Advertisement

Preoperative MRI Offers Questionable Clinical Utility, Delays Time to Hip Arthroscopy, and Lacks Cost-Effectiveness in Patients Aged ≤40 Years With Femoroacetabular Impingement Syndrome: A Retrospective 5-Year Analysis

      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 access
      One-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 Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Egger A.C.
        • Frangiamore S.
        • Rosneck J.
        Femoroacetabular impingement: A review.
        Sports Med Arthrosc Rev. 2016; 24: e53-e58
        • Griffin D.R.
        • Dickenson E.J.
        • O’Donnell J.
        • et al.
        The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement.
        Br J Sports Med. 2016; 50: 1169-1176
        • Trigg S.D.
        • Schroeder J.D.
        • Hulsopple C.
        Femoroacetabular impingement syndrome.
        Curr Sports Med Rep. 2020; 19: 360-366
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Nötzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop. 2003; 417: 112-120
        • Griffin D.R.
        • Dickenson E.J.
        • Wall P.D.H.
        • et al.
        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
        • Kunze K.N.
        • Beck E.C.
        • Nwachukwu B.U.
        • Ahn J.
        • Nho S.J.
        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
        • Pennock A.T.
        • Bomar J.D.
        • Johnson K.P.
        • Randich K.
        • Upasani V.V.
        Nonoperative management of femoroacetabular impingement: A prospective study.
        Am J Sports Med. 2018; 46: 3415-3422
        • Schwabe M.T.
        • Clohisy J.C.
        • Cheng A.L.
        • et al.
        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)
        • Westermann R.W.
        • Lynch T.S.
        • Jones M.H.
        • et al.
        Predictors of hip pain and function in femoroacetabular impingement: A prospective cohort analysis.
        Orthop J Sports Med. 2017; 5 (2325967117726521)
        • Bonazza N.A.
        • Homcha B.
        • Liu G.
        • Leslie D.L.
        • Dhawan A.
        Surgical trends in arthroscopic hip surgery using a large national database.
        Arthroscopy. 2018; 34: 1825-1830
        • Bozic K.J.
        • Chan V.
        • Valone F.H.
        • Feeley B.T.
        • Vail T.P.
        Trends in hip arthroscopy utilization in the United States.
        J Arthroplasty. 2013; 28: 140-143
        • Montgomery S.R.
        • Ngo S.S.
        • Hobson T.
        • et al.
        Trends and demographics in hip arthroscopy in the United States.
        Arthroscopy. 2013; 29: 661-665
        • Sing D.C.
        • Feeley B.T.
        • Tay B.
        • Vail T.P.
        • Zhang A.L.
        Age-related trends in hip arthroscopy: A large cross-sectional analysis.
        Arthroscopy. 2015; 31: 2307-2313.e2
        • Zusmanovich M.
        • Haselman W.
        • Serrano B.
        • Banffy M.
        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
        • Gordon A.M.
        • Flanigan D.C.
        • Malik A.T.
        • Vasileff W.
        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
        • Anthony C.A.
        • Rojas E.O.
        • Glass N.
        • Westermann R.W.
        • Clohisy J.C.
        • Weinstein S.L.
        Obtaining imaging cost and quality information in femoroacetabular impingement: The patient experience.
        Iowa Orthop J. 2020; 40: 185-190
        • Cunningham D.J.
        • Paranjape C.S.
        • Harris J.D.
        • Nho S.J.
        • Olson S.A.
        • Mather R.C.
        Advanced imaging adds little value in the diagnosis of femoroacetabular impingement syndrome.
        J Bone Joint Surg Am. 2017; 99: e133
        • Papanicolas I.
        • Woskie L.R.
        • Jha A.K.
        Health care spending in the united states and other high-income countries.
        JAMA. 2018; 319: 1024-1039
        • Cosgrove T.
        Value-based health care is inevitable and that’s good. Harvard Business Review.
        (Published September 24, 2013. Available at)
        • Porter M.E.
        What is value in health care?.
        N Engl J Med. 2010; 363: 2477-2481
        • Ross J.R.
        • Bedi A.
        • Clohisy J.C.
        • Gagnier J.J.
        • Larson C.M.
        • ANCHOR Study Group
        Surgeon willingness to participate in randomized controlled trials for the treatment of femoroacetabular impingement.
        Arthroscopy. 2016; 32 (e23): 20-24
        • Kahlenberg C.
        • Han B.
        • Patel R.M.
        • Deshmane P.P.
        • Terry M.A.
        Time and cost of diagnosis for symptomatic femoroacetabular impingement.
        Orthop J Sports Med. 2014; 2 (2325967114523916)
        • Rosic T.
        • Naji L.
        • Sanger N.
        • Marsh D.C.
        • Worster A.
        • Thabane L.
        • Samaan Z.
        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)
        • Domb B.G.
        • Chen S.L.
        • Shapira J.
        • Maldonado D.R.
        • Lall A.C.
        • Rosinsky P.J.
        The evolution of hip arthroscopy: What has changed since 2008. A single surgeon’s experience.
        Arthroscopy. 2020; 36: 761-772