Patients With Global Acetabular Overcoverage Have Inferior Outcomes at 10 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Abstract

Background:

Previous studies on the outcomes of hip arthroscopy in patients with global acetabular overcoverage and focal lateral acetabular overcoverage have been limited by short- and intermediate-term follow-up periods and inconsistent radiographic criteria in defining these specific subpopulations with femoroacetabular impingement syndrome (FAIS).

Purpose:

To evaluate the long-term outcomes of hip arthroscopy in patients with FAIS and global acetabular overcoverage, lateral acetabular overcoverage, or normal acetabular coverage over a 10-year period.

Study Design:

Retrospective cohort study; Level of evidence, 3.

Methods:

This retrospective cohort study included patients who underwent hip arthroscopy for FAIS with a minimum follow-up of 10 years. Patients were categorized based on acetabular coverage: global overcoverage (lateral center-edge angle [LCEA] >40° with coxa profunda), lateral overcoverage (LCEA >40° without coxa profunda), and no overcoverage (LCEA = 20°-40°). Functional outcomes were measured using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS). Survivorship rates, including revision arthroscopy and conversion to total hip arthroplasty (THA), were also evaluated. Statistical significance was set at P < .05.

Results:

A total of 163 patients were included with a mean age of 38.90 ± 12.61 years, mean body mass index of 24.86 ± 4.03 kg/m², and mean follow-up of 11.63 ± 1.07 years. Overall, 73.6% (120/163) had no acetabular overcoverage, 17.2% (28/163) had lateral acetabular overcoverage, and 9.2% (15/163) had global acetabular overcoverage. Revision rates were 0.0% for the global overcoverage group, 7.7% for the lateral overcoverage group, and 5.2% for the no overcoverage group (P = .679). THA conversion rates were 0.0% for the global overcoverage group, 11.5% for the lateral overcoverage group, and 8.3% for the no overcoverage group (P = .585). The global overcoverage group exhibited lower mHHS (P = .004) and NAHS (P = .007) scores compared with the other groups. Female sex and higher body mass index were associated with worse long-term hip function (P≤ .05).

Conclusion:

At a minimum of 10 years postoperatively, there was no significant difference in reoperation or THA rates between groups. However, patients with global overcoverage demonstrated worse functional outcomes compared with those with lateral or no overcoverage.

Keywords

acetabular overcoverage femoroacetabular impingement syndrome hip arthroscopy hip preservation pincer deformity

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References

Akpinar

Lin

Bloom

Youm

Hip arthroscopy for femoroacetabular impingement: 1-year outcomes predict 5-year outcomes. Am J Sports Med. 2021;49(1):104-111.

Andriacchi

Mündermann

Smith

Alexander

Dyrby

Koo

A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. 2004;32(3):447-457.

Ansari

Haboubi

Adult obesity complications: challenges and clinical impact. Ther Adv Endocrinol Metab. 2020;11:2042018820934955.

Beck

Kalhor

Leunig

Ganz

Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012-1018.

Bhatia

Lee

Shewman

, et al. Effects of acetabular rim trimming on hip joint contact pressures: how much is too much? Am J Sports Med. 2015;43(9):2138-2145.

Büchler

Grob

Anwander

Lerch

Haefeli

PC.

Good outcome scores and low conversion rate to THA 10 years after hip arthroscopy for the treatment of femoroacetabular impingement. Clin Orthop. 2021;479(10):2256-2264.

Carton

Filan

Mullins

Survivorship rate and clinical outcomes 10 years after arthroscopic correction of symptomatic femoroacetabular impingement. Am J Sports Med. 2022;50(1):19-29.

Chahal

Thiel

GSV

Mather

Lee

Salata

Nho

SJ.

The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. Orthop J Sports Med. 2014;2(2 Suppl):2325967114S00105.

Chandrasekaran

Darwish

Suarez-Ahedo

Lodhia

Domb

BG.

