Surgical Treatment of Femoroacetabular Impingement: Hip Arthroscopy Versus Surgical Hip Dislocation: A Propensity-Matched Analysis

• Published in: Journal of bone and joint surgery. American volume 2020-11, Vol.102 (Suppl 2), p.51-58
• Main Authors: Nepple, Jeffrey J., Zaltz, Ira, Larson, Christopher M., Beaulé, Paul E., Kim, Young-Jo, Millis, Michael B., Sierra, Rafael J., Clohisy, John C.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthroscopy - methods; Female; Femoracetabular Impingement - surgery; Hip Joint - surgery; Humans; Male; Middle Aged; Propensity Score; Prospective Studies; Treatment Outcome; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.20.00265

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.