Faculty Bibliography

PURPOSE/UNASSIGNED:To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy. METHODS/UNASSIGNED:Females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications. RESULTS/UNASSIGNED:85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion. CONCLUSION/UNASSIGNED:Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.

BACKGROUND:Patients with femoroacetabular impingement syndrome (FAIS) due to pincer impingement may have global retroversion. Previously treated with periacetabular osteotomy, this condition has been increasingly treated arthroscopically; however, no evidence is available regarding long-term outcomes of these patients. PURPOSE/OBJECTIVE:To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy with a minimum of 10-year follow-up between patients who had FAIS with and without radiographic signs of global acetabular retroversion. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:value <.05 was considered statistically significant. RESULTS:= .003, respectively). Increased BMI was correlated with worse PROMs in both groups. CONCLUSION/CONCLUSIONS:Patients with global retroversion undergoing hip arthroscopy for FAIS did not have increased failure rates compared with patients without global retroversion and demonstrated significant improvement in outcome scores at 10 years.

PURPOSE/OBJECTIVE:To systematically review the current literature regarding the role of artificial intelligence and machine learning in predicting and optimising clinical outcomes following hip arthroscopy. METHODS:A systematic review of the PubMed, Cochrane, and EMBASE databases was completed in December 2024. Studies were included if they assessed the application of AI/ML to clinical outcomes of hip arthroscopy. Exclusion criteria were imaging-only studies, non-English publications, conference abstracts, review articles and meta-analyses. Extracted data included study characteristics, input features, algorithm types, sample sizes, and model performance. Descriptive statistical analysis was performed due to data heterogeneity. RESULTS:Sixteen studies met inclusion criteria, covering applications across prediction of intraoperative findings (n = 1), prediction of post-operative outcomes (n = 5), prediction of patient-reported outcomes (n = 7) and prediction of revision (n = 3). Input features commonly utilised included demographics, imaging data, preoperative patient-reported outcomes (PROs), and comorbidities. Supervised learning models were the most widely applied, including logistic regression, random forests, support vector machines (SVMs), and artificial neural networks (ANNs). Performance metrics demonstrated robust predictive ability, with AUC values ranging from 0.66 to 0.94 and accuracy rates exceeding 75% in most studies. Applications included predicting revision surgery risk, prolonged opioid use, postoperative satisfaction, and time to return to sport. Imaging-based algorithms, particularly leveraging MRI data, showed promise for surgical planning and diagnostic precision. CONCLUSIONS:AI and ML show significant promise in enhancing outcome prediction and patient stratification in hip arthroscopy. Future research should prioritise the standardisation of datasets, external validation, and interpretability to facilitate clinical translation. LEVEL OF EVIDENCE/METHODS:Level V.

Traditionally, acetabular global overcoverage had been treated by open surgical dislocation of the hip and was a relative contraindication for hip arthroscopy. With advancing arthroscopic techniques, hip arthroscopy can successfully treat acetabular global overcoverage with less morbidity for the patient than an open hip procedure. Successful arthroscopic treatment of this condition is not for the beginner hip arthroscopist. Pitfalls of an arthroscopic technique include difficult entry into the joint and labral insufficiency with the inability to perform a repair and these difficulties should be understood ahead of the procedure. However, with careful, thoughtful technique, arthroscopic treatment of acetabular global overcoverage has successful outcomes and now should be considered the preferred option instead of open surgical dislocation of the hip.

