Preop Osteoarthritis Predicts Poor Prognosis After Surgery for Femoroacetabular Impingement
Key findings
- Pooled analysis of seven studies showed that preoperative osteoarthritis significantly increased the failure rate after surgical management of femoroacetabular impingement (FAI)
- The odds of failure due to conversion to total hip arthroplasty were 19 times higher in patients with FAI plus osteoarthritis than in those with FAI alone
- In contrast, the Western Ontario and McMaster Universities Osteoarthritis Index was significant better in the FAI + osteoarthritis group
- The researchers consider arthroscopic treatment of FAI on a case-by-case basis for patients with early arthritis, but they recommend against it for those with frank osteoarthritis
Femoroacetabular impingement (FAI) is now commonly treated with arthroscopic labral repair or débridement, and good short-term outcomes have been documented. It's not well established, though, whether comorbid osteoarthritis affects functional improvement in patients with FAI.
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In the first meta-analysis of this issue, Scott D. Martin, MD, director of the Joint Preservation Service within the Department of Orthopaedics Sports Medicine Center, and colleagues determined that radiographic osteoarthritis is associated with a higher failure rate in patients with FAI who undergo either hip arthroscopy or open hip surgery. Their report appears in the Journal of the American Academy of Orthopaedic Surgeons.
The Systematic Review
The research team found seven English-language studies published before April 2016 that involved adults with FAI who underwent arthroscopy or open surgery. They collectively included 1,129 patients: 310 with FAI plus osteoarthritis (FAI+OA) and 819 with FAI alone. Other key inclusion criteria were:
- The study compared patients who had FAI alone (no or mild osteoarthritis) with those who had FAI plus radiographically documented osteoarthritis (higher Tönnis grade or joint space width ≤2 mm)
- The follow-up was ≥6 months
- The paper reported the failure rate
Failure Rates
Failure was defined in the various studies as conversion to total hip arthroplasty (THA), need for revision, patient dissatisfaction or modified Harris Hip Score or non-arthritic hip score <70. The overall failure rate was 22%.
The failure rate was substantially higher in the FAI+OA group (45%) than in the group with FAI alone (13%). The odds ratio was 8.5 (95% CI, 4.44–16.26; P < .0001).
Five of the seven studies evaluated failure specifically due to conversion to THA. During an average follow-up of six to 31.6 months, THA was required by 37% of patients in the FAI+OA group and 10% in the group with FAI alone. The odds ratio was 19.42 (95% CI, 7.00–53.85; P < .0001).
Postoperative Clinical Assessment
Four studies used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to evaluate postoperative pain, stiffness and physical function. The WOMAC score was significantly lower (better) in the FAI+OA group than in the FAI group (average difference, −10.82; 95% CI, −16.48 to −5.17; P = .0002).
Suggestions for Surgeons
In patients with early osteoarthritis and FAI, it is unknown whether arthroscopy accelerates deterioration of the hip and clinical symptoms. For such patients they consider arthroscopy on a case-by-case basis, taking patient age into account. They do not recommend arthroscopy for patients with frank osteoarthritis.
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