Orthopaedic surgeons continually seek to refine techniques to improve their patients’ surgical outcomes. Surgical treatments for femoroacetabular impingement (FAI) syndrome are no exception, and careful patient selection is also critical to the success of these interventions. In the June 17, 2020 issue of The Journal, Ceylan et al. analyzed a single-surgeon prospective database to identify risk factors for treatment failure after a particular hip-preservation surgery known as mini-open femoroacetabular osteoplasty (FAO). In this study, the authors defined “failure” as the eventual need for a total hip arthroplasty (THA) over a minimum 2-year follow-up.
The 749 procedures studied were performed between 2004 and 2016 and involved treatment of the femur, acetabular rim, labrum, and chondral surfaces if necessary. Labral repair was performed on all hips that had adequate healthy tissue, while those that did not were treated with partial or total excision of the labrum.
Sixty-eight hips (9%) underwent THA. The patients who did not need a hip replacement were significantly younger (mean age of 33 years vs nearly 42) and were operated on after the surgeon had more experience. Other significant differences among the failure group included the duration of symptoms (twice as long, at 3.6 years), higher preop alpha angles, and a higher percentage of total labral resections performed.
Radiographic evidence of hip dysplasia was also a significant risk factor for failure, along with labral hypertrophy and acetabular retroversion (both of which may be considered proxies for volume-deficient acetabuli). After adjusting for covariates, Ceylan et al. found that less surgeon experience, older patient age, prolonged preoperative symptoms, increased medial joint space narrowing and Tonnis grade, and developmental hip dysplasia were all associated with a higher risk of failure after FAO surgery.
Although these findings do not represent results using the most up-to-date arthroscopic techniques for FAI treatment, they do highlight characteristics that can and should be discussed with patients with FAI when the subject of expected surgical outcomes arises during shared decision making.
Matthew R. Schmitz, MD
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