Purpose
To report 5-year outcomes of arthroscopic treatment of femoroacetabular impingement
syndrome in patients with femoral retroversion compared with a control group of patients
with normal femoral anteversion.
Methods
Data were prospectively collected and retrospectively reviewed for all patients who
underwent hip arthroscopy between August 2008 and April 2013. Patients were included
in analysis if they underwent hip arthroscopy during this period and had femoral version
≤0° calculated using magnetic resonance imaging. Exclusion criteria included prior
ipsilateral hip conditions/surgeries or Tönnis grade >1. These patients were pair
matched with patients having femoral anteversion between 10° and 20° based on gender,
body mass index ± 10, and age ± 10 years. Patient-reported outcomes (PROs) were collected
at 3 months and 1 year postoperatively and annually thereafter. An a priori power
analysis was performed.
Results
A total of 59 patients were identified as the experimental group out of 69 eligible
for inclusion (86%). All 59 patients were matched, with a mean age of 37.4 years and
mean body mass index of 26.9. Twenty patients were female, and 39 were male. These
patients demonstrated significant improvement from their preoperative state in all
patient-reported outcomes and visual analog score scores (P < .001). Thirty-eight patients met the threshold for minimal clinically important
difference, and 35 achieved patient acceptable symptomatic state for the modified
Harris Hip Score questionnaire. Seven patients converted to total hip replacement.
No differences were noted between retroverted and control patients in any of the outcome
measures collected, in pain or satisfaction ratings, in the frequency of or duration
to secondary surgeries or in complication rate (P > .05).
Conclusions
Patients with femoral retroversion demonstrated significantly higher outcomes at minimum
5-year follow-up after undergoing arthroscopic hip surgery. These outcomes were not
different from those of patients with normal femoral version. While femoral retroversion
should not be considered a contraindication to hip arthroscopy, it should be carefully
considered as a factor in patient selection and surgical planning.
Level of Evidence
Level III, retrospective comparative study.
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Article info
Publication history
Published online: October 16, 2019
Accepted:
March 19,
2019
Received:
August 13,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.C.L. receives grant support from Arthrex. B.G.D. receives support from Arthrex, Medacta, Stryker, American Orthopedic Foundation, Adventist Hinsdale Hospital, Amplitude, DJO Global, the Kaufman Foundation, Medacta, Pacira Pharmaceuticals, Stryker, Breg, and Orthomerica; has an ownership interest in Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; and receives royalties from patents with Arthrex, DJO Global, and Orthoamerica. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 3047
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Myth Buster—Is Femoral Retroversion a Contraindication to Hip Arthroscopy in Femoroacetabular Impingement?ArthroscopyVol. 35Issue 11
- PreviewHip arthroscopy can effectively address cam and pincer impingement by reshaping bone prominences or bone edges. However, hip arthroscopy cannot be used to correct severe bone torsion abnormalities such as acetabular or femoral retroversion. As a result, some surgeons contraindicate hip arthroscopy in patients with femoral retroversion absent correction of the torsion abnormalities. However, recent research has suggested that hip arthroscopy absent osteotomy, with a focus on labral preservation and thorough correction of underlying cam and pincer bony abnormalities, achieves positive outcomes.
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