Sivasundaram, Lakshmanan

Purpose To determine whether (1) patient‐reported outcome (PRO) scores after index hip arthroscopy correlate with PRO scores for the contralateral hip in patients undergoing staged bilateral hip arthroscopy and (2) patients who achieved minimal clinically important difference (MCID) or patient‐acceptable symptom state (PASS) for the index hip were more likely to achieve MCID or PASS for the contralateral hip. Methods Patients who underwent staged bilateral hip arthroscopy for femoroacetabular impingement syndrome were retrospectively reviewed. PRO scores were prospectively collected at preoperative and 1‐ and 2‐year timepoints. Odds ratios for achievement of MCID and PASS for the contralateral hip given achievement for the index hip were calculated. Improvements from before surgery to 2 years after surgery were correlated between both hips. Results A total of 143 patients (286 hips) were included in the final analysis. Average time between surgeries was 8.5 months (range, 0.7‐57.2). Both hips demonstrated significant improvement ( P < .05 for all) in all PROs at 2 years. Achievement of MCID in Hip Outcome Score Activities of Daily Living (HOS‐ADL) at the 1‐year timepoint for the index hip was predictive of achievement of MCID in HOS‐ADL at 2 years for the contralateral hip. Achievement of PASS in all PROs at the 1‐year timepoint for the index hip were predictive of achievement of PASS in the equivalent outcome score at the 2‐year mark for the contralateral hip. Achievement of MCID or PASS at the 2‐year timepoint for the index hip was predictive of achievement of the equivalent outcome at the 2‐year timepoint for the contralateral hip. The strongest correlation between improvement in PRO scores for the index and contralateral hips was noted in patients who underwent staged hip arthroscopy within less than 3 months. Conclusion Patients experience significant clinical benefit in both hips after staged bilateral hip arthroscopy. Results from the initial hip arthroscopy at either 1‐ or 2‐year follow‐up can be used to predict outcomes on the contralateral side; however, there is a higher degree of predictive value using 2‐year results. Average correlations between 2‐year PROs on the index and contralateral hips were moderate to strong, regardless of the time between surgeries. Level of Evidence Level III, retrospective cohort study.

Background: Increased attention has been directed toward the acetabular morphology in the management of patients with femoroacetabular impingement syndrome (FAIS). Whether acetabular version influences patient-reported outcomes remains poorly understood. Purpose: To use computed tomography (CT)–based 3-dimensional (3D) bone models to (1) quantify acetabular version in patients with FAIS, (2) compare acetabular version on 3D bone models with current plain radiographic parameters, and (3) explore the relationship between the magnitude of acetabular version and minimum 2-year clinical outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Three-dimensional models of the pelvis and femur were generated by semiautomated segmentation and aligned to a standard coordinate system. Acetabular version was quantified at the 3-o’clock position, and 3 groups were identified: acetabular retroversion (AR; <15°), normal acetabular version (NV; 15°-25°), and acetabular anteversion (AA; >25°). Patient demographic characteristics, plain radiographic parameters, and clinical outcomes were analyzed, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Results: Preoperative CT scans were acquired in 105 consecutive patients before hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum 2-year patient-reported outcomes. The mean ± SD age and body mass index of patients were 33.9 ± 12.6 years and 26.0 ± 5.4, respectively; 70.2% were female. The number of patients and the mean central acetabular version within each group were as follows: AR (n = 12; 11.3°± 2.7°), NV (n = 56; 20.7°± 2.9°), and AA (n = 16; 28.5°± 2.7°). Posterior wall sign was the only plain radiographic parameter that was significantly more observed in the AR group than in the other 2 groups. At minimum 2-year follow-up, significant between-group differences in the mHHS, iHOT-12, and VAS for pain and satisfaction ( P < .05) were appreciated, while post hoc analysis with Bonferroni correction ( P < .0167) found lower scores on the mHHS, iHOT-12, and VAS for pain and satisfaction in patients with AR as compared with NV. Lower scores on the VAS for satisfaction were reported in patients with AR when compared with AA ( P = .006) but not on the mHHS ( P = .023), iHOT-12 ( P = .032), or VAS for pain ( P = .072). Conclusion: Traditional plain radiographic indices to describe AR, including crossover sign and ischial spine sign, were not reliable in defining AR according to 3D models derived from CT scans. Only the posterior wall sign was observed in a higher proportion in the AR group. Patients with AR demonstrated inferior outcomes when compared with patients with NV and AA after hip arthroscopy for FAIS.