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Effect of the presence of cysts in the hip joint on hip arthroscopy
Murat Çiçeklidağ1, Tacettin Ayanoğlu, Ahmet Yiğit Kaptan
1Yenimahalle Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, muratciceklidag@hotmail.com.
Insights
Subchondral cysts in hip impingement patients undergoing arthroscopy were associated with better functional outcomes. Larger cysts (>8 mm) showed a greater improvement in hip scores, indicating positive effects of arthroscopic treatment.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Hip Arthroscopy
Background:
- Femoroacetabular impingement (FAI) and labral pathologies are common causes of hip pain.
- Subchondral cysts are often found in association with FAI.
- The impact of these cysts on surgical outcomes is not fully understood.
Purpose of the Study:
- To investigate the effect of subchondral cyst presence and size on postoperative results in patients undergoing hip arthroscopy for FAI.
- To analyze the relationship between cyst characteristics and clinical outcomes.
Main Methods:
- Retrospective analysis of 261 patients (2010-2019) with cam-pincer-mixed-type FAI and labral pathologies undergoing hip arthroscopy.
- Patients were grouped based on cyst presence and size (<5 mm, 5-8 mm, >8 mm).
- Clinical outcomes were assessed using pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores.
Main Results:
- Patients with cysts had significantly lower preoperative mHHS scores but showed significantly greater improvement in mHHS and VAS scores postoperatively compared to those without cysts.
- In the pincer impingement group, patients with cysts experienced a significantly higher increase in mHHS.
- Cysts larger than 8 mm were associated with a significantly greater increase in mHHS scores compared to smaller cysts (<5 mm).
Conclusions:
- Subchondral cysts are associated with specific types of FAI (cam/mixed-type at femoral head/neck, pincer-type at acetabulum).
- The presence of subchondral cysts correlates with improved functional recovery (higher mHHS, lower VAS) after hip arthroscopy for FAI.
- Arthroscopic treatment of FAI lesions in patients with subchondral cysts can positively influence functional outcomes.
Objectives:
The aim of this study was to investigate whether the presence and size of fibrous cysts affected postoperative results in patients undergoing hip arthroscopy.
Patients And Methods:
Between January 2010 and December 2019, a total of 261 patients (138 males, 123 females; mean age: 39.5±11.9 years; range, 18 to 66 years) who underwent hip arthroscopy with the diagnosis of cam-pincer-mixed-type femoroacetabular impingement (FAI) and labral pathologies were retrospectively analyzed. The study groups (impingements and labral pathologies) and the presence of cyst (or cyst size: <5 mm, 5-8 mm, >8 mm) were used as the fixed effects, and the analysis was adjusted for baseline age, sex, and preoperative scores. Pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores that were applied to all patients were used as an indication of clinical results.
Results:
The mean preoperative mHHS score of the patients with a cyst was significantly lower compared to the patients without a cyst (56.8±12.3 vs. 60.3±12.7, p=0.026). The mean change in the mHHS score and the mean percentage change in VAS score were significantly higher in the patients with a cyst compared to the patients without a cyst (mHHS score: 28.1±14.0 vs. 22.5±14.1, p=0.002; VAS score: 61.9±30.2 vs. 52.6±47.4, p=0.038). The increase in mHHS score over time for patients with a cyst was significantly higher than the patients without cysts in the pincer group (38.1±11.1 vs. 19.3±13.5, p<0.001). The patients with a cyst size of >8 mm had a significantly higher increase in the mHHS scores compared to the patients with a cyst size of <5 mm (29.5±12.9 vs. 23.5±13.8, p=0.043).
Conclusion:
Subchondral cysts in the femoral head and neck junction accompanied cam-type and mixed-type FAI, while subchondral cysts in the acetabulum accompanied pincer-type impingement. In all groups, the mean increase in mHHS scores and the mean decrease in VAS scores were higher in patients with subchondral cysts than in patients without cysts. In patients with subchondral cysts, if the lesion causing FAI is treated arthroscopically, it can positively affect the functional results.
