Outcomes 2 to 5 Years Following Hip Arthroscopy for Femoroacetabular Impingement in the Patient Aged 11 to 16 Years
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.
Available from: Joshua David Harris
- "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).
Available from: Claudio Díaz
- "There is no age limit for hip arthroscopy, as positive results have been proven in young and old patients. Overall, in patients under 40 years, hip arthroscopy can be indicated treating larger chondral defects in an attempt to prolong the lifetime of the hip and eventually prevent THR (Figures 2 and 4). "
Available from: Thomas Gicquel
- "However, patient status regarding the censoring criterion was determined for all evaluated patients, and less than 10% of patients were lost to follow-up. Few studies report outcomes after at least 2 years in a sufficient number of patients (Table 5)      . In our cohort, the good shortterm results were sustained in the mid-term, and the main factor associated with the mid-term outcome and procedure survival was the presence of osteoarthritic lesions on the preoperative radiographs . "
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Outcomes after arthroscopic femoro-acetabular impingement (FAI) surgery are promising in the short-term but have rarely been evaluated in the mid-term (e.g., about 5 years). Here, our objectives were to obtain mid-term data on functional and radiographic outcomes, to identify prognostic factors, and to determine the mid-term rate of arthroplasty revision with the associated risk factors.
We hypothesized that the results of arthroscopic FAI surgery were sustained over time.
Materials and methods
We conducted a prospective multi-surgeon study of 53 Tönnis grade 0 or 1 hips treated arthroscopically for symptomatic FAI (23 cam, 10 pincer, and 20 mixed deformities). We obtained short-term (10 months) and mid-term (4.6 years) data on the functional outcome (WOMAC and satisfaction scores), proportion of patients without revision arthroplasty, and development of osteoarthritis (graded using the Tönnis classification).
In the patients without revision arthroplasty, the WOMAC score improved significantly (P < 0.01) from baseline (61.4 ± 15.6) to 10 months (84.2 ± 15.6) and last follow-up (85.2 ± 15.5) but remained unchanged between the two postoperative time points, confirming the stability of the results. The proportion of satisfied patients was 79% after 10 months and 68% (36/53) at last follow-up (NS). Osteoarthritis developed in 13/35 (37%) hips for which radiographs were obtained at last follow-up. At last follow-up, 46/53 hips (87%; 95%CI, 78–96) did not required revision surgery; arthroplasty was required in the 7 remaining hips. The main prognostic factor was the preoperative osteoarthritis Tönnis grade: at last follow-up, compared to Tönnis grade 0 hips, Tönnis grade 1 hips had lower WOMAC scores (77 vs. 88), lower satisfaction rates (50% versus 77%), a higher rate of osteoarthritis progression (57% versus 24%), and a higher rate of arthroplasty (33.3% versus 2.9%).
Our results are consistent with published data. The outcomes of arthroscopic FAI surgery are sustained over time and the preoperative osteoarthritis status is the main predictor of mid-term outcomes.
Level of evidence
IV, prospective cohort study.
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