Purpose
To report minimum 10-year follow-up survivorship, defined as non-conversion to total
hip arthroplasty (THA), and patient-reported outcome scores (PROS) after primary hip
arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement
syndrome (FAIS) and acetabular chondral lesions, respectively.
Methods
Data were prospectively collected and retrospectively analyzed on all patients who
underwent a primary hip arthroscopy and received an acetabular microfracture between
June 2009 and January 2011. Patients with a minimum 10-year follow-up for the modified
Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale
(VAS) for pain were included. If available, the minimum 10-year follow-up for the
Hip Outcome Score-Sport-Specific Subscale was reported. The demographics, intraoperative
findings, surgical procedures, PROS, rate of achieving the minimal clinical important
difference (MCID), and secondary surgeries were analyzed and reported.
Results
Twenty-two hips (20 patients) were included in the study, and the mean follow-up time
was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from
females. The average patient age at the time of surgery was 42.3 years ± 9.6. All
patients on average experienced statistically significant improvement (P < .05) between preoperative and minimum 10-year follow-up scores for all PROs. In
total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3%
of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain.
Conclusion
At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients who
underwent primary hip arthroscopy with acetabular microfracture for the treatment
of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients
that did not require THA conversion, significant improvement in all PROS was demonstrated.
Level of Evidence
IV, case-series study.
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References
- Trends in hip arthroscopy utilization in the United States.J Arthroplasty. 2013; 28: 140-143
- Trends in hip arthroscopic labral repair: An American Board of Orthopaedic Surgery Database Study.Arthroscopy. 2019; 35: 1413-1419
- 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
- Editorial commentary: Hip arthroscopy—A microcosm in the evolution of arthroscopy in sports medicine.Arthroscopy. 2020; 36: 773-775
- The role of comprehensive capsular management in hip arthroscopy for the treatment of femoroacetabular impingement syndrome.Arthroscopy. 2020; 36: 9-11
- Capsular repair may improve outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement: A systematic review of comparative outcome studies.Arthroscopy. 2021; 37: 2975-2990
- Prospective analysis of arthroscopic hip anatomic labral repair utilizing knotless suture anchor technology: The controlled-tension anatomic technique at minimum 2-year follow-up.Orthop J Sports Med. 2020; 8 (232596712093507)
- Arthroscopic acetabular labral reconstruction: A review.J Hip Preserv Surg. 2020; 7: 611-620
- Lowering the learning curve: Intraoperative automated radiographic visualization tool allows for higher accuracy of cam lesion resection when used by novice surgeon for arthroscopic femoroplasty.Arthroscopy. 2022; 38: 1156-1163
- In search of the spherical femoroplasty: Cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.Am J Sports Med. 2018; 46: 2061-2071
- Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement—A pilot study.Arthroscopy. 2012; 28: 322-329
- Arthroscopic three-dimensional autologous chondrocyte transplantation using spheroids for the treatment of full-thickness cartilage defects of the hip joint.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2032-2037
- Arthroscopic autologous chondrocyte implantation in the hip for the treatment of full-thickness cartilage defects: A case series of 29 patients and review of the literature.SICOT-J. 2017; 3: 72
- Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery.J Hip Preserv Surg. 2020; 7: 503-510
- Capsular management of the hip during arthroscopic acetabular chondral resurfacing: Pearls, pitfalls, and optimal surgical technique.Arthrosc Tech. 2021; 10: e587-e597
- Arthroscopic treatment of hip chondral defect with microfracture and platelet-rich plasma-infused micronized cartilage allograft augmentation.Arthrosc Tech. 2018; 7: e361-e365
- Better clinicoradiological results of BST-CarGel treatment in cartilage repair compared with microfracture in acetabular chondral defects at 2 years.Am J Sports Med. 2020; 48: 1961-1966
- Outcomes of joint preservation procedures for cartilage injuries in the hip: A systematic review and meta-analysis.Orthop J Sports Med. 2018; 6 (232596711877694)
- Prevalence and trends in obesity among US adults, 1999–2000.J Am Med Assoc. 2002; 288: 1723-1727
- Is microfracture necessary? Acetabular chondrolabral debridement/abrasion demonstrates similar outcomes and survival to microfracture in hip arthroscopy: A multicenter analysis.Am J Sports Med. 2019; 47: 1670-1678
- Evaluation and treatment of borderline dysplasia: Moving beyond the lateral center edge angle.Curr Rev Musculoskelet Med. 2020; 13: 28-37
- Does the Modified Harris Hip Score reflect patient satisfaction after hip arthroscopy?.Am J Sports Med. 2012; 40: 2557-2560
- The nonarthritic hip score: Reliable and validated.Clin Orthop. 2003; : 75-83
- Evidence of validity for the hip outcome score in hip arthroscopy.Arthroscopy. 2007; 23: 822-826
- Correlation between changes in visual analog scale and patient-reported outcome scores and patient satisfaction after hip arthroscopic surgery.Orthop J Sports Med. 2017; 5: 2
- Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.J Bone Joint Surg Am. 2017; 99: 997-1004
- Predictors of clinical outcomes after hip arthroscopy: A prospective analysis of 1038 patients with 2-year follow-up.Am J Sports Med. 2018; 46: 1324-1330
- Sex-based differences in the clinical presentation of patients with symptomatic hip labral tears.Am J Sports Med. 2014; 42: 1365-1369
