Preoperative risk factors in hip arthroscopy

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hip Preservation

Background:

• Femoroacetabular impingement (FAI) is a common cause of hip pain.
• Arthroscopic surgery is a standard treatment for FAI.
• Predicting long-term outcomes after FAI surgery is crucial for patient management.

Purpose of the Study:

• To identify preoperative variables that predict the need for hip arthroplasty after arthroscopic FAI surgery.
• To determine indicators of poor prognosis following hip arthroscopy for FAI.

Main Methods:

• Retrospective review of 452 patients undergoing hip arthroscopy for FAI (2007-2017).
• Data collected included patient demographics, radiographic findings (Tönnis grade), cartilage injury (ALAD grade), and patient-reported outcomes (VAS, HOS, mHHS, WOMAC).
• Comparison of variables between patients who did and did not require subsequent hip arthroplasty.

Main Results:

• 18.1% of patients (82/452) required conversion to hip arthroplasty after a mean follow-up of 5.8 years.
• Significant predictors of arthroplasty included ALAD grade 4 chondral injury, Tönnis grade 2, age >55 years, WOMAC >45, and HOS-ADL <50.
• No significant differences were found for side, gender, VAS, or HOS.

Conclusions:

• Preoperative factors like severe chondral damage (ALAD 4), moderate osteoarthritis (Tönnis 2), older age, and worse patient-reported outcomes (WOMAC, mHHS, HOS-ADL) are associated with a higher risk of requiring hip arthroplasty after FAI surgery.
• These findings aid in patient selection and counseling for hip arthroscopy.
• Improved understanding of prognostic factors can optimize treatment strategies for FAI.