ePoster #703 - ISHA Annual Scientific Meeting 2016

Atypical Posterior Pain Presentation of Femoroacetabular Impingement: An Age, Gender and BMI Matched Cohort Analysis

Gregory Cvetanovich
Alexander Weber, MD, Chicago, IL UNITED STATES
Benjamin Kuhns, MD, Chicago, IL UNITED STATES
David Levy, MD, Chicago, IL UNITED STATES
Jennifer Alter, BS, Chicago, IL UNITED STATES
Mitchell J. Greenberg, MS, Chicago, IL UNITED STATES
Richard C. Mather, MD, MBA, Durham, NC UNITED STATES
Michael Jonathan Salata, MD, Cleveland, OH UNITED STATES
Shane J. Nho, MD, MS, Chicago, IL UNITED STATES
Gift C. Ukwuani, MD, Chicago, IL UNITED STATES

Rush University Medical Center, Chicago, Illinois, UNITED STATES

FDA Status Not Applicable

Summary: We present data comparing postoperative outcomes of hip arthroscopy for FAI in groups of patients presenting with atypical posterior pain versus typical anterior hip or groin pain.

Abstract:
Introduction:
Patients with femoroacetabular impingement (FAI) typically present with groin or anterior hip pain. However, a small minority present with primarily posterior hip or buttock pain without typical anterior or groin complaints, but have other clinical and radiographic symptoms consistent with a diagnosis of FAI. The purpose of this study is to compare postoperative outcomes of hip arthroscopy for FAI in groups of patients presenting with atypical posterior pain versus typical anterior hip or groin pain.

Methods:
A clinical repository containing patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) between 1/1/2012-1/1/2014 with a minimum follow up of two years was queried to include patients in this study. The primary outcome measure was the Hip Outcome Score Activities of Daily Living (HOS-ADL) questionnaire. Secondary outcome measures included the HOS Sports Subscale (HOS-SS) and modified Harris Hip Score (HHS), postoperative pain (1-10 visual analog scale), and patient satisfaction. Clinically significant improvements were assessed with the Patient Acceptable Symptomatic State (PASS) cutoffs of 87 for the HOS-ADL, 75 for the HOS-SS, and 74 for the HHS.1 Patients presenting with a primary complaint of posterior hip or buttock pain were classified into an “Atypical” group, whereas patients presenting with anterior hip pain, groin pain, or a c-sign were classified into a “Typical” group. Patients with lateral hip pain were excluded from this study. Atypical patients were matched in a 2:1 cohort to patients in the typical group based on gender, age (±3 years), and BMI (±5). Demographic, preoperative, and postoperative variables along with outcome scores were compared between these groups.

Results:
Out of a repository containing 494 patients undergoing primary hip arthroscopy for FAI, 31 patients (6.5%) presented with atypical pain, compared to 378 (77%) that presented with typical pain. 2 year follow up was available on 28 (90%) of patients, who were matched with 56 patients from the typical group. Between the atypical and typical cohorts there were no differences in gender (18F (64%) vs. 36F (64%); p=0.1), age (35.8±9.9 vs. 35.2±9.8; p=0.78), or BMI (23.8±3.4 vs. 23.8±3.2; p=0.98). Additionally, there were no differences in smoking status, preoperative alpha angle, preoperative lateral center edge angle (LCEA), joint space width, or Tonnis grade. Postoperatively, both groups demonstrated significant improvement in HOS-ADL, HOS-SS, and HHS (p<0.001 for all). There were no differences in score improvement between the atypical and typical groups for HOS-ADL (15.6±14.6 vs. 20.1±16.8; p=0.19), HOS-SS (27.6±30.2 vs. 26.9±27.3; p=0.92) or HHS (18.9±13.4 vs. 16.3±13.1; p=0.48), pain improvement (5.0±3.2 vs. 5.6±2.7; p=0.56), or patient satisfaction (79.5±27.2 vs. 77.5±27.8; p=0.77). Additionally, there were no significant differences in patients meeting PASS between atypical and typical groups for all outcome surveys (HOS-ADL: 18(65%) vs. 31(66%) p=0.88; HOS-SS: (14(52%) vs. 23(52%) p=0.97; HHS: (18(64%) vs. 29(62%) p=0.82).

Conclusion:
Patients with typical and atypical pain presentations of FAI had similar significant improvements in outcome scores, postoperative pain, and satisfaction. Patients with atypical pain demonstrated similar rates of meeting PASS standards compared to patients with typical pain. Surgeons may use this information to treat patients presenting with atypical posterior pain but other findings consistent with a diagnosis of FAI.