Ryan M Degen1, Danyal H Nawabi2, Asheesh Bedi3, Bryan T Kelly2. 1. Center for Hip Pain and Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY, 10021, USA. ryan.degen@gmail.com. 2. Center for Hip Pain and Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY, 10021, USA. 3. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, USA.
Abstract
PURPOSE: To review the literature on femoroacetabular impingement (FAI) treatment outcomes, specifically focusing on potential pre-operative radiographic parameters that may provide prognostic information regarding outcomes following surgical management. METHODS: A comprehensive review of computerized literature databases (Medline Ovid and PubMed) was performed, searching for articles reporting on FAI treatment outcomes. A single reviewer screened titles, abstracts and performed full-text reviews of eligible studies. The references of these studies were further screened for additional potentially relevant studies. A total of 243 studies were reviewed, with 18 meeting inclusion criteria. RESULTS: Thirteen arthroscopic studies reported on 1556 patients, with clinical improvement in 35-92 % of patients and associated failure rates of 12-71 %. Five open surgical studies reported on 238 patients with clinical improvement in 65-95 % of patients and associated failure rates of 0-35 %. Both arthroscopic and open studies identified inferior outcomes with pre-operative radiographic findings of an elevated Tönnis grade (grade 2 or higher), joint space <2 mm, lateral centre-edge angle (LCEA) <20° and incomplete femoral osteoplasty. CONCLUSION: Pre-operative radiographic findings of osteoarthritis (Tönnis grade 2/3, <2 mm joint space) or dysplasia (LCEA < 20°) should be considered relative contraindications to joint preservation surgery as outcomes are worse among these patients and associated with a higher risk of conversion to total hip arthroplasty. Care should also be taken to perform a thorough femoral osteoplasty to reduce the risk of failure and need for revision surgery. LEVEL OF EVIDENCE: III.
PURPOSE: To review the literature on femoroacetabular impingement (FAI) treatment outcomes, specifically focusing on potential pre-operative radiographic parameters that may provide prognostic information regarding outcomes following surgical management. METHODS: A comprehensive review of computerized literature databases (Medline Ovid and PubMed) was performed, searching for articles reporting on FAI treatment outcomes. A single reviewer screened titles, abstracts and performed full-text reviews of eligible studies. The references of these studies were further screened for additional potentially relevant studies. A total of 243 studies were reviewed, with 18 meeting inclusion criteria. RESULTS: Thirteen arthroscopic studies reported on 1556 patients, with clinical improvement in 35-92 % of patients and associated failure rates of 12-71 %. Five open surgical studies reported on 238 patients with clinical improvement in 65-95 % of patients and associated failure rates of 0-35 %. Both arthroscopic and open studies identified inferior outcomes with pre-operative radiographic findings of an elevated Tönnis grade (grade 2 or higher), joint space <2 mm, lateral centre-edge angle (LCEA) <20° and incomplete femoral osteoplasty. CONCLUSION: Pre-operative radiographic findings of osteoarthritis (Tönnis grade 2/3, <2 mm joint space) or dysplasia (LCEA < 20°) should be considered relative contraindications to joint preservation surgery as outcomes are worse among these patients and associated with a higher risk of conversion to total hip arthroplasty. Care should also be taken to perform a thorough femoral osteoplasty to reduce the risk of failure and need for revision surgery. LEVEL OF EVIDENCE: III.
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