Early Surgical Intervention for Femoroacetabular Impingement Syndrome Provides Clinically Significant Outcome Improvement

摘要

Objectives: The purpose of the current study is to assess the outcomes of hip arthroscopy for FAIS according-timing of surgical intervention. Methods: Patients undergoing arthroscopic intervention for FAIS with minimum two year follow-up were included. All patients completed the hip outcome score (HOS)-activities of daily living (ADL), HOS-sports subscale (HOS-SS), modified Harris hip score (mHHS), international hip outcome tool-12 (IHOT-12), and visual analog scales (VAS) for pain and satisfaction. Patients were stratified by time with FAIS symptoms until surgical intervention. We compared 3-6 months of symptoms with other subsequent time frames (6-12 months, 12-24 months, and &24 months). Clinically significant outcome was determined using the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS). Results: A total of 1,094 patients with mean (+ standard deviation) age 32.3+12.4 years and follow-up 30.8+6.7 (range:24-58) months were included. Patients undergoing surgery at 3-6 months of symptoms had no significant differences in outcome compared-those in the 6-12 month group except for the IHOT-12 (p:0.028). Patients with symptom duration of 12-24 months and greater than 24 months had worse outcome across all outcome measures (p&0.0001 for symptoms &24 months). Patients in the 3-6 month symptom group had increased likelihood for achieving MCID on HOS ADL (OR:1.81; 1.20-2.73), and HOS-SS (OR:1.90; 1.11-3.17), as well as PASS on the HOS-ADL (OR:1.85; 1.34-2.56) and HOS-SS (OR:1.58; 1.14-2.18). In multivariate regression analysis, symptom duration was the most predictive of VAS pain (Beta:3.10, 95% Confidence Interval [95%CI]:1.56-4.63; p&0.001) and satisfaction scores (Beta:-4.16, 95%CI:-6.14- -2.18; p&0.001). Conclusion: In patients with FAIS, surgical intervention early after the onset of symptoms (3-6 months) is associated with superior outcomes when compared to patients who underwent surgical intervention beyond this time frame. This information may help guide preoperative decision making on behalf of surgeons and patients who are considering delaying intervention. Table 1. MCID and PASS rates stratified by hip arthroscopy timing 3-6 months 6-12 months 12-24 months &24 months p-value (MCID) p-value (PASS) MCID PASS MCID PASS MCID PASS MCID PASS HOS-ADL 81.3% 72.8% 77.8% 67.8% 75.4% 65.0% 64.6% 55.1% &0.001 &0.001 HOS-SS 89.8% 69.2% 85.7% 62.4% 81.0% 62.6% 77.4% 53.1% &0.001 &0.001 mHHS 85.9% 77.6% 83.4% 74.6% 83.1% 71.7% 72.2% 65.2% &0.001 &0.001 Δ score indicates 2-year change in patient reported outcome score. MCID: Minimal clinically important difference PASS: Patient acceptable symptomatic state