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There is no definite consensus on the adequate radiographic correction in arthroscopic osteochondroplasty for femoroacetabular impingement: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to evaluate and define what is considered an adequate radiographic correction in arthroscopic osteochondroplasty for FAI and to secondarily assess how radiographic outcomes relate to patient reported outcomes and complications.

Methods

The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until January 2021. Studies were screened by two reviewers independently and in duplicate for studies reporting on post-operative radiographic outcomes in arthroscopic osteochondroplasty for FAI. Data on radiographic outcomes as well as data reporting functional outcomes and complications were recorded. A meta-analysis was used to combine the mean pre- and post-operative radiographic outcomes using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score.

Results

The most commonly reported radiographic outcome was the alpha angle with a pooled mean post-operative angle of 44° (95% CI 41°–46°), and mean pre- to post-surgical difference of − 19° (− 22 to − 16, I2 = 96%), followed by the LCEA with a pooled mean post-operative angle of 30° (95% CI 29–31) and mean difference after surgery of − 4° (− 6 to − 1, I2 = 97%,). Eleven studies reported on the correlation between radiographic and clinical outcomes with no consistent consensus correlation found amongst the included studies. Similarly, six studies correlated radiographic outcomes with conversion to THA with no consistent consensus correlation found amongst the included studies.

Conclusion

Based on this review, the main conclusion is that there is no consensus definition on the optimal radiographic correction for FAI and there was no consistent correlation between radiographic correction and functional outcomes. However, based on the uniform improvement in functional outcomes, this review suggests a post-operative alpha angle target of 44° with a correction target of 19° and LCEA target of 30° with a correction target of 3°.

Level of evidence

IV.

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Abbreviations

FAI:

Femoroacetabular impingement

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

MINORS:

Methodological index for non-randomized studies

LCEA:

Lateral center edge angle

ACEA:

Anterior center edge angle

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Dan Cohen, Jeffrey Kay, David Slawaska-Eng, Mahmoud Almasri & Olufemi R. Ayeni

  2. Faculty of Science, McMaster University, Hamilton, ON, Canada

    Abdullah Khan

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Nicole Simunovic, Andrew Duong & Olufemi R. Ayeni

  4. Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA

    Mahmoud Almasri

  5. Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA

    Marc R. Safran

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  1. Dan Cohen
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  2. Abdullah Khan
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  3. Jeffrey Kay
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Contributions

DC participated in the design of the study, carried out the systematic review, extracted data, provided illustrations, and drafted the manuscript. AK carried out the systematic review, extracted data and drafted the manuscript. JK carried out the systematic review, extracted data, completed the statistical analysis and revised the manuscript. Authors DSE and MA participated in the study design and participated in drafting and revising the manuscript. OA conceived of the study and participated in the revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Olufemi R. Ayeni.

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Supplementary Information

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167_2021_6645_MOESM1_ESM.pdf

Additional File 1.pdf Surgical Details and Complications: Table describing the various surgical details and post-operative complications amongst the included studies (PDF 125 KB)

167_2021_6645_MOESM2_ESM.pdf

Additional File 2.pdf Post-operative Rehabilitation Protocol: Table describing the post-operative rehabilitation protocol amongst the included studies (PDF 76 KB)

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Cohen, D., Khan, A., Kay, J. et al. There is no definite consensus on the adequate radiographic correction in arthroscopic osteochondroplasty for femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 29, 2799–2818 (2021). https://doi.org/10.1007/s00167-021-06645-1

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