 

  14. Kelly BT, Philippon M (2004) Arthroscopic hip anatomy. In: Callaghan J, Rosenberg A, Rubash H (eds) The Adult Hip. Lippincott Williams & Wilkin, Philadelphia, pp 78–79

    Google Scholar 

  15. Ha YC, Lee YK, Koo KH, Kwon KB, Song SH (2017) Prevalence and clinical significance of hypertrophic labrum in non-dysplastic hips. J Orthop Sci 22(3):512–516

    Article  Google Scholar 

  16. Gray AJ, Villar RN (1997) The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy 13(5):575–578

    Article  CAS  Google Scholar 

  17. Stalzer S, Wahoff M, Scanlan M (2006) Rehabilitation following hip arthroscopy. Clin Sports Med 25(2):337–357

    Article  Google Scholar 

  18. Clohisy JC, Carlisle JC, Beaulé PE, Kim Y, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Jt Surg Am 90(Suppl 4):47–66

    Article  Google Scholar 

  19. Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD (2020) The lisbon agreement on femoroacetabular impingement imaging-part 1: overview. Eur Radiol 30(10):5281–5297

    Article  Google Scholar 

  20. Werner CM, Copeland CE, Ruckstuhl T, Stromberg J, Turen CH, Kalberer F, Zingg PO (2010) Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign. Acta Orthop Belg 76(2):166–173

    PubMed  Google Scholar 

  21. Tonnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 119:39–47

    Google Scholar 

  22. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Jt Surg 91:16–23

    Article  CAS  Google Scholar 

  23. Wiberg G (1953) Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Jt Surg Am 35(1):65–80

    Article  Google Scholar 

  24. Barton C, Salineros MJ, Rakhra KS, Beaule PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469

    Article  Google Scholar 

  25. Martin RL, Philippon MJ (2007) Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy 23(8):822–826

    Article  Google Scholar 

  26. Seijas R, Sallent A, Ruiz-Ibán MA, Ares O, Marín-Peña O, Cuéllar R, Muriel A (2014) Validation of the Spanish version of the Hip Outcome Score: a multicenter study. Health Qual Life Outcomes 13(12):70

    Article  Google Scholar 

  27. Griffin DR, Parsons N, Mohtadi NG, Safran MR, Multicenter Arthroscopy of the Hip Outcomes Research Network (2012) A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28(5):611–616

    Article  Google Scholar 

  28. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee liga- ment injuries. Clin Orthop Relat Res 198:43–49

    Article  Google Scholar 

  29. Hetsroni I, Dela Torre K, Duke G, Lyman S, Kelly BT (2013) Sex differences of hip morphology in young adults with hip pain and labral tears. Arthroscopy 29(1):54–63

    Article  Google Scholar 

  30. Anderson CN (2016) Iliopsoas: pathology, diagnosis, and treatment. Clin Sports Med 35(3):419–433

    Article  Google Scholar 

  31. Marin-Peña Ó, Sierra-Madrid P, Lax-Pérez R, Ferrero-Manzanal F (2016) Extrarticular hip impingement. Hip Int 26(Suppl 1):14–16

    Article  Google Scholar 

  32. Lindner D, El Bitar YF, Jackson TJ, Sadik AY, Stake CE, Domb BG (2014) Sex-based differences in the clinical presentation of patients with symptomatic hip labral tears. Am J Sports Med 42(6):1365–1369

    Article  Google Scholar 

  33. Joseph R, Pan X, Cenkus K, Brown L, Ellis T, Di Stasi S (2016) Sex differences in self-reported hip function up to 2 years after arthroscopic surgery for femoroacetabular impingement. Am J Sports Med 44(1):54–59

    Article  Google Scholar 

  34. Nwachukwu BU, Chang B, Adjei J, Schairer WW, Ranawat AS, Kelly BT, Nawabi DH (2018) Time required to achieve minimal clinically important difference and substantial clinical benefit after arthroscopic treatment of femoroacetabular impingement. Am J Sports Med 46(11):2601–2606

    Article  Google Scholar 

  35. Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT (2011) Iliopsoas impingement: a newly identified cause of labral pathology in the hip. HSS J 7(2):145–150

    Article  Google Scholar 

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain

    Jesus Mas Martinez, David Bustamante Suarez de Puga, Carmen Verdu-Roman, Enrique Martinez Gimenez, Manuel Morales Santias & Javier Sanz-Reig

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  1. Jesus Mas Martinez
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  2. David Bustamante Suarez de Puga
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  3. Carmen Verdu-Roman
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  4. Enrique Martinez Gimenez
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  6. Javier Sanz-Reig
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Correspondence to Javier Sanz-Reig.

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Mas Martinez, J., Bustamante Suarez de Puga, D., Verdu-Roman, C. et al. Significant improvement after hip arthroscopy for femoroacetabular impingement in women. Knee Surg Sports Traumatol Arthrosc 30, 2181–2187 (2022). https://doi.org/10.1007/s00167-021-06802-6

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  • DOI: https://doi.org/10.1007/s00167-021-06802-6

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