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Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery

  • Stephanie E. Wong
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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  • Alexander C. Newhouse
    Correspondence
    Address correspondence to Alexander C. Newhouse, B.S., Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, 1611 W Harrison St, Chicago, IL 60612, U.S.A.
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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  • Daniel M. Wichman
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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  • Felipe Bessa
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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  • Joel Williams
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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  • Shane J. Nho
    Affiliations
    Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
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Published:October 25, 2021DOI:https://doi.org/10.1016/j.arthro.2021.10.012

      Purpose

      The purpose of this study was to compare outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index and in patients without radiographic evidence of hip instability.

      Methods

      Data from consecutive patients with borderline hip dysplasia (lateral center edge angle between 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of FAIS were analyzed. Baseline demographic data, radiographic parameters, preoperative, and 2-year postoperative patient-reported outcome measures were collected. The FEAR index was measured by 3 different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinically important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and <2°.

      Results

      A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7 ± 13.2 (P < .325) years and 25.1 ± 5.6 kg/m2 (P < .862). There were no statistically significant demographic differences between the groups. Nineteen (13.0%) patients were found to have a FEAR index of over 2˚. The FEAR index <2° and FEAR index ≥2° groups had a mean preoperative FEAR index (standard deviation, range) of −7.0 (5.2, −26.8 to 1.9) and 4.8 (2.5, 2.0-11.8), respectively. The interrater intraclass correlation coefficient was 0.96. Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement were not statistically different between the radiographically stable and unstable groups. (p>0.05 for all).

      Conclusion

      Patients with borderline hip dysplasia and radiographic evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips after arthroscopic treatment of FAIS.

      Clinical Relevance

      Retrospective Level III cohort study
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