Article

Outcomes 2 to 5 Years Following Hip Arthroscopy for Femoroacetabular Impingement in the Patient Aged 11 to 16 Years

Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 05/2012; 28(9):1255-61. DOI: 10.1016/j.arthro.2012.02.006
Source: PubMed

ABSTRACT The purpose of this study was to evaluate clinical outcomes after treatment for femoroacetabular impingement in the pediatric and adolescent population with a minimum of 2 years' follow-up.
Prospectively collected data on 60 consecutive pediatric and adolescent patients (65 hips), aged 16 years or younger, who underwent hip arthroscopy were retrospectively analyzed. Patients were excluded if they had previous surgery on the hip and if they presented a center-edge angle below 25°.
The mean age at the time of surgery was 15 years (range, 11 to 16 years), and 31% of patients were boys and 69% were girls. The femoral physis was open in 10% of patients, partially closed in 19%, and closed in 71%. Cam impingement was found in 10% of cases, pincer impingement in 15%, and mixed type in 75%. The mean center-edge angle was 36° (95% confidence interval [CI], 34° to 38°), and the mean alpha angle was 64° (95% CI, 60° to 69°). There was a significant association between age and alpha angle (r = 0.324, P = .02). After the index procedure, 8 patients (all girls) needed second-look diagnostic arthroscopies because of intra-articular adhesions. At a mean follow-up of 3 years (range, 2 to 5 years) with 91% follow-up, the modified Harris Hip Score increased from a mean of 57 (95% CI, 51 to 62) to a mean of 91 (95% CI, 88 to 94) (P < .001). The median rating for patient satisfaction with outcome was 10 (range, 5 to 10).
Hip arthroscopy in the pediatric and adolescent population is a safe procedure, with excellent clinical outcomes at 2 to 5 years. In this study there was an association between alpha angle and age. Clinical scores showed a significant improvement after surgery; however, 13% of patients did require a second procedure for capsulolabral adhesions.
Level IV, therapeutic case series.

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    • "NA 2001-2003 4 34 40.5 Beck et al 3 (2004) Clin Orthop Relat Res Switzerland 56.4 (48-62.4) 37.2 1996-1997 4 19 36 Murphy et al 29 (2004) Clin Orthop Relat Res USA 62.4 (24-144) 76.8-114 NA 4 23 35.4 Hip Arthroscopy Polesello et al 37 (2014) Hip Int Brazil 73.2 (60-96) NR 2002-2007 4 26 34.6 Skendzel et al 40 (2014) Am J Sports Med USA 73 (60-97) 31.6 2005-2008 3 466 39.6 Larson et al 20 (2012) Am J Sports Med USA 42 (24-72) 12 2004-2007 3 94 30 Malviya et al 23 (2012) J Bone Joint Surg Br UK 38.4 (12-84) NA 2005-2009 4 612 36.7 Palmer et al 32 (2012) Arthroscopy USA 46 (36-70) 17.7 2005-2008 4 201 40.2 Philippon et al 36 (2012) Arthroscopy USA 42 (24-60) NA 2005-2008 4 65 15 Horisberger et al 18 (2010) Arthroscopy Switzerland 36.0 (18-49.2) 16.8 2004-2007 4 20 47.3 "
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    ABSTRACT: Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition. To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up. Systematic review and meta-analysis. A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed. A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P = .06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P < .001). Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI. © 2015 The Author(s).
    The American Journal of Sports Medicine 06/2015; DOI:10.1177/0363546515587719 · 4.70 Impact Factor
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