ePoster #1105 - ISHA Annual Scientific Meeting 2016

What are the Short-Term Outcomes of Patients Undergoing Open Hip Preservation Surgery for Symptomatic Extraarticular Femoroacetabular Impingement?

Benjamin F Ricciardi, MD, New York, NY UNITED STATES
Kara Fields, MS, New York, NY UNITED STATES
Catherine Wentzel, BS, New York, NY UNITED STATES
Bryan Talmadge Kelly, MD, New York, NY UNITED STATES
Ernest Loumaine Sink, MD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, NY, UNITED STATES

FDA Status Cleared

Summary: The purposes of this study were to evaluate a cohort of patients undergoing surgery for extra-articular FAI at a single urban tertiary referral center to (1) describe the short-term disease specific patient reported outcome scores, and (2) identify preoperative factors that predict treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI.

Abstract:
Abstract Background Extraarticular femoroacetabular impingement (FAI) can result in symptomatic hip pain, however, outcomes of surgical treatment are limited. The purposes of this study were to (1) describe the short-term disease specific patient reported outcome scores, and (2) generate hypotheses about preoperative factors that may be associated with treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI. Methods A prospective single-center hip preservation registry was used to retrospectively identify patients with symptomatic extraarticular FAI presenting between October 2010 and November 2013. Extraarticular impingement was defined as abnormal contact between the extraarticular regions of the proximal femur (greater trochanter, lesser trochanter, extracapsular femoral neck) and the ilium or ischium. This diagnosis was confirmed intraoperatively by direct observation of impingement with hip range of motion after arthrotomy. Patients with a minimum of 1 year follow up from their last hip surgery with patient reported outcomes scores or reoperation during the study period were eligible for inclusion (N=51 patients, 62 hips; median clinical follow up 24 months [range 11-49 months]). Detailed demographic data and physical examination characteristics were recorded. Radiographs, CT, and MRI scans were reviewed for all patients. Outcome instruments including modified Harris hip score (HHS), Hip Outcome Score (HOS), and International Hip Outcome Tool (iHOT-33) were assessed preoperatively, 6 months, and each year subsequently. Patients that experienced treatment failure by most recent follow up (defined as < 10 point improvement in iHOT-33 postoperatively or reoperation) were identified. Potential preoperative predictive factors of failure were explored on a univariate basis. Results Median follow-up for patient reported outcomes from most recent hip surgery was 22 months. iHOT-33 improved from 33 (standard deviation [SD] 18) to 62 (26) at most recent follow-up, and 76% of patients had improved by a minimum important change (MIC). HHS improved from 53 (15) to 75 (17) at most recent follow-up, and 79% of patients had improved by MIC. HOS activities of daily living (ADL) improved from 64 (19) to 83 (18) at most recent follow-up, and 75% of patients had improved by MIC. HOS Sport improved from 45 (26) to 66 (28) at most recent follow-up, and 60% of patients had improved by MIC. Continued improvements in mean follow-up scores were seen from 1 year to 2 years from most recent surgery (p<0.05). Overall, 16 patients were considered treatment failures (N=7 for reoperation, N=9 for failure to improve by MIC at most recent follow-up). Preoperative HOS Sport was higher in patients experiencing treatment failure (58 [SD 19] versus 40 [SD 27] respectively; p=0.03). No other demographic, physical examination, or radiographic factors examined were associated with treatment failure. Conclusions Open treatment of extraarticular FAI results in short-term improvements in hip specific patient reported outcome scores in the majority of patients. No demographic, radiographic, or physical examination findings were associated with treatment failure. Higher HOS Sport scores were increased preoperatively in patients experiencing treatment failure, suggesting that higher functioning patients may be less likely to experience benefits with surgical treatment over the short-term.