Abstract
Background:
There is a paucity of literature regarding prevalence of femoral resection in the setting of revision hip arthroscopy. Few studies have examined different types of resections and their presentation.
Purpose:
To describe the prevalence of femoral resection types in the setting of revision hip arthroscopy for residual femoroacetabular impingement syndrome (FAIS) symptomatology.
Methods:
A search of the institutional prospective registry was performed for patients who presented for evaluation of failed previous arthroscopy between February 2008 and June 2022, and subsequently underwent revision arthroscopy. AP and Dunn view radiographs were reviewed from our study population. On the basis of measurements on both radiographs, patients were divided into 3 categories: overresection (OR) in which the resection measured 5% or more of the femoral head diameter, underresection (UR) in which residual CAM morphology was found (alpha angle >60°), and neutral resection, alpha angle less than 60° and no overresection. Both AP and Dunn radiographs were used to identify over- and under- resections.
Results:
A total of 622 hips were reviewed and measured on both AP and Dunn radiographs. Of the 622 hips, there were 373 right and 249 left hips. The average age was 33.7 ± 12.0, and the average body mass index (BMI) was 26.0 ± 5.2. Three hundred sixty-five hips were classified as UR and 265 hips as OR. The mean prevalence rates from 2008 to 2022 for neutral resection, over-resection and under-resection were 48.1%, 20.3%, and 31.6%, respectively. The prevalence rates of UR have decreased since 2008, while prevalence rates of OR have increased concomitantly. The steadily decreasing prevalence rates of UR was negatively correlated with the increasing OR ((R=-0.829, P<.0001), as well as with neutral resections (R=-0.735, P=0.002). The ratio of UR to OR reversed entirely, from 4:1 in 2010, to 1: 2.3 (P < 0.00001) in 2020.
Conclusions:
Amongst patients presenting for failed hip arthroscopy over the last 14 years, the pendulum has swung from under-resection towards over-resection. Indeed, as of 2020, over-resections were more than twice as common as under-resections. This may be a result of heightened awareness in FAIS, and previous literature emphasizing the risks of under-resection. As we gain increased understanding of the risks of over-resection, the findings of this study highlight the importance of achieving an anatomical spherical resection.