Mechanical Symptoms as a Predictor of Short-term Outcomes of Hip Arthroscopy in Patients with FAI over the Age of 40

Transcription

1 Mechanical Symptoms as a Predictor of Short-term Outcomes of Hip Arthroscopy in Patients with FAI over the Age of 40 Hugh S West Jr, MD Brandy Horton, BS, PTA Krista M Ellis, MS Diana L Handrahan, BS Jennifer D Marland, PT, DPT

2 DISCLOSURE Hugh S West, MD I have financial relationships with the following companies: DePuy Synthes Mitek Sports Medicine ConMed Linvatec

3 BACKGROUND Symptomatic FAI without advanced changes of osteoarthritis in patients over 40 years old is common. Outcomes of arthroscopic treatment of FAI in the population of patients over 40 are variable and there is a need for predictive preoperative indicators of postoperative outcome. 1,2,3,4. Mechanical symptoms defined as acute sharp moments of pain with or without associated clicking, locking or catching are a frequent presenting complaint in this population. We question if the presence or absence of preoperative mechanical symptoms is associated with outcome.

4 PURPOSE To determine if the presence of mechanical symptoms in the hip can be used to help predict the outcome of hip arthroscopy in patients over 40 years old with FAI.

5 HYPOTHESIS We hypothesize that patients that preoperatively report mechanical symptoms will show greater subjective improvement following hip arthroscopy for FAI than patients without mechanical symptoms.

6 METHODS This study was approved by the Institution Review Board (IRB #001640). Retrospective analysis of our patient database from January 2011 to August All surgeries were conducted by one surgeon (HSW). All patients followed the same rehabilitation protocol supervised by the same physical therapist (JDM). The patients included in this study were diagnosed with FAI, were active and aged 40 or older. Patients were excluded from this study if they were diagnosed radiographically with OA Tonnis grade >2, peritrochanteric pain, internal or external snapping hip or dysplasia. Patients were also excluded if they had hip pain due to trauma (e.g. motor vehicle accident).

7 METHODS Patients were divided into two groups based on the presence or absence of mechanical symptoms. Mechanical symptoms in the hip were defined as acute sharp moments of pain with or without associated clicking, locking or catching. Dull, achy, constant pain was not considered a mechanical symptom. The international Hip Outcome Tool (ihot-12) 5 was recorded preoperatively, 3 months and 1 year postoperatively. A linear mixed effects analysis was used to evaluate the outcomes of the two groups of patients 6. P-values were obtained by likelihood ratios 7. P<0.05 was significant.

8 RESULTS 45 hips (45 patients) met the inclusion criteria, mean age 47, range A) 36 hips were grouped into mechanical or nonmechanical symptoms for statistical analysis 1) 22 hips had mechanical symptoms -17 female, 5 male -mean pre-op ihot of 29 2) 14 hips had non-mechanical symptoms -11 female, 3 male -mean pre-op ihot of 27 B) 9 hips were lost to follow-up

9 RESULTS No statistical difference in preop scores, gender, hip side (p>0.05) ihot-12 Outcomes for Patients with Mechanical and Nonmechanical Symptoms over Time 70 Statistically significant difference between mechanical and non-mechanical symptoms over time (p=0.002). ihot-12 Outcomes NON- MECH MECH PRE 3 MO 1 YR Time

10 RESULTS 3 patients converted to THA before 1 year, 2 with mechanical symptoms (1 female, 1 male) and 1 without mechanical symptoms (1 female). 2 additional patients were diagnosed with AVN and went on to THA at 6 and 9 months.

11 DISCUSSION Future research includes the accumulation of more patient outcomes so that the cohort is larger. We also plan to track these patients to look at longer term outcomes (> 1 yr). Finally, we want to compare these results to a cohort of patients younger than 40 years old.

12 CONCLUSION The presence of mechanical symptoms is predictive of greater subjective improvement with arthroscopic treatment of FAI in patients over 40 years compared with patients who present with no mechanical symptoms.

13 REFERENCES 1. Cooper AP, Basheer SZ, Maheshwari R, Regan L, Madan SS. Outcomes of hip arthroscopy. A prospective analysis and comparison between patients under 25 and over 25 years of age. Br J Sports Med. 2013;47(4): Philippon MJ, Schroder ESBG, Briggs KK. Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthroscopy. 2012;28(1): Ben Tov T, Amar E, Shapira A, Steinberg E, Atoun E, Rath E. Clinical and functional outcome after acetabular labral repair in patients aged older than 50 years. Arthroscopy. 2014;30(3): Javed A, O'Donnell JM. Arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement in patients over 60 years of age. J Bone Joint Surg Br. 2011;93(3): Griffin DR, Parsons N, Mohtadi NG, Safran MR. A short version of the International Hip Outcome Tool (ihot-12) for use in routine clinical practice. Arthroscopy. 2012;28(5): R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria Bates D, Maechler M, Bolker B, Walker S. lme4: Linear mixed-effects models using Eigen and S4. R package version