Evaluation and Treatment of Femoroacetabular Impingement Prior to Arthroscopic Surgery

Transcription

1 Evaluation and Treatment of Femoroacetabular Impingement Prior to Arthroscopic Surgery International Society for Hip Arthroscopy Annual Scientific Meeting Rio de Janeiro, Brazil Benjamin D. Streufert, BS 1 Shane Nho, MD 2 Michael Salata, MD 3 Steve Olson, MD 1 Richard C. Mather, III, MD 1 1 Duke University Medical Center, Durham, NC, USA 2 Rush University Medical Center, Chicago, IL, USA 3 University Hospitals Case Medical Center, Cleveland, OH, USA

2 Disclosures Benjamin D. Streufert, BS I have no financial relationships to disclose.

3 Background Femoroacetabular impingement (FAI) has been recognized as a cause or contributor to hip pain and arthritis (Ganz et al, CORR, 2003) Arthroscopy is an effective treatment (Harris, Curr Rev Musc Med, 2013) FAI has remained a challenge to diagnose and promptly treat - Why? Sometimes nonspecific, chronic symptoms groin, back, knee (Nepple et al, JAAOS, 2013) Providers unfamiliar with the presentation or further evaluation of FAI (Reid et al, J Rheum, 2010; Yeung et al, Arthroscopy, 2014)

4 Methods Study population: Insurance claims from over 20 million privately insured patients in the United States from Search performed using PearlDiver Patient Records Database (PearlDiver Technologies, Fort Wayne, IN) Inclusion: Patients undergoing hip arthroscopy for femoroacetabular impingement: Femoroplasty (CPT code 29914) Acetabuloplasty (CPT code 29915) Labral Repair (CPT code 29916)

5 Methods Pre-operative analysis Imaging in the 1 year prior to surgery (CPT codes) Radiographs, magnetic resonance imaging, computed tomography, arthrography Diagnoses in the 6 months prior to surgery (ICD-9 diagnosis codes) Hip, knee, or back pain (or associated diagnoses) Treatments in the 1 year prior to surgery (CPT codes) Physical therapy, hip injection/aspiration, lumbar MRI, chiropractic treatment, spinal injection, spine surgery

6 Results Arthroscopic Procedures 1,462 patients underwent arthroscopic treatment with femoroplasty, acetabuloplasty, or labral repair Femoroplasty: 1164 (79.6%) Acetabuloplasty: 737 (50.4%) Diagram showing the number of procedures performed in combination or alone Labral Repair: 743 (50.4%)

7 Results Preoperative Imaging Imaging of the hip or pelvis in the 1 year prior to arthroscopy Modality Patients (%) Radiographs 965 (66.0) Magnetic resonance imaging Computed tomography 961 (65.8) 183 (12.5) Arthrography 323 (22.1)

8 Results Associated Diagnoses Diagnoses present 6 months prior to arthroscopy Most had hip pain diagnosed 6 months prior to arthroscopy, and many had other symptoms Diagnosis Group Patients (%) Hip Pain 1356 (92.8) Back Pain 236 (16.1) Knee Pain 174 (11.9)

9 Results Preoperative Treatments or Other Evaluation Treatments or other imaging in the 1 year prior to arthroscopy Modality Patients (%) Treatment Physical Therapy (any) 620 (42.4) Hip Injection 375 (25.7) Chiropracty 198 (13.5) Spinal Injection 18 (1.2) Imaging Lumbar MRI 117 (8.0)

10 Discussion Femoroplasty often performed with other arthroscopic procedures for FAI Fixation of labral injuries common Preoperative imaging is variable Radiographs only versus more advanced imaging? (Yen et al, J Pediatr Orthop, 2013) Most patients had at least 6 month history of hip pain, although many with other symptoms Appropriate time from diagnosis to treatment? Does the presence of associated diagnoses represent difficulty in evaluation or concomitant pathology?

11 Limitations Retrospective review of aggregated claims data Different types of providers (primary care vs orthopaedic specialist) order imaging or treatment Time of original diagnosis unclear, based on lack of specific diagnosis code for FAI OR if out of this network

12 Next Steps Determine timing of presentation to eventual treatment Explore the role of primary care or other providers prior to seeing an orthopaedic surgeon Understand the impact of variability of preoperative imaging and treatment on disease process or cost or quality of care

13 References Ganz, R., Parvizi, J., Beck, M., Leunig, M., Notzli, H., & Siebenrock, K. A. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res(417), Harris, J. D., Erickson, B. J., Bush-Joseph, C. A., & Nho, S. J. (2013). Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med, 6(3), Nepple, J. J., Prather, H., Trousdale, R. T., Clohisy, J. C., Beaule, P. E., Glyn-Jones, S., & Kim, Y. J. (2013). Clinical diagnosis of femoroacetabular impingement. J Am Acad Orthop Surg, 21 Suppl 1, S Reid, G. D., Reid, C. G., Widmer, N., & Munk, P. L. (2010). Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis? J Rheumatol, 37(7), Yen, Y. M., & Kocher, M. S. (2013). Clinical and radiographic diagnosis of femoroacetabular impingement. J Pediatr Orthop, 33 Suppl 1, S Yeung, M., Khan, M., Schreiber, V. M., Adamich, J., Letkemann, S., Simunovic, N.,... Ayeni, O. R. (2014). Global Discrepancies in the Diagnosis, Surgical Management, and Investigation of Femoroacetabular Impingement. Arthroscopy. In press.