Objectives
To develop recommendations for clinical and radiographic criteria to help define the
“acceptable” surgical correction of femoroacetabular impingement syndrome (FAIS) and
identify/define complications postoperatively.
Methods
A 3-phase modified Delphi study was conducted involving a case-based survey; a Likert/multiple
choice-based survey concerning radiographic and physical examination characteristics
to help define FAIS correction, as well as the prevalence and definition of potential
postoperative complications; and 2 consensus meetings.
Results
Of the 75 experts invited, 54 completed the Phase I survey, 50 completed the Phase
II survey (72% and 67% response rate), and 50 participated in the Phase III consensus
meetings. For both typical and atypical (complex) cases, there was consensus that
fluoroscopy with multiple views and dynamic hip assessment should be used intraoperatively
(96% and 100%, respectively). For typical FAIS cases, the Expert Panel agreed that
Dunn lateral and anteroposterior radiographs were the most important radiographs to
evaluate the hip postoperatively (88%, consensus). When asked about evaluating the
correction of cam impingement postoperatively, 87% voted that they use subjective
evaluation of the “sphericity” of the femoral head. In the case of focal and global
pincer-type FAIS, there was consensus that the reduction or elimination of the crossover
sign (84%) and lateral center-edge angle (91%) were important to inform the extent
of the FAIS correction. There was consensus for recommending further investigation
at 6 months postoperatively if hip pain had increased/plateaued (92% agreed); that
additional investigation and treatment should occur between 6 and 12 months (90% agreed);
and that a reoperation may be recommended at 12 months or later following this investigation
period (89% agreed).
Conclusions
This consensus project identified the importance of using fluoroscopy and dynamic
hip assessment intraoperatively; Dunn lateral and anteroposterior view radiographs
postoperatively; evaluating the “sphericity” of the femoral head for cam-type correction
and the use of dynamic hip assessment; reducing/eliminating the crossover sign for
focal pincer-type FAIS; evaluating the lateral center-edge angle for global pincer-type
FAIS; and avoiding overcorrection of pincer-type FAIS. In cases in which postoperative
hip pain increased/plateaued, further investigation and treatment is warranted between
6 and 12 months, and a reoperation may be recommended at a minimum of 12 months depending
on the cause of the hip pain.
Clinical Relevance
Hip arthroscopy surgeons have yet to reach a firm agreement on what constitutes an
“acceptable” or “good” surgery radiographically and how they can achieve desired clinical
outcomes. Although this was a comprehensive effort, more study is needed to determine
therapeutic thresholds that can be universally applied.
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 11,
2022
Received in revised form:
November 7,
2022
Received:
June 15,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: O.R.A. reports speakers’ bureau for CONMED. V.K. reports President, British Hip Society; and Chair, ESSKA and ISAKOS Hip Arthroscopy Committee. J.B. reports $100 honorarium for speaking at the 2021 Saskatchewan Nurse Practitioners Education Conference, also an honorarium for a presentation in 2020 to the Physiotherapists on Hip Disorders, and payment for travel expenses and hotel accommodations for speaking at the 2019 Saskatchewan Practical Orthopaedics Conference. Finally, J.B. received financial support for travel expenses and hotel accommodations from CONMED to attend the 2020 Complex Knee Surgery Symposium and 2019 Clearwater Arthroscopy Meeting. E.B. reports grants from CHIR, the Department of Defense, and FAROQ; personal fees from BodyCad, Pendopharm, Victhom, Stryker, CONMED, and Johnson & Johnson, outside the submitted work; and editorial board of Orthopaedics & Traumatology: Surgery & Research. D.O. reports personal fees from CONMED and ISHA, Vice Chair, Technology. S.U. reports personal fees from Smith & Nephew and CONMED, outside the submitted work. The institution of the authors has received, during the study period, funding from a McMaster Surgical Associates Innovation Grant (ORA). 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
