Top

Archives of Orthopaedic and Trauma Surgery

Published in:

12-11-2021 | Wound Debridement | Arthroscopy and Sports Medicine

Arthroscopic surgery for femoroacetabular impingement has limited effect in patients with Tönnis grade-2 at 4-year follow-up

Authors: Jesus Mas Martinez, Carmen Verdu-Roman, David Bustamante Suarez de Puga, Manuel Morales Santias, Enrique Martinez Gimenez, Javier Sanz-Reig

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Abstract

Introduction

This study evaluated intraoperative findings and outcomes in Tönnis grade-2 patients after hip arthroscopy and compared these results with patients with Tönnis grade-0 and grade-1.

Materials and methods

Retrospective cohort study of patients undergoing hip arthroscopy between January 2013 and December 2017. Patients were divided into either Tönnis grade-2, grade-1, and grade-0 osteoarthritis groups. Labral and chondral status were evaluated. Radiographic analysis, modified Harris hip score (mHHS), a self-administered Hip Outcome Score (HOS) questionnaire, with activity of daily living (ADL) and sports subscale (SSS), and a self-administered short version of the International Hip Outcome Tool (IHOT-12) were assessed at 6, 12 months, and then yearly. Clinical meaningful outcomes were measured with the minimal clinical important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for mHHS, HOS-ADL and HOS-SSS, and IHOT-12.

Results

A total of 264 hip arthroscopic procedures met the inclusion criteria. There were 38 patients Tönnis grade-2, 91 patients Tönnis grade-1, and 135 patients Tönnis grade-0. Mean follow-up was 48.7 months in Tönnis grade-2 group, 48.6 months in Tönnis grade-0 group, and 48.1 months in Tönnis grade-1 group. Tönnis grade-2 patients had more extensive rim chondral damage, and a higher rate of labral debridement was performed in this group. There were no statistically significant differences in preoperative PROs among the groups. Tönnis grade-2 group had statistically significant improvement in mHHS, but not in HOS-AVD, HOS-SSS and IHOT-12. Between T1 and T2 groups there were no statistically significant differences in outcomes. Lower significant percentage values of Tönnis grade-2 patients achieved MCID, PASS, and SCB threshold.

Conclusion

Improvements in PROs and rates of achieving clinical meaningful outcomes were limited for patients with Tönnis grade-2 after HA at 4-year follow-up. The outcomes of the Tönnis grade-2 cohort deteriorate over mid-term follow-up. Our results could be used in orthopedic practice to inform patients about the limited role of hip arthroscopy as a joint preservation procedure in these selected patients.

Level of evidence

Cohort study, level 3.

Mella VI, Núñez A, Paccot D, Díaz-Ledezma C (2015) Hip arthroscopy and osteoarthritis: where are the limits and indications? SICOT J 1:27. https://doi.org/10.1051/sicotj/2015027CrossRefPubMedPubMedCentral

Tonnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 119:39–47

Lee JK, Hwang DS, Kang C, Hwang JM, Lee GS, Zeng L, Park YC (2020) Midterm-clinical outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis. Hip Pelvis 32(1):17–25. https://doi.org/10.5371/hp.2020.32.1.17CrossRefPubMedPubMedCentral

Byrd JWT, Bardowski EA, Jones KS (2018) Influence of Tönnis grade on outcomes of arthroscopic management of symptomatic femoroacetabular impingement. Arthroscopy 34(8):2353–2356. https://doi.org/10.1016/j.arthro.2018.03.021CrossRefPubMed

Chandrasekaran S, Darwish N, Gui C, Lodhia P, Suarez-Ahedo C, Domb BG (2016) Outcomes of hip arthroscopy in patients with Tönnis grade-2 osteoarthritis at a mean 2-year follow-up: evaluation using a matched-pair analysis with Tönnis grade-0 and grade-1 cohorts. J Bone Jt Surg Am 98(12):973–982. https://doi.org/10.2106/JBJS.15.00644CrossRef

Domb BG, Gui C, Lodhia P (2015) How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy 31(3):520–529. https://doi.org/10.1016/j.arthro.2014.11.008CrossRefPubMed

Kemp JL, MacDonald D, Collins NJ, Hatton AL, Crossley KM (2015) Hip arthroscopy in the setting of hip osteoarthritis: systematic review of outcomes and progression to hip arthroplasty. Clin Orthop Relat Res 473(3):1055–1073. https://doi.org/10.1007/s11999-014-3943-9CrossRefPubMed

Sogbein OA, Shah A, Kay J, Memon M, Simunovic N, Belzile EL, Ayeni OR (2019) Predictors of outcomes after hip arthroscopic surgery for femoroacetabular impingement: a systematic review. Orthop J Sports Med 7(6):2325967119848982. https://doi.org/10.1177/2325967119848982CrossRefPubMedPubMedCentral

Nwachukwu BU, Beck EC, Kunze KN, Chahla J, Rasio J, Nho SJ (2020) Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up. Am J Sports Med 48(4):901–907. https://doi.org/10.1177/0363546520902736CrossRefPubMed

10.

Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50(19):1169–1176CrossRef

11.

Callaghan JJ, Rosenberg AG, Rubash HE (2007) The adult hip. Lippincott Williams & Wilkins, Philadelphia

12.

Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT (2011) Iliopsoas impingement: a newly identified cause of labral pathology in the hip. HSS J 7(2):145–150. https://doi.org/10.1007/s11420-011-9198-zCrossRefPubMedPubMedCentral

13.

Gray AJ, Villar RN (1997) The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy 13(5):575–578. https://doi.org/10.1016/s0749-8063(97)90182-1CrossRefPubMed

14.

Larson CM (2010) Arthroscopic management of pincer-type impingement. Sports Med Arthrosc Rev 18(2):100–107. https://doi.org/10.1097/JSA.0b013e3181dc652eCrossRefPubMed

15.

Clohisy JC, Carlisle JC, Beaulé PE, Kim Y, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Jt Surg Am 90(Suppl. 4):47–66. https://doi.org/10.2106/JBJS.H.00756CrossRef

16.

Werner CM, Copeland CE, Ruckstuhl T, Stromberg J, Turen C, Kalberer F, Zingg P (2010) Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign. Acta Orthop Belg 76(2):166–173PubMed

17.

Bedi A, Kelly BT (2013) Femoroacetabular impingement. J Bone Jt Surg Am 95(1):82–92. https://doi.org/10.2106/JBJS.K.01219CrossRef

18.

Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Jt Surg 91(1):16–23. https://doi.org/10.1302/0301-620X.91B1.21329CrossRef

19.

Wiberg G (1953) Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Jt Surg Am 35(1):65–80CrossRef

20.

Barton C, Salineros MJ, Rakhra KS, Beaule PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469. https://doi.org/10.1007/s11999-010-1624-xCrossRefPubMed

21.

Martin RL, Philippon MJ (2007) Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy 3(8):822–826. https://doi.org/10.1016/j.arthro.2007.02.004CrossRef

22.

Seijas R, Sallent A, Ruiz-Iban MA, Ares O, Marin-Peña O, Cuellar R, Muriel A (2014) Validation of the Spanish version of the Hip Outcome Score: a multicenter study. Health Qual Life Outcomes 12:70. https://doi.org/10.1186/1477-7525-12-70CrossRefPubMedPubMedCentral

23.

Griffin DR, Parsons N, Mohtadi NG, Safran MR (2012) Multicenter Arthroscopy of the Hip Outcomes Research N. A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28(5):611–616. https://doi.org/10.1016/j.arthro.2012.02.027CrossRefPubMed

24.

Chandrasekaran S, Gui C, Darwish N, Lodhia P, Suarez-Ahedo C, Domb BG (2016) Outcomes of hip arthroscopic surgery in patients with Tönnis grade 1 osteoarthritis with a minimum 2-year follow-up: evaluation using a matched-pair analysis with a control group with Tönnis grade 0. Am J Sports Med 44(7):1781–1788. https://doi.org/10.1177/0363546516638087CrossRefPubMed

25.

Horisberger M, Brunner A, Herzog RF (2010) Arthroscopic treatment of femoral acetabular impingement in patients with preoperative generalized degenerative changes. Arthroscopy 26(5):623–629. https://doi.org/10.1016/j.arthro.2009.09.003 (Epub 2010 Feb 11)CrossRefPubMed

26.

Haviv B, O’Donnell J (2010) The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients. Sports Med Arthrosc Rehabil Ther Technol 29:2–18. https://doi.org/10.1186/1758-2555-2-18CrossRef

27.

Schüttler KF, Schramm R, El-Zayat BF, Schofer MD, Efe T, Heyse TJ (2018) The effect of surgeon’s learning curve: complications and outcome after hip arthroscopy. Arch Orthop Trauma Surg 138(10):1415–1421. https://doi.org/10.1007/s00402-018-2960-7CrossRefPubMed

28.

Olach M, Gerhard P, Giesinger K, Lampert C, Erhardt JB (2019) Clinical and radiological outcome at mean follow-up of 11 years after hip arthroscopy. Arch Orthop Trauma Surg 139(1):1–6. https://doi.org/10.1007/s00402-018-3024-8CrossRefPubMed

29.

Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, Wijdicks CA (2014) The hip fluid seal, part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc 22(4):722–729CrossRef

30.

Tijssen M, Van Cingel R, Van Melick N, De Visser E (2011) Patient-reported outcome questionnaires for hip arthroscopy: a systematic review of the psychometric evidence. BMC Musculoskelet Disord 12:117. https://doi.org/10.1186/1471-2474-12-117CrossRefPubMedPubMedCentral

Title: Arthroscopic surgery for femoroacetabular impingement has limited effect in patients with Tönnis grade-2 at 4-year follow-up
Authors: Jesus Mas Martinez
Carmen Verdu-Roman
David Bustamante Suarez de Puga
Manuel Morales Santias
Enrique Martinez Gimenez
Javier Sanz-Reig
Publication date: 12-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Wound Debridement
Hip Arthroscopy
Femuroacetabular Impingement
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-04249-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arthroscopic surgery for femoroacetabular impingement has limited effect in patients with Tönnis grade-2 at 4-year follow-up

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 10/2022

Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial

Anatomical and reverse megaprosthesis in proximal humerus reconstructions after oncologic resections: a systematic review and meta-analysis

Comparison between headless compression screws and tension band wires for the fixation of medial malleolar fractures: a prospective randomized trial

Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients

Long-term follow-up of conservative treatment of Charcot feet

The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series