ePoster #708 - ISHA Annual Scientific Meeting 2016

Clinically Meaningful Improvements Following Hip Arthroscopy For Femoroacetabular Impingement In Pediatric Patients Regardless Of Gender

Gregory Cvetanovich
Alexander Weber, MD, Chicago, IL UNITED STATES
Benjamin Kuhns, MD, Chicago, IL UNITED STATES
Charles P. Hannon, MD, Chicago, IL UNITED STATES
Dwayne D'souza, BS, Chicago, IL UNITED STATES
Joshua David Harris, MD, Houston, TX UNITED STATES
Richard C. Mather, MD, MBA, Durham, NC 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: Pediatric patients undergoing hip arthroscopy for femoroacetabular impingement demonstrate clinically significant improvements irrespective of gender.

Abstract:
Introduction:

Hip arthroscopy has more recently been applied to pediatric and adolescent patients with FAI, offering the potential not only to improve function and relieve pain, but also to theoretically preserve the hip joint by relieving impingement before advanced chondrolabral damage occurs. The objective of this study was to determine if pediatric patients undergoing hip arthroscopy for symptomatic femoroacetabular impingement (FAI) experience clinically meaningful improvements in functional outcome scores.

Methods:

A consecutive series of patients who underwent primary hip arthroscopy for FAI was identified using our institution’s hip registry between 1/26/2012 and 7/19/2013. Inclusion criteria were a diagnosis of FAI, failure of conservative management, 2 years clinical follow-up, and age of 18 years or younger. Demographics, preoperative radiographic measurements, and pre and postoperative patient reported outcome scores (Hip Outcome Score (HOS) Activity of Daily Living (ADL) and Sports-Specific Subscale (SS), and Modified Harris Hip Score (MHHS)) were collected. Percentage of patients achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) were determined using published cutoffs for HOS and MHHS in FAI patients.

Results:

Forty-three patients met study inclusion criteria, and 37 patients (86%) were available at a minimum follow-up of 2 years. Mean age was 17.0 ± 1.4 years, 70% were female, and 8.1% had an open proximal femoral physis. All competitive high school and college athletes were able to return to sport. Patients experienced significant improvements following hip arthroscopy in HOS-ADL, HOS-SS, and MHHS scores (all p<.0001). MCID was achieved in 81% of patients (27/34) for HOS-ADL, 97% (33/34) for HOS-SS, and 84% (27/32) for MHHS. PASS was achieved for 76% of patients (26/34) for HOS-ADL, 79% (27/34) for HOS-SS, and 81% (26/32) for MHHS. Lower BMI but not age or gender was correlated with a greater improvement in MHHS scores (r=0.39; p=0.03). There were two minor complications and no revision surgery.

Conclusion:

Pediatric patients experienced statistically significant improved functional outcomes two years after hip arthroscopy for FAI. Additionally, these outcomes can be achieved with a low complication rate and a high return to preoperative activity. Approximately 80% of patients achieved clinically significant outcomes based on MCID and PASS criteria. Patient improvements in MHHS were equal regardless of age or gender; however, lower preoperative BMI led to greater postoperative MHHS improvements.