Issue: October 2018
Perspective from Robert W. Westermann, MD
October 16, 2018
3 min read

Capsular management of FAI yielded low rates of revision, conversion to THA

Longer follow-up is needed to see if improvements are maintained beyond 2 years.

Issue: October 2018
Perspective from Robert W. Westermann, MD
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Results published in The American Journal of Sports Medicine showed clinically significant outcomes as well as low rates of revision and conversion to total hip arthroplasty among patients who underwent hip arthroscopic surgery with routine capsular closure for femoroacetabular impingement.

Among 474 patients who underwent primary hip arthroscopic surgery with routine capsular closure for femoroacetabular impingement (FAI) and had failed nonsurgical management, Gregory L. Cvetanovich, MD, sports medicine fellow at Rush University Medical Center, and his colleagues collected demographics, radiographic measurements, intraoperative characteristics and patient-reported outcome measures for 81.4% of patients at a minimum 2-year follow-up. Achieving published thresholds for the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) for the hip outcome score-activities of daily living (HOS-ADL) in patients with FAI impingement was considered the primary outcome measure. Secondary outcome measures were the HOS–sport-specific subscale (SSS), complications and reoperations.

Gregory L. Cvetanovich, MD
Gregory L. Cvetanovich

Low failure rate reported

Results showed statistically significant improvements in all patient-reported outcomes at a minimum 2-year follow-up, with 1.2% and 1.7% rates of revision hip arthroscopic surgery and of conversion to total hip arthroplasty, respectively.

“We were surprised at how low the rate of revision surgery and conversion to hip replacement was with overall less than a 3% failure rate on that combined revision and hip replacement outcome, and that is lower than a lot of what has been reported in the existing hip arthroscopy literature,” Cvetanovich told Orthopedics Today. “We think that is potentially related to patient selection and/or to surgical technique, including comprehensively addressing the FAI deformity, as well as closing the capsule completely in our patients.”

Researchers found 78.8% and 78.7% of patients achieved the MCID for the HOS-ADL and HOS-SSS, respectively. The results showed the PASS was achieved in 62% of patients for the HOS-ADL and in 60% for the HOS-SSS. In addition, 49% of patients achieved both the MCID and PASS for the HOS-ADL and HOS-SSS.

“Younger patients and those who have a low evidence of joint space narrowing are the ones who do best with this procedure, but the patients still had significant improvements even if they were a little older or had some minor narrowing,” Cvetanovich said.

Joint space drop-off, maintenance

Despite a high follow-up rate, Cvetanovich noted longer follow-up is needed to learn if the surgery is beneficial in the longer term.

“It would be interesting to see how these results translate at 5 years or longer follow-up in order to see if these significant improvements and the hip joint outcomes are maintained over the long term or whether these patients have a drop-off at 5 [years] or 10 years,” he said. “We would like to be able to address these [issues] and have patients do well for a long time and potentially even help to preserve the joint.” – by Casey Tingle

Disclosure: Cvetanovich reports no relevant financial disclosures.