Aims

The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery.

The purpose of this study was to determine patient-reported outcomes of patients with mild to moderate developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) undergoing arthroscopy of the hip in the treatment of chondrolabral pathology. A total of 28 patients with a centre-edge angle between 15° and 19° were identified from an institutional database. Their mean age was 34 years (18 to 53), with 12 female and 16 male patients. All underwent labral treatment and concomitant correction of FAI. There were nine reoperations, with two patients requiring revision arthroscopy, two requiring periacetabular osteotomy and five needing total hip arthroplasty.

Patients who required further major surgery were more likely to be older, male, and to have more severe DDH with a larger alpha angle and decreased joint space.

At a mean follow-up of 42 months (24 to 89), the mean modified Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p < 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to 43; p < 0.001). Median patient satisfaction was 9.0/10 (1 to 10). Patients reported excellent improvement in function following arthroscopy of the hip.

This study shows that with proper patient selection, arthroscopy of the hip can be successful in the young patient with mild to moderate DDH and FAI.

Cite this article: Bone Joint J 2015;97-B:1316–21.

Purpose: This purpose of this study was to report 2 year outcomes following hip arthroscopy for the treatment of femoroacetabular impingement and chondrolabral dysfunction and determine factors associated with outcomes.

Method: Between 3/2005 and 10/2005, 122 patients underwent hip arthroscopy by a single surgeon. Patients were included if they underwent arthroscopic treatment for FAI and chondrolabral dysfunction. All patients were prospectively enrolled in an IRB approved follow-up study. Ten patients refused to participate following enrollment.

Results: At arthroscopy, for treatment of impingement, 23 patients underwent only osteoplasty for CAM impingement, 3 patients underwent only rim reduction for pincer impingement and 86 patients underwent osteoplasty and rim reduction for mixed type impingement. Ten patients underwent total hip arthroplasty at an average of 16 months (range: 8–26) after arthroscopy. Average follow-up was obtained on 90%(92/102) at 2.3 years (range: 2.0–2.9). The modified Harris Hip score(MHHS) improved from 57 to 84. HOS ADL improved from 69 to 88. HOS Sport improved from 41 to 69. NAHS improved from 64 to 82. All scores significantly improved (p< 0.05). The average patient satisfaction was 8.4 (range: 1–10). All patients returned to work (15% returned within 1 week, 53% returned in 1–5 weeks, 18% returned in 6–8 weeks, 13% returned in 2 to 6 months). Ten patients underwent THA at an average of 16 months. These patients were significantly older at arthroscopy (58 vs. 39;p=0.0001), had significantly less joint space at all 3 weight bearing surfaces (p=0.001), and patients with microfracture on both femoral head and acetabulum were more likely to undergo THA (p=0.001). The predictors of higher post-operative MHHS were preoperative modified Harris Hip score (p=0.018), joint space of 2mm or greater(p=0.005), and repair of labral pathology instead of debridement (p=0. 032)(r2=0.32;p=0.001). Patients with labral repair had higher MHHS compared to patients with labral debridement (87vs81). Independent predictors of patient satisfaction were postoperative MHHS(p=0.001) and joint space of 2mm or greater(p=0.040) (r2=0.67; p=0.001).

Conclusion: Hip arthroscopy for femoroacetabular impingement accompanied by the prescribed rehabilitation led to return to excellent function and high patient satisfaction. Factors associated with higher outcomes included joint space of greater than 2mm, and labral repair for treatment of labral pathology.

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.

Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy.

The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing ≥ 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032).

Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.