- Evaluation of the hip: history and physical examination.North Am J Sports Phys Ther. 2007; 2: 231-240
- Radiographic and demographic factors can predict the need for primary labral reconstruction in hip arthroscopic surgery: A predictive model using 1398 hips.Am J Sports Med. 2020; 48: 173-180
- Perineal pressure during hip arthroscopy is reduced by use of Trendelenburg: A prospective study with randomized order of positioning.Clin Orthop. 2019; 477: 1851-1857
- Do not take for granted! The art of elevating the capsule in hip arthroscopy: A stepwise approach.Arthrosc Tech. 2019; 8: e883-e887
- Forget the greater trochanter! Hip joint access with the 12 o’clock portal in hip arthroscopy.Arthrosc Tech. 2019; 8: e575-e584
- ann. Anatomy, pathologic features, and treatment of acetabular labral tears.Clin Orthop. 2003; : 38-47
- Anatomy, histologic features, and vascularity of the adult acetabular labrum.Clin Orthop. 2001; : 232-240
- Acetabular chondral lesions in hip arthroscopy: Relationships between grade, topography, and demographics.Am J Sports Med. 2017; 45: 2501-2506
- Outerbridge grade IV cartilage lesions in the hip identified at arthroscopy.Arthroscopy. 2016; 32: 814-819
- The ligamentum teres of the adult hip.J Bone Joint Surg Br. 2009; 91: 8-15
- Tears of the ligamentum teres: Prevalence in hip arthroscopy using 2 classification systems.Am J Sports Med. 2011; 39: 117-125
- Selective debridement with labral preservation using narrow indications in the hip: Minimum 5-year outcomes with a matched-pair labral repair control group.Am J Sports Med. 2018; 46: 297-304
- Arthroscopic labral base repair in the hip: 5-Year minimum clinical outcomes.Am J Sports Med. 2017; 45: 2882-2890
- The effect of complete tearing of the ligamentum teres in patients undergoing primary hip arthroscopy for femoroacetabular impingement and labral tears: A match-controlled study.Arthroscopy. 2019; 35: 80-88
- Acetabular microfracture in hip arthroscopy: Clinical outcomes with minimum 5-year follow-up.Hip Int. 2018; 28: 649-656
- Microfracture in hip arthroscopy. Keep it simple!.Arthrosc Tech. 2019; 8: e1063-e1067
- Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability.Arthroscopy. 2013; 29: 162-173
- Correlation between changes in visual analog scale and patient-reported outcome scores and patient satisfaction after hip arthroscopic surgery.Orthop J Sports Med. 2017; 5 (232596711772477)
- Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.Med Care. 2003; 41: 582-592
- Microfracture: Surgical technique and rehabilitation to treat chondral defects.Clin Orthop. 2001; : S362-S369
- Microfracture for cartilage repair in the knee: A systematic review of the contemporary literature.Knee Surg Sports Traumatol Arthrosc. 2020; 28: 670-706
- Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement.Clin Orthop. 2009; 467: 739-746
- Indications and outcomes for microfracture as an adjunct to hip arthroscopy for treatment of chondral defects in patients with femoroacetabular impingement: A systematic review.Arthroscopy. 2016; 32 (e2): 190-200
- Microfracture for acetabular chondral defects in patients with femoroacetabular impingement: Results at second-look arthroscopic surgery.Am J Sports Med. 2012; 40: 2725-2730
- Acetabular chondral lesions associated with femoroacetabular impingement treated by autologous matrix-induced chondrogenesis or microfracture: A comparative study at 8-year follow-up.Arthroscopy. 2018; 34: 3012-3023
- Can microfracture produce repair tissue in acetabular chondral defects?.Arthroscopy. 2008; 24: 46-50
- Arthroscopic management of hip chondral defects: A systematic review of the literature.Arthroscopy. 2016; 32: 1435-1443
- The evolution of hip arthroscopy: What has changed since 2008—A single surgeon’s experience.Arthroscopy. 2020; 36: 761-772
- Surgeon experience in hip arthroscopy affects surgical time, complication rate, and reoperation rate: A systematic review on the learning curve.Arthroscopy. 2020; 36: 3092-3105
- Optimal treatment of cam morphology may change the natural history of femoroacetabular impingement.Am J Sports Med. 2020; 48: 2887-2896
- Complete capsule closure provides clinically significant outcome improvement and higher survivorship after hip arthroscopy at minimum 5-year follow-up.Arthroscopy. 2021; 37: 1833-1842
- Hip arthroscopy for femoroacetabular impingement in adolescents: 10-Year patient-reported outcomes.Am J Sports Med. 2021; 49: 76-81
Article info
Publication history
Published online: December 07, 2022
Accepted:
November 14,
2022
Received:
May 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: The research reported in this article was supported by IIRR-01431 study funding from Arthrex. B.G.D. reports grants from American Orthopedic Foundation, Arthrex, Stryker, Breg, Medwest Associates, ATI Physical Therapy, Ossur; personal fees from Amplitude, Arthrex, DJO Global, Medacta, Stryker, Orthomerica, St. Alexius Medical Center; non-financial support from Arthrex, DJO Global, Medacta, Stryker, Medwest Associates, St. Alexius Medical Center, Zimmer Biomet, DePuy Synthes Sales, Medtronic, Prime Surgical, Trice Medical; other from American Orthopedic Foundation, Stryker; patent 8920497 - Method and instrumentation for acetabular labrum reconstruction with royalties paid to Arthrex, patent 8708941 – Adjustable multi-component hip orthosis with royalties paid to Orthomerica and DJO Global, and patent 9737292 – Knotless suture anchors and methods of tissue repair with royalties paid to Arthrex; board membership of American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, the Journal of Arthroscopy; and has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD #3, North Shore Surgical Suites, and Munster Specialty Surgery Center. D.R.M. reports non-financial support from Arthrex, Stryker, Smith & Nephew, and Ossur; and board membership of the Journal of Arthroscopy. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
