Jeffrey J. Nepple
BOSTON — A multicenter, prospective study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting highlighted the predictors of persistent symptoms and reoperation after surgical treatment for femoroacetabular impingement.
Jeffrey J. Nepple , MD, and colleagues recorded patient characteristics, baseline patient-reported outcomes, imaging findings, intraoperative pathology and surgical treatments among 760 hips undergoing primary surgical treatment of femoroacetabular impingement across nine institutions. The modified Harris Hip Score was used to identify patients who failed to reach the minimally clinically important difference and patient acceptable symptom state, according to Nepple.
Overall, 81.6% of hips with a mean 4.3-year follow-up were included in the study. Nepple noted 4% of patients underwent total hip arthroplasty, 11% of patients underwent reoperation overall and 25.9% of patients had persistent symptoms. He added deformity severity predicted persistent symptoms, but not reoperation.
“Lower preoperative alpha angle was associated with higher rates of persistent symptoms,” Nepple said. “Similarly, elevations in lateral center edge above 40° were predictive of higher rates of persistent symptoms.”
Patients younger than 18 years experienced lower rates of persistent symptoms, according to Nepple, while women, non-athletes and alpha angle smaller than 55° predicted higher rates of persistent symptoms.
“When we go into the multivariate analysis for total hip, things you would expect — age, acetabular microfracture, femoral head chondroplasty — all independently predicted this outcome,” Nepple said.
He added preoperative Harris Hip Score strongly predicted reoperation, especially among female patients, non-athletes or patients with a higher BMI.
“So these patients get better [and] have some level of persistent symptoms that leads to higher likelihood of reoperation,” Nepple said. – by Casey Tingle
Nepple JJ, et al. Abstract 77. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Nepple reports he is a paid consultant for Responsive Arthroscopy and Smith & Nephew, is a paid presenter or speaker for Smith & Nephew and receives research support from Smith & Nephew and Zimmer.