Summary

The purpose of this study was to evaluate symptom duration and its relationship to patient reported outcomes and survivorship following hip arthroscopy for treatment of femoroacetabular impingement (FAI) in adolescents.

Abstract

Purpose

Earlier surgical intervention for symptomatic femoroacetabular impingement (FAI) has been associated with superior outcomes in adults. There is lack of literature on optimal timing of hip arthroscopy in the adolescent population. The purpose of this study was to evaluate symptom duration and its relationship to patient reported outcomes and survivorship following hip arthroscopy for treatment of FAI in adolescents.

Methods

Patients 18 years of age or younger at time of primary hip arthroscopy for FAI between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Symptom duration was categorized as less than or equal to 12 and >12 months or 0-6 months, >6-12 months, >12-24 months, and >24 months. Minimum 2-year patient-reported outcomes (modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)Activities of Daily Living (ADL), HOS-Sport Scale (SSS), Short Forms 12 (SF-12)), minimum clinically significant difference (MCID) and patient acceptable symptom state (PASS) rates, and revision surgery rates, were compared based on symptom duration.

Results

Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with mean age of 16.4±1.1 (range: 13.0-18.0). The mean symptom duration was 17.2±15.2 months (range: 0.33-72.4). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3±1.0 years (range, 0.9 to 4.3 years). At a mean follow-up of 4.8±2.2 years (range, 2 to 10 years), there were statistically significant improvements in all PROs (p<.05 for all). There were no significant differences in the rates of revision, post-operative scores, or patient satisfaction between the 12 month and >12 month groups (p< 0.05 for all). Symptom duration was treated as a continuous variable and showed no significant correlation to post-operative scores (correlation coefficient range: -0.162 to -.078, p>0.05 for all).

Conclusion

In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in patient reported outcome measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable.
Keywords
Adolescents; FAI; timing; onset