Objectives

The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).

Purpose

Periacetabular osteotomy (PAO) is a versatile acetabular reorienting procedure that is most commonly used to provide greater femoral head coverage in adolescent hip dysplasia. However, PAO can also be used to reorient the acetabulum in the opposite direction to treat femoroacetabular impingement (FAI) due to acetabular over-coverage. We describe the indications, surgical technique, and early results of reverse PAO to reduce femoral head coverage in symptomatic hips with FAI due to acetabular over-coverage.

Purpose: To identify the determinants of patient satisfaction with outcome after arthroscopic treatment of femoroacetabular impingement.

Method: 206 patients underwent arthroscopic treatment of femoroacetabular impingement. Included patients had minimum 1 year follow-up (mean = 16 months; range: 12 to 27 months) with complete demographic, surgical, subjective, and objective data. Average age at time of surgery was 39 years(range:16–77). Outcomes data were collected from modified Harris Hip score(MHHS), Hip outcome score ADL(HOS ADL), Hip outcome score Sports scale(HOS Sport), non-arthritic hip score(NAHS) and patient satisfaction (1=unsatisfied, 10=very satisfied). Dependent variables were patient satisfaction and modified Harris hip score. Independent variables included demographic, surgical, objective and subjective follow-up parameters. Univariate and multivariate analyses were performed to identify determinants of satisfaction and outcome.

Results: Average patient satisfaction was 8(range:1–10) and was not normally distributed so nonparametric univariate analysis was used. Average MHHS improved 18 points to 81(range:18–100, p=0.001). Average HOS ADL improved 14 points to 85(range: 28–100, p=0.001). Average HOS Sport improved 22 points to 63(range: 0–100, p=0.001). Average NAHS improved 16 points to 81(range: 0–100, p=0.001. Variables not associated with satisfaction were BMI (p=0.110)(average 24.5 ^kg/_m²) and preoperative MHHS (p=0.318). Factors associated with patient satisfaction were age(p=0.001), gender(p=0.006), time from onset of symptoms to surgery (p=0.021), joint space (p=0.001), femoral head microfracture (p=0.006), and acetabular microfracture (p=0.001). Satisfaction was related to improvement in MHHS (p=0.001), NAHS (p=0.001), HOS ADL (p=0.001), and HOS Sport (p=0.001). Fifteen(5%) patients underwent total hip arthroplasty at an average of 12.4 months(range: 3.2–24.3 months) post-arthroscopy. Patients who had a joint space less than 2.0mm, were 6.8 times more likely to undergo THA following hip arthroscopy(CI: 2.3–20). Multivariate analysis demonstrated increased satisfaction with increased post-op modified Harris hip score and decreased age(r²=0.57, p=0.0001). Independent predictors of improvement in MHH were age, preoperative MHH and microfracture(r²=0.36, p=0.001).

Conclusion: Predictors of increased patient satisfaction include high MHH and absence of microfracture treatment. Patients experienced significant improvement in function at least 1-year postoperatively. This study illustrates the potential of functional improvement and offers patients with FAI a less invasive procedure through arthroscopic methods.