PURPOSE/OBJECTIVE:The purpose of this study was to evaluate patient-reported outcomes (PROs) and survivorship in obese patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 10-year follow-up. METHODS:A retrospective review was conducted of patients who underwent arthroscopy for FAIS from 2010-2013. Patients were assessed at baseline, 1 month, 6 months, 1-, 2-, 5-, and 10 years using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS). Patients were categorized based on BMI into normal, overweight, and obese cohorts. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) were calculated for both PROs. Improvements from baseline were analyzed and differences between groups were evaluated while controlling for age. Survival to revision surgery was assessed with Kaplan-Meier survival curves. RESULTS:144 patients (65.2% female) with a mean age of 38.8 ± 13.0 years and an average follow-up of 11.6 (range 10.0-13.8) years were included, and categorized into normal weight (59.7%), overweight (26.4%), and obese (13.9%). All groups showed significant improvement in PROs at 10 years compared to baseline (p=0.007). Obese patients had lower postoperative scores (mHHS: 72.8 vs. 90.1, p=0.009; NAHS: 68.4 vs.. 88.6, p=0.003) and improvement in scores from baseline (mHHS: 23.4 vs. 37.7, p=0.013; NAHS: 18.4 vs. 40.0, p=0.004) at 10-year follow-up, as well as lower achievement of mHHS PASS (60.0% vs 87.2%, p=0.015), NAHS PASS (50.0% vs. 89.5%, p<.001) and NAHS MCID (70.0% vs. 93.0%, p=0.008). Obese patients also had a higher rate of conversion to THA (17.4% vs 3.3%, p=0.012). The overall complication rate was 4.2% compared to 10% in the obese group, with obese patients experiencing a superficial infection more frequently (p=0.002). CONCLUSION/CONCLUSIONS:Although obese patients still have significantly improved outcomes compared to baseline, at 10-year follow-up they have inferior outcomes compared to nonobese patients and higher rates of conversion to THA. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative study.

OBJECTIVE:To assess the correlation of pre-operative symptoms, pre-operative diagnostic imaging for cartilage loss, and intra-operative cartilage findings in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. MATERIALS AND METHODS/METHODS:Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips for acetabular/femoral cartilage loss utilizing a simplified "high-low" classification and the International Cartilage Repair Society grading system. Severity of supra-foveal central femoral head cartilage loss was separately noted. Pre-operative radiographs were graded using the Tonnis and Kellgren-Lawrence systems and for central joint space narrowing. Pre-operative patient symptoms were prospectively gathered utilizing the Nonarthritic Hip Score and the modified Harris Hip Score. Intra-operatively, cartilage loss was recorded using the Outerbridge system. RESULTS: CONCLUSION/CONCLUSIONS:Despite MRI underestimation of cartilage loss, the very weak-to-weak correlation of clinical symptoms with pre-operative imaging and intra-operative findings emphasizes the importance of MRI in pre-operative evaluation.

The acetabular labrum deepens the hip socket and provides a suction seal to the femoral head. Anatomic restoration of the suction seal is the goal of hip labral repair. Labral debridement outcomes are inferior to labral repair because this suction seal is disrupted. Labral height, surface area, and volume contribute to the suction seal and are important to consider in order to restore hip stability. Labral height should be measured on MRI prior to arthroscopy. If the labrum is insufficient, surgeons should plan labral augmentation and reconstruction using a graft. Labral reconstruction can lead to successful outcomes in cases of short labral height or hypoplastic labrum by restoring the suction seal.

PURPOSE/OBJECTIVE:This study aims to evaluate patient-reported outcomes (PROs) and reoperation rates in patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) over a minimum 10-year follow-up stratified by sex, age, and body mass index (BMI). METHODS:Primary hip arthroscopies performed for FAIS between 2010 and 2013, with a minimum 10-year follow-up, were reviewed. Procedures consisting of microfracture, or labral debridement without repair, were excluded. Ten-year PROs were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were categorized into three groups by age (<30, 30-44, >45 years) and BMI (<25.0, 25.0-29.9, ≥30). Minimum clinically important difference (MCID) was set to half the preoperative standard deviation of the cohort. Reoperation rates and PROs were compared, and regression analysis identified independent predictors of PROs. RESULTS:At minimum 10-year follow-up (mean: 11.6 [10.0-13.9] years), 59.2% follow-up was achieved, representing 154 hips (141 patients). The cohort had a mean age of 38.5 years, BMI of 24.4, and was 68.2% female. At follow-up, 91.6% of the cohort achieved MCID with a 9.7% re-operation rate. In the middle-aged group, males had higher mHHS (mean, 92.8 vs. 85.2, P = 0.015) and NAHS (mean, 91.6 vs. 83.4, P = 0.008) scores compared to females. In the BMI ≥30 group, males had higher mHHS (mean, 83.3 vs. 66.4, P = 0.030) and NAHS scores (mean, 83.0 vs. 58.5, P = 0.035). Only 72.7% of females with BMI ≥30 achieved MCID for mHHS and NAHS, compared to BMI < 25 (96.6% and 94.9%, respectively) and 25-29.9 (87.5% and 83.3%) (mHHS: P = 0.016; NAHS: P = 0.038). Similarly, 78.8% of females aged ≥ 45 achieved MCID for NAHS, compared to 92.9% of those aged < 30 and 97.1% of those 30-44 (P = 0.040). Multivariable regression identified older age (mHHS: P=0.019; NAHS: P=0.042) and higher BMI (mHHS: P=0.007; NAHS: P<0.001) as independently predictive of worse 10-year PROs. CONCLUSION/CONCLUSIONS:Older age and greater BMI independently predicted poorer long-term functional outcomes after hip arthroscopy for FAIS. Female sex, while not independently predictive, may make patients more susceptible to the negative effects of older age and BMI. No significant association was observed for reoperation rates. LEVEL OF EVIDENCE/METHODS:Level IV, retrospective therapeutic case series.

