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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Femoroacetabular impingement: A review.Sports Med Arthrosc Rev. 2016; 24: e53-e58
- The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement.Br J Sports Med. 2016; 50: 1169-1176
- Femoroacetabular impingement syndrome.Curr Sports Med Rep. 2020; 19: 360-366
- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop. 2003; 417: 112-120
- Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial.Lancet. 2018; 391: 2225-2235
- Early hip arthroscopy for femoroacetabular impingement syndrome provides superior outcomes when compared with delaying surgical treatment beyond 6 months.Am J Sports Med. 2019; 47: 2038-2044
- Nonoperative management of femoroacetabular impingement: A prospective study.Am J Sports Med. 2018; 46: 3415-3422
- Short-term clinical outcomes of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement: A systematic review and meta-analysis of randomized controlled trials.Orthop J Sports Med. 2020; 8 (2325967120968490)
- Predictors of hip pain and function in femoroacetabular impingement: A prospective cohort analysis.Orthop J Sports Med. 2017; 5 (2325967117726521)
- Surgical trends in arthroscopic hip surgery using a large national database.Arthroscopy. 2018; 34: 1825-1830
- Trends in hip arthroscopy utilization in the United States.J Arthroplasty. 2013; 28: 140-143
- Trends and demographics in hip arthroscopy in the United States.Arthroscopy. 2013; 29: 661-665
- Age-related trends in hip arthroscopy: A large cross-sectional analysis.Arthroscopy. 2015; 31: 2307-2313.e2
- The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States.Arthroscopy. 2022; 38: 82-87
- Orthopaedic surgery sports medicine fellows see substantial increase in hip arthroscopy procedural volume with high variability from 2011 to 2016.Arthroscopy. 2021; 37: 521-527
- Obtaining imaging cost and quality information in femoroacetabular impingement: The patient experience.Iowa Orthop J. 2020; 40: 185-190
- Advanced imaging adds little value in the diagnosis of femoroacetabular impingement syndrome.J Bone Joint Surg Am. 2017; 99: e133
- Health care spending in the united states and other high-income countries.JAMA. 2018; 319: 1024-1039
- Value-based health care is inevitable and that’s good. Harvard Business Review.(Published September 24, 2013. Available at)https://hbr.org/2013/09/value-based-health-care-is-inevitable-and-thats-goodDate accessed: October 12, 2017
- What is value in health care?.N Engl J Med. 2010; 363: 2477-2481
- Surgeon willingness to participate in randomized controlled trials for the treatment of femoroacetabular impingement.Arthroscopy. 2016; 32 (e23): 20-24
- Time and cost of diagnosis for symptomatic femoroacetabular impingement.Orthop J Sports Med. 2014; 2 (2325967114523916)
- Factors associated with increased opioid use during the COVID-19 pandemic: A prospective study of patients enrolled in opioid agonist treatment.J Addict Med. 2022; (online ahead of print)
- The evolution of hip arthroscopy: What has changed since 2008. A single surgeon’s experience.Arthroscopy. 2020; 36: 761-772
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