Mithilesh V Kumar1, Ajaykumar Shanmugaraj2, Jeffrey Kay2, Nicole Simunovic2, Michael J Huang3, Thomas H Wuerz4, Olufemi R Ayeni5,6. 1. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. 2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. 3. Colorado Springs Orthopaedic Group, Colorado Springs, CO, USA. 4. Boston Sports & Shoulder Center, Waltham, MA, USA. 5. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. ayenif@mcmaster.ca. 6. McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca.
Abstract
PURPOSE: Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications. METHODS: This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957). CONCLUSIONS: Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter. LEVEL OF EVIDENCE: Level IV.
PURPOSE: Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications. METHODS: This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957). CONCLUSIONS: Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter. LEVEL OF EVIDENCE: Level IV.
Authors: Rintje Agricola; Jan H Waarsing; Nigel K Arden; Andrew J Carr; Sita M A Bierma-Zeinstra; Geraint E Thomas; Harrie Weinans; Sion Glyn-Jones Journal: Nat Rev Rheumatol Date: 2013-07-23 Impact factor: 20.543
Authors: Gregory L Cvetanovich; Alexander E Weber; Benjamin D Kuhns; Charles P Hannon; Dwayne D'Souza; Joshua Harris; Richard C Mather; Shane J Nho Journal: J Pediatr Orthop Date: 2018-10 Impact factor: 2.324
Authors: Olufemi R Ayeni; Jon Karlsson; Diane Heels-Ansdell; Lehana Thabane; Volker Musahl; Nicole Simunovic; Andrew Duong; Mohit Bhandari; Asheesh Bedi; Teppo Järvinen; Douglas Naudie; Matti Seppänen; Gerard Slobogean; Matthew Skelly; Ajay Shanmugaraj; Sarah Crouch; Sheila Sprague; Lisa Buckingham; Tim Ramsay; John Lee; Petteri Kousa; Sasha Carsen; Hema Choudur; Yan Sim; Kelly Johnston; Sheila Sprague; Ivan Wong; Ryland Murphy; Sara Sparavalo; Daniel Whelan; Ryan Khan; Gavin C A Wood; Fiona Howells; Heather Grant; Douglas Naudie; Bryn Zomar; Michael Pollock; Kevin Willits; Andrew Firth; Stacey Wanlin; Alliya Remtulla; Nicole Kaniki; Etienne L Belzile; Sylvie Turmel; Uffe Jørgensen; Annie Gam-Pedersen; Tays Hatanpää; Raine Sihvonen; Marko Raivio; Pirjo Toivonen; Mari Pirjetta Routapohja Journal: Am J Sports Med Date: 2020-09-24 Impact factor: 6.202
Authors: Michael S Lee; Andrew E Jimenez; Jade S Owens; Andrew J Curley; Olivia A Paraschos; David R Maldonado; Ajay C Lall; Benjamin G Domb Journal: Orthop J Sports Med Date: 2022-06-08