Minimum 2-year outcomes of arthroscopic management of symptomatic hip labrum tears in patients with global acetabular overcoverage. Arthroscopy. 2017;33(8):1514-1520.

10.

Chow

Krych

Levy

BA.

Arthroscopic acetabular rim resection in the treatment of femoroacetabular impingement. Arthrosc Tech. 2013;2(4):e327-e331.

11.

Colvin

Koehler

Bird

Can the change in center-edge angle during pincer trimming be reliably predicted?

Clin Orthop. 2011;469(4):1071-1074.

12.

Diesel

Ribeiro

Coussirat

Scheidt

Macedo

CAS

Galia

CR.

Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects. Bone Joint J. 2015;97(4):478-483.

13.

Domb

Annin

Monahan

Lee

Jimenez

Maldonado

DR.

Ten-year survivorship, outcomes, and sports participation in athletes after primary hip arthroscopy for femoroacetabular impingement syndrome. Am J Sports Med. 2023;51(9):2383-2395.

14.

Fortier

Popovsky

Durci

Norwood

Sherman

Kaye

AD.

An updated review of femoroacetabular impingement syndrome. Orthop Rev. 2022;14(3):37513.

15.

Glein

Jimenez

Miecznikowski

, et al. Patient-reported outcome scores and rate of return to sport after hip arthroscopic surgery: a sex-based comparison in professional and collegiate athletes. Am J Sports Med. 2021;49(12):3242-3249.

16.

Dang

, et al. Relationship between the depth of acetabuloplasty and outcomes of hip arthroscopy in patients with global pincer femoroacetabular impingement: study with a minimum follow-up period of 2 years. Orthop Surg. 2023;15(6):1571-1578.

17.

Kingery

Akpinar

Rynecki

Campbell

Lin

Youm

Intermediate-term outcomes of hip arthroscopy for femoroacetabular impingement syndrome in patients with global versus isolated lateral acetabular overcoverage. Am J Sports Med. 2024;52(1):45-53.

18.

Klosterman

Zacharias

Dooley

, et al. Treatment of coxa profunda with open surgical hip dislocation, rim resection, cam resection, and labral reconstruction. Arthrosc Tech. 2022;11(8):e1499-e1508.

19.

Kuroda

Hashimoto

Saito

, et al. Obesity is associated with less favorable outcomes following hip arthroscopic surgery: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(5):1483-1493.

20.

Maldonado

Chen

Walker-Santiago

, et al. Radiographic and demographic factors can predict the need for primary labral reconstruction in hip arthroscopic surgery: a predictive model using 1398 hips. Am J Sports Med. 2020;48(1):173-180.

21.

Matar

Rajpura

Board

TN.

Femoroacetabular impingement in young adults: assessment and management. Br J Hosp Med. 2019;80(10):584-588.

22.

Matsuda

Kivlan

Nho

, et al. Arthroscopic outcomes as a function of acetabular coverage from a large hip arthroscopy study group. Arthroscopy. 2019;35(8):2338-2345.

23.

Perets

Chaharbakhshi

, et al. Hip arthroscopy in patients ages 50 years or older: minimum 5-year outcomes, survivorship, and risk factors for conversion to total hip replacement. Arthroscopy. 2018;34(11):3001-3009.

24.

Sogbein

Shah

Kay

, et al. Predictors of outcomes after hip arthroscopic surgery for femoroacetabular impingement: a systematic review. Orthop J Sports Med. 2019;7(6):2325967119848982.

25.

Teichtahl

Wang

Smith

, et al. Bone geometry of the hip is associated with obesity and early structural damage: a 3.0 T magnetic resonance imaging study of community-based adults. Arthritis Res Ther. 2015;17(1):112.

26.

Trigg

Schroeder

Hulsopple

Femoroacetabular impingement syndrome. Curr Sports Med Rep. 2020;19(9):360-366.

27.

Zhou

Melugin

Hale

, et al. Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement. J Hip Preserv Surg. 2021;8(3):233-239.