Atypical Posterior Pain Presentation of Femoroacetabular Impingement: An Age, Gender and BMI Matched Cohort Analysis
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1 Atypical Posterior Pain Presentation of Femoroacetabular Impingement: An Age, Gender and BMI Matched Cohort Analysis Gregory Cvetanovich 1 MD Alexander Weber 1 MD Benjamin Kuhns 1 MD David Levy 1, MD Jennifer Alter 1, MS Mitchell J. Greenberg 1 MS Richard C. Mather 2 MD, MBA Michael J. Salata 3 MD Gift C. Ukwuani 1 MD Shane J Nho 1 MD, MSc. 1 Chicago, Illinois, USA. 2 Durham, North Carolina, USA. 3 Cleveland, Ohio, USA.
2 Disclosures GLC, AEW, BDK, DML; JA, MG, GCU: none MJS: Smith and Nephew: paid consultant RCM: AANA board/committee member, KNG health consulting, NC Orthopaedic Association board/committee member, Stryker paid consultant, Zimmer research support SJN: Allosource research support, American Journal of Orthopedics editorial board, AOSSM board/committee member, Arthrex research support, AANA board/committee member, Athletico research support, DJ Orthopaedics research support, Linvatec research support, Miomed research support, Ossur paid consultant, Smith and Nephew research support, Springer publishing royalties, Stryker consulting and research support
3 Introduction and Purpose Patients with femoroacetabular impingement (FAI) most commonly present with anterior groin pain A minority of patients present primarily with posterior pain, but otherwise have clinical and radiographic evidence of FAI. Purpose: The objective of this study was to compare outcomes of hip arthroscopy for FAI in patients with atypical posterior pain to a matched control group with the typical anterior pain presentation
4 Patient Selection Consecutive patients undergoing primary hip arthroscopy for FAI that had failed conservative management were identified using our institutional hip registry between 1/2012 and 1/2014. Typical pain group Anterior groin pain or c-sign. Atypical pain group Posterior hip or buttock pain. Atypical patients matched 1:2 to typical patients based on gender, age, and BMI Patients with thigh, knee, lateral, and low back pain were excluded.
5 Data Collection Patient demographics: sex, age, BMI, range of motion, and sports participation. Radiographic measurements: lateral center edge angle (LCEA), alpha angle, and Tonnis grade. Intraoperative data: procedures performed and findings Preoperative and minimum 2-year postoperative hip-specific functional outcome scores Modified Harris Hip Score (MHHS). Hip Outcome Score Sport-Specific and Activities of Daily Living subscales (HOS-SS and HOS-ADL). Complications and reoperations
6 Data Analysis Student s t-tests used to compare typical to atypical groups and pre- to post-operative values. Fischer s exact test, one-way ANOVA, and bivariate regression were used as needed to compare data. Alpha value of 0.05 statistically significant.
7 Typical and Atypical Patients 503 hip arthroscopies for FAI during the study period 31 with atypial posterior pain (6.2%). 373 with typical pain (74.2%). 99 excluded with other pain locations (19.6%). 28/31 (90.3%) atypical pain patients available at minimum 2-year follow-up Matched to 56 typical patients. No preoperative differences between typical and atypical groups (p>0.05).
8 Patient Reported Outcomes At 2.6+/-0.6 years follow-up, there were no differences in outcomes between atypical and typical groups Both groups improved significantly for all outcomes (p<0.0001) compared to preoperative values. Preop Score Atypical Typical P-value HOS-ADL 68.5+/ / HOS-SS 42.0+/ / mhhs 60.1+/ / Postop Score Atypical Typical P-value HOS-ADL 88.6+/ / HOS-SS 71.0+/ / mhhs 78.8+/ /
9 Revision and THA Conversion Revision and THA conversion Revision arthroscopy Atypical Typical P-value 1 (3.6%) 0 (0%) 0.33 THA conversion 0 (0%) 1 (1.8%) 0.48 No significant difference in revision/tha conversion/
10 Patients Achieving PASS and MCID Atypical Typical P-value PASS HOS-ADL 64% 66% 0.99 PASS HOS-SS 52% 52% 0.99 PASS mhhs 64% 62% 0.99 MCID HOS-ADL 74% 67% 0.58 MCID HOS-SS 72% 72% 0.99 MCID mhhs 79% 77% 0.86 No difference between atypical and typical patients.
11 Discussion and Limitations Despite analyzing our large registry, atypical posterior pain presentation of FAI was uncommon. Only 6.2% of patients with this as primary complaint. Small sample size introduces possibility of type 2 error Regardless, we report a relatively large series of patients with atypical posterior pain and that results are comparable to patients with typical pain complaints. Patients with more unusual locations of pain including knee and lateral were excluded. Pain is subjective and experienced differently by different patients, making comparisons challenging.
12 Conclusions Atypical posterior hip pain is an uncommon presentation of FAI. Patients with atypical pain demonstrate similar significant improvements in outcome scores compared to controls with typical anterior groin pain or c-sign. Patients with atypical pain also had similar rates of clinically significant differences based on MCID and PASS rates.
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