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Defining Sex-Based Outcomes Following Hip Arthroscopy In Patients With Borderline Hip Dysplasia.


Benjamin G. Domb, MD
UNITED STATES

Defining Sex-Based Outcomes Following Hip Arthroscopy In Patients With Borderline Hip Dysplasia.

Benjamin Saks, MD, UNITED STATES James Fox, BBA, UNITED STATES Jade S Owens, BS, UNITED STATES Andrew Jimenez, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES

American Hip Institute Research Foundation, Des Plaines, Illinois, UNITED STATES

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Hip / Groin / Thigh

Diagnosis / Condition

Impingement

Treatment / Technique

Arthroscopy

Patient Populations

Gender Specific

Anatomic Structure

Capsuloligamentous Complex Labrum

Diagnosis Method

Physical Examination X-ray

Sports Medicine

Outcome Studies

Labrum

Labrum Tears Labrum Treatment

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Summary: Female patients with BHD presented with more severe disability but achieved equivalent clinical outcomes to males at 5-years following hip arthroscopy for FAI.

Background

Patient sex has been shown to influence outcomes following arthroscopic hip surgery.

Purpose

To evaluate for sex-based differences in outcomes following hip arthroscopy in patients with borderline hip dysplasia at a minimum of 5 years.

Methods

Between January 2011 and August 2015, data was prospectively collected on patients with borderline hip dysplasia (BHD) (lateral center edge angle [LCEA] 18-25°) undergoing primary hip arthroscopy. Patients were divided by sex, then propensity score matched for BMI, age, and Tönnis grade. All included patients had preoperative and minimum five-year postoperative scores for the 12-item Short Form Health Survey (SF-12), the Modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Visual Analog Scale (VAS) for pain. Minimum 5-year scores for the International Hip Outcome Tool-12 (iHOT-12), the Veterans RAND 12-Item Healthy Survey Physical Component Summary and Mental Component Summary (VR-12), the 12-item Health Survey Physical Component Summary and Mental Component Summary (SF-12), and VAS for patient satisfaction were also required. The rates of patients who achieved the minimal clinically importance difference (MCID) and patient acceptable symptomatic state (PASS) for the mHHS were also recorded. Radiographic characteristics, procedures performed, intraoperative findings, secondary surgeries, and survivorship were recorded and compared between the groups.

Results

A total of 242 patients met the inclusion criteria and 196 patients had adequate follow-up (81%). One hundred twenty-six patients were propensity score matched (63 males and 63 females). Both males and females showed significant improvements in all outcome scores recorded (P<0.001) and achieved MCID and PASS at high rates. Females reported significantly lower baseline NAHS (P=0.017) and higher baseline VAS pain (P=0.035). There were no significant differences between males and females for any postoperative patient reported outcome measure (PRO). Females trended toward larger improvements in all PROs following surgery. Male patients had significantly higher preoperative alpha angles (P<0.001) requiring a femoroplasty more frequently (P=0.016), as well as higher grades of acetabular cartilage injury (P<0.001) requiring a microfracture more frequently (P<0.001). Females required iliopsoas fractional lengthening more frequently (P=0.002). Overall reoperation rate was 19%, and females had a slightly higher rate of reoperation and conversion to total hip arthroplasty (THA) than males, but the rates were not significantly different.

Conclusion

Female patients with BHD presented with more severe disability but achieved equivalent clinical outcomes to males at 5-years following hip arthroscopy for FAI. Male patients had larger preoperative alpha angles and higher-grade acetabular cartilage pathology, though this did not translate to higher rates of secondary surgery or conversion to THA

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