Key result
Patients with borderline hip dysplasia and radiographic evidence of hip instability (FEAR index ≥2°) achieved similar 2-year patient-reported outcomes compared to those with stable hips (P>0.05).
Why the study?
Does radiographic evidence of hip instability (FEAR index ≥2˚) worsen 2-year patient-reported outcomes in patients with borderline hip dysplasia undergoing hip arthroscopy for FAIS?
Cohort (n=140)
Does radiographic evidence of hip instability (FEAR index ≥2˚) worsen 2-year patient-reported outcomes in patients with borderline hip dysplasia undergoing hip arthroscopy for FAIS?
p-value: p=>0.05
Patients with borderline hip dysplasia and radiographic evidence of hip instability achieve similar 2-year outcomes after arthroscopic treatment of FAIS compared to those with radiographically stable hips.
Similar 2-year PROs after FAIS arthroscopy in FEAR-defined unstable vs stable borderline dysplastic hips; leaves open role of FEAR index for patient selection.
Purpose The purpose of this study was to compare outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index and in patients without radiographic evidence of hip instability. Methods Data from consecutive patients with borderline hip dysplasia (lateral center edge angle between 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of FAIS were analyzed. Baseline demographic data, radiographic parameters, preoperative, and 2-year postoperative patient-reported outcome measures were collected. The FEAR index was measured by 3 different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinically important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and <2°. Results A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7 ± 13.2 ( P < .325) years and 25.1 ± 5.6 kg/m 2 ( P < .862). There were no statistically significant demographic differences between the groups. Nineteen (13.0%) patients were found to have a FEAR index of over 2˚. The FEAR index <2° and FEAR index ≥2° groups had a mean preoperative FEAR index (standard deviation, range) of −7.0 (5.2, −26.8 to 1.9) and 4.8 (2.5, 2.0-11.8), respectively. The interrater intraclass correlation coefficient was 0.96. Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement were not statistically different between the radiographically stable and unstable groups. (p>0.05 for all). Conclusion Patients with borderline hip dysplasia and radiographic evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips after arthroscopic treatment of FAIS. Clinical Relevance Retrospective Level III cohort study
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Wong et al. (2021) conducted a cohort in Femoroacetabular impingement syndrome (FAIS) with borderline hip dysplasia (n=140). Radiographic evidence of hip instability (FEAR index ≥2°) vs. No radiographic evidence of hip instability (FEAR index <2°) was evaluated on Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement (p=>0.05). Patients with borderline hip dysplasia and radiographic evidence of hip instability (FEAR index ≥2°) achieved similar 2-year patient-reported outcomes compared to those with stable hips (P>0.05).
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