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A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy
Michael Buldo-Licciardi1, Dhruv S Shankar1, Berkcan Akpinar1
1Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.
Insights
Superolateral cam lesions increase the risk of total hip replacement after hip arthroscopy compared to anterolateral lesions. However, cam location did not impact patient-reported outcomes at five years.
Area of Science:
- Orthopedic surgery
- Hip arthroscopy
- Femoroacetabular impingement
Background:
- Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain.
- Cam lesions are a type of bony abnormality associated with FAIS.
- The location of cam lesions may influence treatment outcomes.
Purpose of the Study:
- To investigate the association between radiographic cam lesion location and hip survivorship.
- To evaluate the impact of cam lesion location on patient-reported outcomes (PROs) at 5-year follow-up.
- To compare revision, reoperation, and conversion to total hip arthroplasty (THA) rates based on cam lesion location.
Main Methods:
- A review of prospectively collected data from patients undergoing hip arthroscopy for FAIS.
- Cam lesions were categorized into superolateral, anterolateral, or anterior locations.
- Assessment of THA conversion, revision, and reoperation rates, along with PROs (mHHS, NAHS) at 5 years.
Main Results:
- Superolateral cam lesions were associated with a higher likelihood of THA conversion compared to anterolateral lesions.
- The superolateral cohort was younger than the anterior and anterolateral cohorts.
- No significant differences in 5-year improvement in modified Harris Hip Scores (mHHS) or Non-Arthritic Hip Scores (NAHS) were observed across groups.
Conclusions:
- Superolateral cam lesions are a risk factor for THA conversion within 5 years post-hip arthroscopy.
- Cam lesion location does not appear to influence the improvement in patient-reported outcomes at the 5-year mark.
- Younger patient age was noted in the superolateral cam lesion group.
Purpose:
To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up.
Methods:
We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up.
Results:
Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P = .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P = .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P = .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P = .65).
Conclusions:
A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up.
Level Of Evidence:
Level III, retrospective comparative prognostic trial.
