Purpose
To assess the clinical utility of preoperative magnetic resonance imaging (MRI) and
quantify the delay in surgical care for patients aged ≤40 years undergoing primary
hip arthroscopy with history, physical examination, and radiographs concordant with
femoroacetabular impingement syndrome (FAIS).
Methods
From August 2015 to December 2020, 1,786 consecutive patients were reviewed from the
practice of 1 fellowship-trained hip arthroscopist. Inclusion criteria were FAIS,
primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication,
reattempt of conservative management, or concomitant periacetabular osteotomy. After
nonoperative treatment options were exhausted and a surgical plan was established,
patients were stratified by those who presented with versus without MRI. Those without
existing MRI received one, and any deviations from the surgical plan were noted. All
preoperative MRIs were compared with office evaluation and intraoperative findings
to assess agreement. Demographic data, Hip Disability and Osteoarthritis Outcome Score
(HOOS)-Pain, and time from office to MRI or arthroscopy were recorded.
Results
Of the patients indicated by history, physical examination, and radiographs alone
(70% female, body mass index 24.8 kg/m2, age 25.9 years), 198 patients presented without MRI and 934 with MRI. None of the
198 had surgical plans altered after MRI. Patients in both groups had MRI findings
demonstrating anterosuperior labral tears that were visualized and repaired intraoperatively.
Mean time from office to arthroscopy for patients without MRI versus those with was
107.0 ± 67 and 85.0 ± 53 days, respectively (P < .001). Time to MRI was 22.8 days. No difference between groups was observed among
the 85% of patients who surpassed the HOOS-Pain minimal clinically important difference
(MCID).
Conclusion
Once indicated for surgery based on history, physical examination, and radiographs,
preoperative MRI did not alter the surgical plan for patients aged ≤40 years with
FAIS undergoing primary hip arthroscopy. Moreover, preoperative MRI delayed time to
arthroscopy. The necessity of routine preoperative MRI in the young primary FAIS population
should be challenged.
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Article Info
Publication History
Published online: March 29, 2022
Accepted:
March 11,
2022
Received:
February 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
