Radiographic predictors of femoroacetabular impingement treatment outcomes.
Review
Overview
abstract
PURPOSE: To review the literature on femoroacetabular impingement (FAI) treatment outcomes, specifically focusing on potential pre-operative radiographic parameters that may provide prognostic information regarding outcomes following surgical management. METHODS: A comprehensive review of computerized literature databases (Medline Ovid and PubMed) was performed, searching for articles reporting on FAI treatment outcomes. A single reviewer screened titles, abstracts and performed full-text reviews of eligible studies. The references of these studies were further screened for additional potentially relevant studies. A total of 243 studies were reviewed, with 18 meeting inclusion criteria. RESULTS: Thirteen arthroscopic studies reported on 1556 patients, with clinical improvement in 35-92 % of patients and associated failure rates of 12-71 %. Five open surgical studies reported on 238 patients with clinical improvement in 65-95 % of patients and associated failure rates of 0-35 %. Both arthroscopic and open studies identified inferior outcomes with pre-operative radiographic findings of an elevated Tönnis grade (grade 2 or higher), joint space <2 mm, lateral centre-edge angle (LCEA) <20° and incomplete femoral osteoplasty. CONCLUSION: Pre-operative radiographic findings of osteoarthritis (Tönnis grade 2/3, <2 mm joint space) or dysplasia (LCEA < 20°) should be considered relative contraindications to joint preservation surgery as outcomes are worse among these patients and associated with a higher risk of conversion to total hip arthroplasty. Care should also be taken to perform a thorough femoral osteoplasty to reduce the risk of failure and need for revision surgery. LEVEL OF EVIDENCE: III.
