Background
The objectives of this study were to develop recommendations for clinical and radiographic criteria to help define the “acceptable” surgical correction of femoroacetabular impingement (FAI) and identify/define complications postoperatively.
Methods
A three-phase modified Delphi study was conducted involving a case-based survey; a Likert/multiple choice-based survey concerning radiographic and physical exam characteristics to help define FAI correction, as well as the prevalence and definition of potential postoperative complications; and two consensus meetings.
Results
Of the 75 experts invited, 54 completed the Phase I survey, 50 completed the Phase II survey (72% and 67% response rate), and 50 participated in the Phase III consensus meetings. For both typical and atypical (complex) cases, there was consensus that fluoroscopy with multiple views and dynamic hip assessment should be used intraoperatively (96% and 100%, respectively). For typical FAI cases, the Expert Panel agreed that Dunn lateral and anterior posterior (AP) x-rays were the most important radiographs to evaluate the hip postoperatively (88%, consensus). When asked about evaluating the correction of cam impingement postoperatively, 87% voted that they use subjective evaluation of the ‘sphericity’ of the femoral head. In the case of focal and global pincer-type FAI, there was consensus that the reduction or elimination of the crossover sign (84%) and lateral centre-edge angle (91%) were important to inform the extent of the FAI correction. There was consensus for recommending further investigation at 6 months postoperatively if hip pain had increased/plateaued (92% agreed); that additional investigation and treatment should occur between 6-12 months (90% agreed); and that a reoperation may be recommended at 12 months or later following this investigation period (89% agreed).
Conclusions
This consensus project identified some general goals for the surgical correction of FAI. Although this was a comprehensive effort, more study is needed to determine therapeutic thresholds that can be universally applied.