Femoroacetabular Impingement Syndrome - Outcomes of Arthroscopic Hip Surgery

Hip and groin problems are common among young, active individuals. Femoroacetabular impingement (FAI) syndrome is an important cause of hip pain and reduced hip function among these patients. Bony abnormalities at the femoral head and neck junction and/or the acetabular rim may result in abnormal contact between these structures. Recent advancements in hip arthroscopy have made it possible to treat this condition using a minimally invasive approach and this is currently the standard procedure. The initial results of the treatment have been promising and there is emerging scientific evidence of promising outcomes at long-term follow-ups. The aim of this thesis is to evaluate medium- to long-term outcome, and predictors of outcome in patients undergoing arthroscopic treatment for FAI syndrome, and to evaluate the methodological quality of the current evidence for this treatment. Study I is a prospective cohort study comprising 289 patients, evaluating the outcome of arthroscopic treatment for FAI syndrome at a two-year follow-up using patient-reported outcome measurements (PROMs). A significant and clinically relevant improvement was noted. Study II is a retrospective cohort study comprising 198 patients, evaluating predictors of treatment outcome at a two-year follow-up using multiple linear regression analysis. Greater preoperative patient-reported hip function was associated with a higher postoperative patient-reported hip function. Study III is a cross-cultural adaptation and validation of a PROM to evaluate the level of physical activity. The Swedish version was deemed to be a reliable and valid measurement to determine the level of physical activity in patients with FAI syndrome. Study IV is a systematic review evaluating the methodological quality of prospective cohort studies of arthroscopic treatment for FAI syndrome. A total of 53 studies were included and the methodological quality of the included studies was deemed to be of moderate quality for both non-comparative and comparative studies. Study V is a prospective cohort study comprising 184 patients, evaluating the outcome of arthroscopic treatment for FAI syndrome at a five-year follow-up using PROMs. A significant and clinically relevant improvement was noted

Arthroscopic iliopsoas tenotomy after total hip arthroplasty: safe method for the right patient

Abstract Purpose To evaluate the outcome of arthroscopic treatment for iliopsoas impingement after total hip arthroplasty (THA) 2 years after surgery using patient reported outcomes (PROM). Methods In this study 12 patients (13 hips) were included from a local hip arthroscopy registry. Patients completed web-based PROMs preoperatively and at a minimum of 2 years postoperatively. The PROMs included the International Hip Outcome Tool short version (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analog Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. Results The mean age was 64.4 years (±15.1SD), mean body mass index (BMI) was 26.6 (±4.3SD), mean follow-up time was 49.8 months (±25SD). Comparing PROMs preoperatively with 2-year follow up showed an improvement for many of the PROMs used. The PROMs scores were iHOT-12 (24.9 vs 34.5, p = 0.13), HAGOS subscales (symptoms 38.2 vs 54.5, p = 0.05; pain 36 vs 53, p = 0.04; sport 14.1 vs 35.1, p = 0.03; daily activity 31 vs 47.5, p = 0.04; physical activity 21.8 vs 24, p = 0.76; quality of life 24 vs 35, p = 0.03), EQ-VAS (57.9 vs 58, p = 0.08), EQ-5D (0.34 vs 0.13, p = 0.07) and VAS for overall hip function (43.1 vs 46.2, p = 0.14). In total, 10 out of the 12 patients (83%) were satisfied with the intervention. Conclusion Patients undergoing surgery for iliopsoas impingement after previous THA showed improved self-reported hip function where most patients were satisfied with treatment

Good functional outcomes after endoscopic treatment for greater trochanteric pain syndrome

Abstract Purpose Greater trochanteric pain syndrome (GTPS) is a term covering different conditions generating lateral hip pain. Recalcitrant cases may require surgery but there are only a few studies evaluating endoscopic treatment. This study aimed to evaluate the outcome of endoscopically treated GTPS at minimum two years postoperatively using patient‐reported outcome measures (PROMs), and to assess the complication rate associated with endoscopic surgery. Methods A total of 33 patients, mean age 43.2 years, 88% women, with a mean symptom duration of 3.5 years, were included in the study. A total of 36 operated hips were included. Pre‐ and at minimum two years postoperatively the patients completed questionnaires consisting of the International Hip Outcome Tool (iHOT‐12) and the Hip Sports Activity scale (HSAS), the Visual analogue scale for overall hip function (VAS‐OHF), the Copenhagen Hip and Groin Outcome Score (HAGOS), the EuroQoL‐5 Dimension Questionnaire (EQ‐5D) and the EQ‐VAS. Complications were assessed using the Clavien‐Dindo classification. Results Median follow‐up time was 24.5 months postoperatively. Statistically significant improvements were seen for the following PROMs (p < 0.05); iHOT‐12 (36.3 vs 54.0), HAGOS different subscores (40.8 vs 59.0, 46.5 vs 62.6, 29.9 vs 53.1, 33.5 vs 51.4, 20.7 vs 41.4, 23.4 vs 43.3), EQ‐VAS (55.9 vs 63.3) and EQ‐5D (0.392 vs 0.648). VAS‐OHF and HSAS did not reach significance. There was a 71% satisfaction rate with the surgery. Three Clavien‐Dindo grade 1 and one grade 2 complications were registered postoperatively, with 41% of patients achieving PASS for iHOT‐12 at two years follow‐up. Conclusion Endoscopic surgery for greater trochanteric pain syndrome improved patient‐reported outcomes and the procedure was associated with low risk of complications. Level of evidence Level IV