BACKGROUND:Three-dimensional MR fingerprinting (3D-MRF) has been increasingly used to assess cartilage degeneration, particularly in the knee joint, by looking into multiple relaxation parameters. A comparable 3D-MRF approach can be adapted to assess cartilage degeneration for the hip joint, with changes to accommodate specific challenges of hip joint imaging. PURPOSE/OBJECTIVE:in clinically feasible scan times. STUDY TYPE/METHODS:Prospective. SUBJECTS/METHODS:Eight healthy subjects, three patients with mild osteoarthritis (OA), and one of the OA patients had femoral acetabular impingement (FAI). A National Institute of Standards and Technology/International Society for Magnetic Resonance in Medicine (NIST/ISMRM) system phantom was also used. FIELD STRENGTH/SEQUENCE/UNASSIGNED:mapping. ASSESSMENT/RESULTS:maps of 3D-MRF sequence were evaluated on a NIST/ISMRM phantom and human subjects. Differences in the parametric maps between OA and healthy subjects were assessed. STATISTICAL TESTS/METHODS:Regression, Bland-Altman, Kruskal-Wallis, and Wilcoxon tests were used to assess for accuracy, repeatability, and subregional variation. The P-value <0.05 indicated statistically significant. RESULTS:) in femoral lateral compartment of the hip joint compared to healthy controls. DATA CONCLUSION/CONCLUSIONS:3D-MRF may be a feasible approach for simultaneous, quantitative mapping of bilateral hip joint cartilage in healthy and mild OA patients. EVIDENCE LEVEL/METHODS:1 TECHNICAL EFFICACY: Stage 1.

BACKGROUND:The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. In hip arthroscopy (HA) for femoroacetabular impingement (FAI) syndrome, these values have been defined for the short- and midterm postoperative period, but meaningful long-term thresholds have not been established. PURPOSE/OBJECTIVE:To define the MCID, PASS, and SCB for the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at a minimum follow-up of 10 years for patients who underwent HA for FAI syndrome. STUDY DESIGN/METHODS:Case series; Level of evidence, 4. METHODS:A retrospective cohort study including all patients who underwent primary HA for FAI with a single surgeon from February 2010 to December 2013 was performed. Patient outcomes were assessed with an anchor question, mHHS, and NAHS at baseline and at 1, 5, and 10 years of follow-up. MCID was calculated using the distribution-based method at all time points, using 0.5 standard deviations as the threshold. The anchor-based MCID, PASS, and SCB were calculated at 10 years using thresholds representing the optimal cutoff on a receiver operating characteristic curve. Correlations between baseline characteristics and achievement of the MCID, PASS, and SCB were assessed with binomial logistic regressions. RESULTS:= .01). CONCLUSION/CONCLUSIONS:The establishment of the MCID, SCB, and PASS for the NAHS and mHHS provides a valuable clinical context for improvements in outcome scores after HA. Anchor-based calculations were consistently higher than distribution-based calculations.