Summary

Patient specific factors such as age, sex, and hypertension may impact the risk for hip fracture following femoroacetabular impingement surgery.

Abstract

Purpose

To identify risk factors associated with hip fracture and dislocation following arthroscopic surgical management of femoroacetabular impingement (FAI).

Methods

We queried the MarketScan database to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: (1) acetabuloplasty only or (2) femoroplasty only. Those underwent concomitant procedures were excluded. Reoperations, and postoperative surgical complications were followed for postoperatively for 180 days. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for covariates and identify independent risk factors for hip dislocation and fracture.

Results

This study identified 13,809 patients (mean age, 36.3 years) who underwent FAI surgery. Unadjusted postoperative complication rates were similar between the two cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, p = 0.0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, p = 0.0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, p < 0.0001) were higher in the femoroplasty only cohort. Combined acetabuloplasty and femoroplasty was associated with the highest postoperative complication burden of 21.6% (p < 0.0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (p > 0.05). Patients who were aged under 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (OR 0.3, 95% CI 0.1 – 0.8). Hypertension was independently associated with increased odds of hip fracture (OR 1.7, 95% CI 1.2 – 3.5).

Conclusions

Hip fractures and dislocations are uncommon but severe complications following femoral osteoplasty and acetabuloplasty. Older age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient and procedure specific factors that could be assessed with this database did not influence risk for hip dislocation,