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Total volume of cam deformity alone predicts outcome in arthroscopy for femoroacetabular impingement

  • Sarah H. EllisEmail author
  • Diana M. Perriman
  • Alexander W. R. Burns
  • Teresa M. Neeman
  • Joseph T. Lynch
  • Paul N. Smith
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  • 7 Downloads

Abstract

Purpose

Rates for arthroscopic surgery for femoroacetabular impingement (FAI) are rising and there is growing concern related to the effectiveness and costs associated with this treatment. There is a general lack of consensus as to the criteria for surgical selection of patients. The purpose of this study was to determine whether patient outcome following arthroscopic surgery for FAI could be predicted based on the size and location of deformity. The specific questions were: (1) what is the morphology of FAI in terms of size and location of deformity in a cohort of patients selected for surgery? (2) Do morphological factors predict postoperative improvement in hip scores? (3) Do morphological factors predict preoperative hip scores? (4) Are there clusters of morphological factors which explain postsurgical improvement in hip scores?

Materials and methods

Computer tomography (CT) surgical plans of 90 hips in 79 patients who had undergone primary hip arthroscopy for FAI were retrospectively reviewed. Four parameters for the femur and acetabulum were created: total depth of deformity, maximal depth, extent and the position of maximal deformity. This data were compared with prospectively acquired preoperative and postoperative patient outcome data using generalised linear models.

Results

The cohort comprised 33 males and 46 females aged 37.9 (18–61). The majority (74%) had mixed morphology, 23% isolated cam, and 3% isolated pincer. Overall, the bone depth was greatest and more extensive on the femur. Increased total additional cam deformity alone predicted poorer postoperative outcome (p = 0.045). None of the morphological factors were related to preoperative scores and there was no association between the meta-variables and postoperative outcome.

Conclusions

The results of this study indicate that a greater total volume of cam deformity led to poorer postoperative patient outcome scores at 1 year. This information provides the surgeon with more accurate patient-specific data for prediction of expected outcomes.

Level of evidence

Level III diagnostic.

Keywords

FAI Hip Impingement Acetabulum Morphology Arthroscopy 

Abbreviations

FAI

Femoroacetabular impingement

CT

Computer tomography

Dyonics PLAN

Dyonics PLAN Hip Impingement Planning System

iHOT-33

International Hip Outcome Tool

MCID

Minimal clinical important difference

Notes

Author contributions

SE conducted the research, analysed the images, and conducted the analysis and was primarily responsible for the manuscript preparation. DP conceived the research idea, devised, and supervised the research plan, assisted with the analysis and the manuscript preparation. AB contributed to the research plan, advised and supervised the image measurement and contributed to the manuscript preparation. JL contributed to the research plan, analysis, and the manuscript preparation. TN devised the analysis plan and supervised the analysis. PN contributed to the research plan and manuscript preparation. All authors read and approved the final manuscript.

Funding

There was no funding recieved for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval for this study was obtained through the Australian Capital Territory Health and Australian National University Human Ethics Committees (ETHLR.13.044 and Human Ethics Protocol 2015/070, respectively).

References

  1. 1.
    Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23:1286–1292CrossRefGoogle Scholar
  2. 2.
    Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Jt Surg Br 87:1012–1018CrossRefGoogle Scholar
  3. 3.
    Colvin AC, Harrast J, Harner C (2012) Trends in hip arthroscopy. J Bone Jt Surg Am 94:e23CrossRefGoogle Scholar
  4. 4.
    Degen RM, Nawabi DH, Bedi A, Kelly BT (2017) Radiographic predictors of femoroacetabular impingement treatment outcomes. Knee Surg Sports Traumatol Arthrosc 25:36–44CrossRefGoogle Scholar
  5. 5.
    Frank JM, Harris JD, Erickson BJ, Slikker W III, Bush-Joseph CA, Salata MJ et al (2015) Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy 31:1199–1204CrossRefGoogle Scholar
  6. 6.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120Google Scholar
  7. 7.
    Gicquel T, Gedouin JE, Krantz N, May O, Gicquel P, Bonin N et al (2014) Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: a prospective study after a mean follow-up of 4.6 (4.2–5.5) years. Orthop Traumatol Surg Res 100:651–656CrossRefGoogle Scholar
  8. 8.
    Griffin D, Wall P, Realpe A, Adams A, Parsons N, Hobson R et al (2016) UK FASHIoN: feasibility study of a randomised controlled trial of arthroscopic surgery for hip impingement compared with best conservative care. Health Technol Assess 20:1–172CrossRefGoogle Scholar
  9. 9.
    Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M et al (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169–1176CrossRefGoogle Scholar
  10. 10.
    Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J et al (2018) Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 391:2225–2235CrossRefGoogle Scholar
  11. 11.
    Haversath M, Hanke J, Landgraeber S, Herten M, Zilkens C, Krauspe R et al (2013) The distribution of nociceptive innervation in the painful hip: a histological investigation. Bone Jt J 95-B:770–776CrossRefGoogle Scholar
  12. 12.
    Ito KMI, Leunig MA, M (2001) Femoro-acetabular impingement and the cam-effect: a MRI-based quantitative study of the femoral head-neck offset. J Bone Jt Surg Br 83:171–176CrossRefGoogle Scholar
  13. 13.
    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 44:54–59CrossRefGoogle Scholar
  14. 14.
    Kemp JL, Collins NJ, Roos EM, Crossley KM (2013) Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. Am J Sports Med 41:2065–2073CrossRefGoogle Scholar
  15. 15.
    Larson CM, Giveans MR (2008) Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy 24:540–546CrossRefGoogle Scholar
  16. 16.
    Larson CM, Giveans MR, Taylor M (2011) Does arthroscopic FAI correction improve function with radiographic arthritis? Clin Orthop Relat Res 469:1667–1676CrossRefGoogle Scholar
  17. 17.
    Milone MT, Bedi A, Poultsides L, Magennis E, Byrd JW, Larson CM et al (2013) Novel CT-based three-dimensional software improves the characterization of cam morphology. Clin Orthop Relat Res 471:2484–2491CrossRefGoogle Scholar
  18. 18.
    Mohtadi NG, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N et al (2012) The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy 28:595–605CrossRefGoogle Scholar
  19. 19.
    Montgomery SR, Ngo SS, Hobson T, Nguyen S, Alluri R, Wang JC et al (2013) Trends and demographics in hip arthroscopy in the United States. Arthroscopy 29:661–665CrossRefGoogle Scholar
  20. 20.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240:778–785CrossRefGoogle Scholar
  21. 21.
    Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum 2-year follow-up. J Bone Jt Surg Br 91:16–23CrossRefGoogle Scholar
  22. 22.
    Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ (2007) Revision hip arthroscopy. Am J Sports Med 35:1918–1921CrossRefGoogle Scholar
  23. 23.
    Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M (2007) Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med 35:1571–1580CrossRefGoogle Scholar
  24. 24.
    Röling MA, Visser MI, Oei EH, Pilot P, Kleinrensink G-J, Bloem RM (2015) A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation-cadaveric validation study. BMC Musculoskelet Disord 16:50–56CrossRefGoogle Scholar
  25. 25.
    Tannenbaum EP, Ross JR, Bedi A (2014) Pros, cons, and future possibilities for use of computer navigation in hip arthroscopy. Sports Med Arthrosc Rev 22:33–41CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Australian National University Medical School, College of Health and MedicineAustralian National UniversityActonAustralia
  2. 2.Trauma and Orthopaedic Research UnitCanberra HospitalGarranAustralia
  3. 3.Statistical Consulting UnitAustralian National UniversityActonAustralia

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