Improvements After Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in High-Level Ice Hockey Players : 2-Year Outcomes by Player Position

Background: Ice hockey players often undergo arthroscopic treatment for femoroacetabular impingement syndrome (FAIS); however, only a few studies have reported postoperative patient-reported outcomes. It has been debated whether player position is related to FAIS. Purpose: To evaluate the change in patient-reported outcome measures (PROMs) in high-level ice hockey players from presurgery to 2 years after arthroscopic treatment for FAIS. The secondary aim was to evaluate differences in outcomes among player positions and whether stick handedness is related to the side of the symptomatic hip. Study Design: Case series; Level of evidence, 4. Methods: Ice hockey players undergoing treatment for FAIS between 2011 and 2019 were prospectively included. Preoperative and 2-year follow-up scores were collected for the following PROMs: HAGOS (Copenhagen Hip and Groin Outcome Score), iHOT-12 (12-item International Hip Outcome Tool), EQ-5D (EuroQol–5 Dimensions) and EQ-VAS (EuroQol–Visual Analog Scale), Hip Sports Activity Scale, and visual analog scale for overall hip function. Player position and stick handedness were collected from public sources. Preoperative and follow-up outcomes were compared for the entire cohort and among player positions. Results: The cohort included 172 ice hockey players with a mean age of 28 years, a mean body mass index of 25.6, and a mean symptom duration of 46.3 months. In the 120 players with 2-year follow-up data, there was significant improvement in all PROMs as compared with presurgery: HAGOS subscales (symptoms, 47.5 vs 68.0; pain, 57.0 vs 75.8; activities of daily living, 62.5 vs 81.0; sports, 40.0 vs 64.7; physical activity, 30.9 vs 57.2; quality of life, 32.5 vs 57.8), iHOT-12 (45.2 vs 66.7), EQ-5D (0.59 vs 0.75), EQ-VAS (68.3 vs 73.2), and visual analog scale for overall hip function (49.6 vs 69.2) (P <.0001 for all). At 2-year follow-up, 83% reported satisfaction with the procedure. There was no difference in the improvement in PROMs among player positions. Further, there was no significant relationship between stick handedness and side of symptomatic hip; however, because of the number of bilateral procedures and large number of left-handed shooters, no conclusions could be drawn. Conclusion: High-level ice hockey players undergoing arthroscopic treatment for FAIS reported improvements in PROMs 2 years after surgery, regardless of player position

Prior hip arthroscopy does not affect 1-year patient-reported outcomes following total hip arthroplasty: a register-based matched case-control study of 675 patients

Background and purpose — Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and may contribute to the development of osteoarthritis. We investigated whether a prior hip arthroscopy affects the patient-reported outcomes (PROMs) of a later total hip arthroplasty (THA). Patients and methods — Patients undergoing hip arthroscopy between 2011 and 2018 were identified from a hip arthroscopy register and linked to the Swedish Hip Arthroplasty Register (SHAR). A propensity-score matched control group without a prior hip arthroscopy, based on demographic data and preoperative score from the EuroQoL visual analogue scale (EQ VAS) and hip pain score, was identified from SHAR. The group with a hip arthroscopy (treated group) consisted of 135 patients and the matched control group comprised 540 patients. The included PROMs were EQ-5D and EQ VAS of the EuroQoL group, and a questionnaire regarding hip pain and another addressing satisfaction. Rate of reoperation was collected from the SHAR. The follow-up period was 1 year. Results — The mean interval from arthroscopy to THA was 27 months (SD 19). The EQ-5D was 0.81 and 0.82, and EQ VAS was 78 and 79 in the treated group and the matched control group respectively. There were no differences in hip pain, and reported satisfaction was similar with 87% in the treated group and 86% in the matched control group. Interpretation — These results offer reassurance that a prior hip arthroscopy for FAIS does not appear to affect the short-term patient-reported outcomes of a future THA and indicate that patients undergoing an intervention are not at risk of inferior results due to their prior hip arthroscopy