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Multicenter Study
. 2024 Mar 1;44(3):141-146.
doi: 10.1097/BPO.0000000000002581. Epub 2023 Nov 20.

Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient

Yi-Meng Yen  1 , Young-Jo Kim  1 , Henry B Ellis  2 , Ernest L Sink  3 , Michael B Millis  1 , Ira Zaltz  4 , Wudbhav N Sankar  5 , John C Clohisy  6 , Jeffrey J Nepple  6 ; ANCHOR Group
Collaborators, Affiliations
Multicenter Study

Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient

Yi-Meng Yen et al. J Pediatr Orthop. .

Abstract

Background: Surgical treatment for adolescent patients with femoroacetabular impingement (FAI) is increasing. The purpose of this study was to determine the clinical outcomes of FAI surgery in a multicenter cohort of adolescent patients and to identify predictors of suboptimal outcomes.

Methods: One hundred twenty-six adolescent hips (114 patients < 18 years of age) undergoing surgery for symptomatic FAI were studied from a larger multicenter cohort. The group included 74 (58.7%) female and 52 male hips (41.3%) with a mean age of 16.1 (range 11.3 to 17.8). Clinical outcomes included the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (5 domains), and University of California Los Angeles activity score. Failure was defined as revision surgery or clinical failure (inability to reach minimally clinical important differences or patient acceptable symptoms state for the mHHS). Statistical analysis was used to identify factors significantly associated with failure.

Results: There was clinically important improvement in all patient-reported outcomes for the overall group, but an 18.3% failure rate. This included a revision rate of 8.7%. Females were significantly more likely than males to be classified as a failure (25.7 vs. 7.7%, P =0.01), in part because of lower preoperative mHHS (59.1 vs. 67.0, P < 0.001). Mild cam deformity (alpha angle <55 degrees) was present in 42.5% of female hips compared with 17.3% male hips. Higher alpha angles were inversely correlated with failure. Alpha angles >63 have a failure rate of 8.3%, between 55 and 63 degrees, 12.0% failure rate, and <55 degrees (mild cam) failure rate of 37.5%. Patients who participated in athletics had a 10.3% failure rate compared with nonathletes at 25.0% ( P =0.03, RR (relative risk) 2.4).

Conclusions: Adolescent patients undergoing surgical treatment for FAI generally demonstrate significant improvement. However, female sex, mild cam deformities, and lack of sports participation are independently associated with higher failure rates. These factors should be considered in surgical decision-making and during patient counseling.

Level of evidence: Level III-retrospective comparative study.

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Conflict of interest statement

Y.M.Y. serves as consultant for Smith and Nephew Inc. and Orthopediatrics; Y.J.K. serves as a consultant for Imagen and Orthopediatrics; H.B.E. receives educational payments from Pylant Medical and Orthopediatrics, non-consulting fees from Smith and Nephew Inc. and Synthes; E.L.S. has received compensation for serving as faculty or as a speaker from Synthes; M.B.M. reports personal fees from Saunders/Mosby-Elsevier; I.Z. has received consulting fees and royalties from OrthoPediatrics; speaking fees from Synthes; W.N.S. no conflicts of interest; J.C.C. reports personal fees for Wolters Kluwer Health, Microport Orthopedics, and Zimmer Biomet; J.J.N. received research grant from Smith and Nephew Inc. and served as a consultant; received research grant from Stryker, Zimmer Biomet, Department of Defense, AOSSM/OREF; received royalties from Responsive Arthroscopy and served as a consultant. C.M.L. has received consulting fees from Responsive Arthroscopy and Smith + Nephew; P.E.B. has received consulting fees and research support from DePuy, MatOrtho, MicroPort, and Zimmer; and royalties from Corin U.S.A., MatOrtho, Medacta, and MicroPort; D.J.S. received royalties from Globus Medical; D.A.P. serves as a consultant for Orthofix, and receives royalties from Elsevier; T.H.M receives non-consulting fees from Smith and Nephew Inc. and Orthopediatrics; E.L.B. is consultant and receives royalties from BodyCad, non-consultant fees from Conmed Linvatec, Depuy, Ergoresearch, Pendopharm, and Stryker; consultant for Victhom. The remaining authors declare no conflicts of interest.

References

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    1. Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50:1169–1176.
    1. Philippon MJ, Yen YM, Briggs KK, et al. Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report. J Pediatr Orthop. 2008;28:705–710.
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