Faculty Bibliography

BACKGROUND:Patients with symptomatic femoroacetabular impingement (FAI) frequently have bilateral deformity and inquire about the prognosis of their contralateral, asymptomatic hip. Idiopathic coxarthrosis has been established as an independent risk factor for joint failure on the other side. PURPOSE/OBJECTIVE:To determine the prevalence of bilateral arthroscopic treatment for FAI and to identify predictive patient demographics and radiographic findings for bilateral, symptomatic disease. STUDY DESIGN/METHODS:Case control study; Level of evidence, 3. METHODS:Over a 2-year period, patients receiving single-sided FAI surgery for pain and radiographic deformity were identified as unilateral. In the same period, patients undergoing their second side were labeled bilateral, regardless of when the first surgery was performed. Proximal femoral alpha angle; lateral center edge angle; sagittal center edge angle; acetabular version at 1, 2, and 3 o'clock; and femoral torsion were measured on preoperative computed tomography scans. RESULTS:The unilateral group included 514 patients, and the bilateral group included 132 patients. Women composed 48% of the unilateral group but only 35% of the bilateral group (P = .006). The mean age of unilateral patients was 30.3 (±10.7) years and 27.6 (±9.7) years for the first side of bilateral patients (P = .010). The bilateral hips had higher alpha angles (63.8° vs 59.8°, P = .004), less acetabular anteversion at the 3-o'clock position (13.0° vs 15.9°, P < .001), and similar femoral torsion (15.1° vs 15.5°, P = .793) compared with unilateral hips. A multivariable logistic regression model found that for every 5 years of younger age, 5° higher alpha angle, and 5° decrease in 3-o'clock acetabular version, patients were more likely to undergo bilateral treatment for FAI, by 13.5%, 14.5%, and 25.5%, respectively. In a side-to-side comparison of both hips in bilateral patients, alpha angle (r = 0.72) and acetabular version at 1 o'clock (r = 0.73) showed high correlation. CONCLUSION/CONCLUSIONS:Male sex, younger age, higher alpha angles, and reduced acetabular anteversion at initial presentation are significant risk factors for identifying patients who may ultimately require bilateral surgery for symptomatic FAI. Among bilaterally treated patients, no radiographic parameters were predictive of which side would require treatment first. Patients with FAI requiring surgery should be closely monitored for contralateral hip disease.

PURPOSE/OBJECTIVE:To describe an arthroscopic technique for decompression of a prominent anterior inferior iliac spine (AIIS) leading to extra-articular hip impingement and to provide short-term outcome after this procedure. METHODS:We retrospectively reviewed office charts, imaging studies, operative reports, arthroscopic images, preoperative and postoperative hip flexion range of motion, and preoperative and postoperative modified Harris Hip Scores in a consecutive series of 10 male patients who had arthroscopic decompression of symptomatic AIIS deformities leading to extra-articular hip impingement. The procedure was performed through standard anterolateral and mid-anterior hip arthroscopy portals that were also used to explore the joint and address concomitant intra-articular pathologies. RESULTS:The mean age was 24.9 years, with 8 of 10 patients aged younger than 30 years. In 9 patients, an anterior cam lesion was identified and decompressed before the AIIS decompression. The mean follow-up time was 14.7 months (range, 6 to 26 months). Hip flexion range of motion improved from 99° ± 7° before surgery to 117° ± 8° after surgery (P < .001). The modified Harris Hip Score improved from 64 ± 18 before surgery to 98 ± 2 at latest follow-up after surgery (P < .001). CONCLUSIONS:Arthroscopic decompression of a symptomatic AIIS deformity is a reproducible procedure that can provide excellent outcomes at short-term follow-up. As opposed to using an open approach for decompressing a prominent AIIS, an arthroscopic approach may be of particular value in patients with mixed intra- and extra-articular sources of hip dysfunction, because it enables the surgeon to address all pathologies with a single arthroscopic procedure. LEVEL OF EVIDENCE/METHODS:Level IV, therapeutic case series.

BACKGROUND:Minimally invasive techniques to treat femoroacetabular impingement (FAI), snapping hip syndrome, and peritrochanteric space disorder (PSD) were developed to reduce complications and recovery time. Although a multitude of studies have reported on the incidence of heterotopic ossification (HO) after open procedures of the hip, there is little known about the rate of HO after hip arthroscopy. HYPOTHESES/OBJECTIVE:The incidence of HO after hip arthroscopy is comparable with that after open surgical dislocation of the hip and can be reduced with the addition of indomethacin to an existing nonsteroidal anti-inflammatory medication prophylaxis protocol. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:Between July 2008 and July 2010, 616 primary hip arthroscopies were performed to treat FAI and PSD. In July 2009, indomethacin was added in the acute postoperative period to an existing HO prophylactic protocol of naproxen administered for 30 days postoperatively. Postoperative radiographs were reviewed to detect the presence and classify the size and location of HO. Odds ratios and logistic regression explored predictor variables and their relationships with HO, with P < .05 defined as significant. RESULTS:Twenty-nine (21 male, 8 female) of 616 (4.7%) hip procedures developed HO postoperatively. Brooker classification of HO was 18 grade I, 4 grade II, 6 grade III, and 1 grade IV. Mean follow-up was 13.2 months (range, 2.9-26.5 months). Rate of HO for cases with and without indomethacin for prophylaxis was 1.8% (6/339) and 8.3% (23/277), respectively. This difference was statistically significant (P < .05), and patients who underwent protocol 1 were 4.36 times more likely to develop HO postoperatively than those who had protocol 2. The majority of cases of HO (72.4%) occurred in male patients, and all cases occurred in the setting of osteoplasty performed for symptomatic FAI. We were not able to demonstrate statistically significant clinical risk factors that were predictive for the development of postoperative HO. However, the data clearly demonstrate that the performance of arthroscopic osteoplasty with a capsular cut in male patients represented the majority of cases, who are likely the group at highest risk. Seven cases (~1%) required revision procedures to excise HO. There were no cases of recurrence of HO after excision, whether it was performed open or arthroscopically. CONCLUSION/CONCLUSIONS:The addition of indomethacin is effective in reducing the incidence of HO after hip arthroscopy and should be especially considered in male patients who undergo osteoplasty for correction of symptomatic FAI.