TY - JOUR
T1 - Surgical Treatment of Femoroacetabular Impingement
T2 - Hip Arthroscopy Versus Surgical Hip Dislocation: A Propensity-Matched Analysis
AU - ANCHOR Group
AU - Nepple, Jeffrey J.
AU - Zaltz, Ira
AU - Larson, Christopher M.
AU - Beaulé, Paul E.
AU - Kim, Young Jo
AU - Millis, Michael B.
AU - Sierra, Rafael J.
AU - Clohisy, John C.
N1 - Funding Information:
Disclosure: This study was supported in part by a clinical research grant from Zimmer-Biomet, Inc. to some of the authors (J.C.C., J.J.N.), The Curing Hip Disease Fund (J.C.C.), and the ANCHOR Fund (J.C.C.). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work ( http://links.lww.com/JBJS/G107 ).
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/11/4
Y1 - 2020/11/4
N2 - Background:Surgical treatment of femoroacetabular impingement (FAI) continues to evolve and is most commonly approached with either hip arthroscopy (HA) or surgical dislocation (SD) of the hip. The purpose of this study was to compare the outcomes of similar patients undergoing surgical treatment of FAI with either HA or SD.Methods:A prospective multicenter cohort study of patients undergoing primary surgical treatment of FAI was performed. Follow-up at a minimum of 1 year (mean, 4.3 years) was available for 621 hips (81.7%), including 399 procedures with HA and 222 procedures with SD. Propensity scores were calculated and reflect the likelihood of surgical treatment with HA versus SD for a given set of covariates. Propensity scores allowed 1:1 matching to identify similar patients at baseline. After propensity matching, 128 matched pairs of patients who underwent HA and 128 matched pairs of those who underwent SD were included in the study. The primary outcome was the postoperative modified Harris hip score (mHHS); secondary outcomes included the Hip disability and Osteoarthritis Outcome Score (HOOS), the University of California Los Angeles (UCLA) activity score, and the Short Form-12 (SF-12) physical and mental subscores, as well as the rate of persistent symptoms, revision surgery, and total hip arthroplasty (THA).Results:After propensity matching, the 2 groups exhibited similar distributions of all of the covariates that were included in the model. Both groups demonstrated significant improvements in all patient-reported outcomes (PROs). The final mHHS was not significantly different between the 2 matched groups (81.3 for the HA group versus 80.2 for the SD group, p = 0.67). Likewise, the HOOS pain subscale was similar at the time of final follow-up (77.6 versus 80.5, respectively, p = 0.32). No difference between the HA group and the SD group was identified in the rate of THA (0% and 3.1%, respectively, p = 0.41) and revision surgery (7.8% and 10.9%, respectively, p = 0.35); overall rates of persistent symptoms were 21.9% for the HA group and 24.4% for the SD group (p = 0.55).Conclusions:In a propensity-matched analysis of patients who were treated with either approach, patients undergoing HA or SD demonstrated similar outcomes at a mean of 4 years postoperatively.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
AB - Background:Surgical treatment of femoroacetabular impingement (FAI) continues to evolve and is most commonly approached with either hip arthroscopy (HA) or surgical dislocation (SD) of the hip. The purpose of this study was to compare the outcomes of similar patients undergoing surgical treatment of FAI with either HA or SD.Methods:A prospective multicenter cohort study of patients undergoing primary surgical treatment of FAI was performed. Follow-up at a minimum of 1 year (mean, 4.3 years) was available for 621 hips (81.7%), including 399 procedures with HA and 222 procedures with SD. Propensity scores were calculated and reflect the likelihood of surgical treatment with HA versus SD for a given set of covariates. Propensity scores allowed 1:1 matching to identify similar patients at baseline. After propensity matching, 128 matched pairs of patients who underwent HA and 128 matched pairs of those who underwent SD were included in the study. The primary outcome was the postoperative modified Harris hip score (mHHS); secondary outcomes included the Hip disability and Osteoarthritis Outcome Score (HOOS), the University of California Los Angeles (UCLA) activity score, and the Short Form-12 (SF-12) physical and mental subscores, as well as the rate of persistent symptoms, revision surgery, and total hip arthroplasty (THA).Results:After propensity matching, the 2 groups exhibited similar distributions of all of the covariates that were included in the model. Both groups demonstrated significant improvements in all patient-reported outcomes (PROs). The final mHHS was not significantly different between the 2 matched groups (81.3 for the HA group versus 80.2 for the SD group, p = 0.67). Likewise, the HOOS pain subscale was similar at the time of final follow-up (77.6 versus 80.5, respectively, p = 0.32). No difference between the HA group and the SD group was identified in the rate of THA (0% and 3.1%, respectively, p = 0.41) and revision surgery (7.8% and 10.9%, respectively, p = 0.35); overall rates of persistent symptoms were 21.9% for the HA group and 24.4% for the SD group (p = 0.55).Conclusions:In a propensity-matched analysis of patients who were treated with either approach, patients undergoing HA or SD demonstrated similar outcomes at a mean of 4 years postoperatively.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
UR - http://www.scopus.com/inward/record.url?scp=85095798996&partnerID=8YFLogxK
U2 - 10.2106/JBJS.20.00265
DO - 10.2106/JBJS.20.00265
M3 - Article
C2 - 32925230
AN - SCOPUS:85095798996
SN - 0021-9355
VL - 102
SP - 51
EP - 58
JO - Journal of Bone and Joint Surgery - Series A
JF - Journal of Bone and Joint Surgery - Series A
IS - Suppl 2
ER -