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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2013

01-08-2013 | Symposium: Advanced Hip Arthroscopy

Surgical Approaches for Cam Femoroacetabular Impingement: The Use of Multicriteria Decision Analysis

Authors: Claudio Diaz-Ledezma, MD, Javad Parvizi, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2013

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Abstract

Background

Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available.

Questions/purposes

We therefore executed a multidimensional structured comparison considering the benefits, opportunities, costs, and risk (BOCR) of the different approaches using multicriteria decision analysis (MCDA).

Methods

A MCDA using analytic hierarchical process (AHP) was conducted to compare SHD, HA, and MO in terms of BOCR on the basis of available evidence, institutional experience, costs, and our understanding of pathophysiology of FAI. A preclinical decision-making model was created for cam FAI to establish the surgical approach that better accomplishes our objectives regarding the surgical treatment. A total score of an alternative’s utility and sensitivity analysis was established using commercially available AHP software.

Results

The AHP model based on BOCR showed that MO is the best surgical approach for cam FAI (normalized score: 0.38) followed by HA (normalized score: 0.36) and SHD (normalized score: 0.25). The sensitivity analysis showed that HA would turn into the best alternative if the variable risks account for more than 61.8% of the priority during decision-making. In any other decision-making scenario, MO remains as the best alternative.

Conclusions

Using a recognized method for decision-making, this study provides supportive data for the use of MO approach as our preferred surgical approach for cam FAI. The latter is predominantly derived from the lower cost of this approach. Our data may be considered a proxy performance measurement for surgical approaches in cam FAI.

Level of Evidence

Level II, economic and decision analyses. See the Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Surgical Approaches for Cam Femoroacetabular Impingement: The Use of Multicriteria Decision Analysis
Authors
Claudio Diaz-Ledezma, MD
Javad Parvizi, MD
Publication date
01-08-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2934-6

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