ePoster #744 - ISHA Annual Scientific Meeting 2016
Do Patients With Borderline Dysplasia Or Pincer Morphology Have Inferior Outcomes Following Hip Arthroscopy For Fai With Capsular Plication Compared To Patients With Normal Lcea?
Alexander Weber, MD, Chicago, IL UNITED STATES
Benjamin Kuhns, MD, Chicago, IL UNITED STATES
Jennifer Alter, BS, Chicago, IL UNITED STATES
David Levy, MD, Chicago, IL 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 evaluating differences in outcomes of hip arthroscopy for FAI based on preoperative Lateral Center Edge Angle of Wiberg (LCEA).
Patients with femoroacetabular impingement (FAI) can have a wide range of acetabular morphology ranging from dysplastic and borderline dysplastic to focal or global acetabular overcoverage. The purpose of this study was to assess differences in outcomes of hip arthroscopy for FAI based on preoperative Lateral Center Edge Angle of Wiberg (LCEA) in groups of patients with borderline dysplasia, normal LCEA, and pincer morphology.
A clinical repository containing patients undergoing primary hip arthroscopy for FAI between 1/1/2012-1/1/2014 with a minimum follow up of two years was queried to include patients in this study. Operative procedures included labral debridement and repair, acetabular rim trimming, femoral osteochondroplasty and complete capsular closure. The primary outcome measure was the Hip Outcome Score Activities of Daily Living (HOS-ADL) questionnaire. Secondary outcome measures included the HOS Score Sports Subscale (HOS-SS) and modified Harris Hip Score (MHHS), patient pain, and patient satisfaction with surgery. Patients were segregated into 3 groups based on their preoperative LCEA: a borderline dysplastic group (LCEA 18-24.9), a normal group (LCEA 25-39.9) and a pincer group (LCEA >40). There was one patient with an LCEA of less than 18 which was excluded from the study. The Patient Acceptable Symptomatic State (PASS) cutoffs of 87 for the HOS-ADL, 75 for the HOS-SS, and 74 for the HHS were used to assess for clinically significant improvement. The borderline dysplasia and pincer groups were compared to the normal group to identify outcome differences.
Out of a repository of 494 consecutive patients undergoing arthroscopic surgery for FAI, 478 had accessible preoperative radiographs, and 375 (80.5%) had follow up at two years. There were 38 (8%) patients in the borderline dysplastic group, 382 (80%) in the normal group, and 58 (12%) in the pincer group. There were no differences between the groups based on age, BMI, smoking status, preoperative alpha angle, preoperative joint space width, or Tonnis grade. The borderline dysplastic group had more females than the normal group (30/38 (79%) vs. 222/382 (58%); p=0.01), but there were no gender differences between the pincer and normal groups. All three groups demonstrated significant improvements from preoperative to postoperative scores for the HOS-ADL, HOS-SS, and MHHS (p<0.05 in all cases). There were no differences between the borderline dysplastic and normal groups in two-year postoperative HOS-ADL (83.0±18.2 vs. 85.8±16.5; p=0.40, or MHHS (74.5±16.9 vs. 76.4±15.9; p=0.55). There were no differences in two-year postoperative scores between the normal and pincer groups. There were no differences in patients meeting PASS between the three groups (HOS-ADL: Borderline 15(56%), Normal 99(64%), Pincer 34(73%) p=0.32; HOS-SS: Borderline 11(42%), Normal 168 (58%), Pincer 24(53%) p=0.25; HHS: Borderline 14(52%), Normal 193 (62%), Pincer 32 (70%) p=0.32.)
Patients undergoing hip arthroscopy for FAI with complete capsular closure experienced significant clinical improvements regardless of whether their acetabulum has borderline dysplasia, normal LCEA, or pincer morphology. Further follow-up in larger patient cohorts with long-term follow-up will be necessary to confirm these findings and their durability over time in challenging patients with borderline dysplasia.