Ehsan Saadat1, Scott D Martin2, Thomas S Thornhill3, Sarah A Brownlee4, Elena Losina5, Jeffrey N Katz6. 1. Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, Massachusetts Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts. 2. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts. 3. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts. 5. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts. 6. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts jnkatz@partners.org.
Abstract
BACKGROUND: With the recent increased recognition of femoroacetabular impingement (FAI) as a cause of hip pain and early osteoarthritis, surgical treatment has proliferated. There is a growing body of literature on outcomes of surgical intervention for FAI, but factors associated with inferior surgical outcomes have not been reviewed systematically. PURPOSE: To review the available literature and identify factors associated with the failure of open or arthroscopic surgery for FAI. STUDY DESIGN: Systematic review. METHODS: Using the PubMed database, we searched for relevant English-language articles published from January 1966 through August 2012. Inclusion criteria were a primary focus on the surgical treatment of FAI, measurement of functional or pain outcomes, identification of treatment failures, and statistical analysis of factors leading to failure. Exclusion criteria were review articles, technique-only articles, and studies of nonoperative management. Two definitions of failure were considered: (1) a lack of statistically significant improvement in validated measures of pain, function, or satisfaction postoperatively; and (2) revision surgery or conversion to hip arthroplasty because of persistent symptoms. The consistency of association between preoperative variables and clinical outcomes was reported across all studies. RESULTS: Thirteen studies were included. Three were retrospective; there were no randomized controlled trials. Many studies had important methodological limitations. Preoperative cartilage damage or osteoarthritis had the strongest and most consistent relationship with conversion to hip arthroplasty and with a lack of improvement in pain or function. Greater age at the index operation, worse preoperative modified Harris Hip Score, and longer duration of symptoms preoperatively (>1.5 years) were associated with conversion to hip arthroplasty. CONCLUSION: Older age, presence of arthritic changes, longer duration of symptoms, and worse preoperative pain and functional scores are associated with poor outcomes of surgery for FAI. Incorporation of these data into discussions with patients may facilitate informed, shared decision making about the surgical treatment of FAI.
BACKGROUND: With the recent increased recognition of femoroacetabular impingement (FAI) as a cause of hip pain and early osteoarthritis, surgical treatment has proliferated. There is a growing body of literature on outcomes of surgical intervention for FAI, but factors associated with inferior surgical outcomes have not been reviewed systematically. PURPOSE: To review the available literature and identify factors associated with the failure of open or arthroscopic surgery for FAI. STUDY DESIGN: Systematic review. METHODS: Using the PubMed database, we searched for relevant English-language articles published from January 1966 through August 2012. Inclusion criteria were a primary focus on the surgical treatment of FAI, measurement of functional or pain outcomes, identification of treatment failures, and statistical analysis of factors leading to failure. Exclusion criteria were review articles, technique-only articles, and studies of nonoperative management. Two definitions of failure were considered: (1) a lack of statistically significant improvement in validated measures of pain, function, or satisfaction postoperatively; and (2) revision surgery or conversion to hip arthroplasty because of persistent symptoms. The consistency of association between preoperative variables and clinical outcomes was reported across all studies. RESULTS: Thirteen studies were included. Three were retrospective; there were no randomized controlled trials. Many studies had important methodological limitations. Preoperative cartilage damage or osteoarthritis had the strongest and most consistent relationship with conversion to hip arthroplasty and with a lack of improvement in pain or function. Greater age at the index operation, worse preoperative modified Harris Hip Score, and longer duration of symptoms preoperatively (>1.5 years) were associated with conversion to hip arthroplasty. CONCLUSION: Older age, presence of arthritic changes, longer duration of symptoms, and worse preoperative pain and functional scores are associated with poor outcomes of surgery for FAI. Incorporation of these data into discussions with patients may facilitate informed, shared decision making about the surgical treatment of FAI.
Authors: Florian D Naal; Hermes H Miozzari; Michael Schär; Tobias Hesper; Hubert P Nötzli Journal: Am J Sports Med Date: 2012-05-03 Impact factor: 6.202
Authors: Steven B Cohen; Ronald Huang; Michael G Ciccotti; Christopher C Dodson; Javad Parvizi Journal: Am J Sports Med Date: 2012-05-04 Impact factor: 6.202
Authors: Arel Gereli; Baris Kocaoglu; Kerem Tekin Ulku; Abdul Veli Ismailoglu; Sena Silay; Mustafa Karahan Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-09-29 Impact factor: 4.342
Authors: Nicolás Fiz; Mikel Sánchez; Juan Carlos Pérez; Jorge Guadilla; Diego Delgado; Juan Azofra; Beatriz Aizpurua Journal: Arthrosc Tech Date: 2014-07-14
Authors: Xi Ming Zhu; Asra Toobaie; Alla Iansavichene; Moin Khan; Ryan M Degen Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-05-23 Impact factor: 4.114
Authors: Michael Q Potter; James D Wylie; Grant S Sun; James T Beckmann; Stephen K Aoki Journal: Clin Orthop Relat Res Date: 2014-02-27 Impact factor: 4.176
Authors: Adam I Edelstein; Jeffrey J Nepple; Wahid Abu-Amer; Cecilia Pascual-Garrido; Charles W Goss; John C Clohisy Journal: Clin Orthop Relat Res Date: 2021-05-01 Impact factor: 4.176