Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement

Abstract

Background:

In patients with symptomatic femoroacetabular impingement syndrome, bilateral hip pain has been reported to occur in high frequency. However, not all patients require bilateral hip arthroscopy.

Purpose:

To determine the incidence, patient-specific variables, and postoperative outcomes in patients who presented with bilateral hip pain at the time of index hip arthroscopy and underwent subsequent contralateral arthroscopic hip surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who presented with bilateral hip pain, underwent primary hip arthroscopy between January 2012 and June 2018 for indication of femoroacetabular impingement syndrome, and had minimum 2-year follow-up were retrospectively analyzed. Baseline descriptive data, preoperative hip range of motion, and radiographic measurements were recorded with pre- and postoperative patient-reported outcomes (PROs). Independent samples t test was used to compare continuous variables, and chi-square test was used to compare categorical variables between patients undergoing unilateral and bilateral surgery. Bivariate correlations and a multivariable binary logistic regression were performed to determine factors predictive of the need for future contralateral hip arthroscopy.

Results:

In total, 108 patients were identified who reported bilateral hip pain during the index evaluation, underwent primary hip arthroscopy, and had 2-year follow-up. Among these, 42% (n = 45) elected to undergo hip arthroscopy on the contralateral hip at a mean of 6.0 months (range, 1-17 months) after the index surgery. Patients requiring bilateral surgery were significantly younger (P = .004) and had a larger preoperative anterior center-edge angle (ACEA; P = .038) when compared with patients who had unilateral surgery. There were no significant differences in alpha angle measurements between patients who had unilateral and bilateral surgery. On bivariate analysis, younger age at the time of the index surgery (r = −0.272; P = .005) and preoperative ACEA (r = 0.249; P = .016) were significantly correlated with the need for bilateral surgery. On multivariate analysis, younger age remained a significant predictor for bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). Patients who underwent bilateral hip arthroscopy reported significant improvement in all PROs (P < .001), with a significantly greater mean Hip Outcome Score− Sports Specific Subscale score when compared with patients undergoing unilateral surgery (P = .037).

Conclusion:

Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. Younger age at the time of the index surgery and greater ACEA were predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significantly improvement in PROs at minimum 2-year follow-up.

Keywords

femoroacetabular impingement syndrome hip arthroscopy bilateral hip arthroscopy FAI

Femoroacetabular impingement syndrome (FAIS), characterized by bony deformity to the femoral head and acetabular rim, leads to abnormal hip joint kinematics and contact forces, increasing the risk for damage to the acetabular labrum and articular cartilage.^3,12,33 Given the pathologic contact between the femoral head and acetabular rim, the pathomorphology associated with FAIS has become increasingly recognized as a common source of hip pain and disability.^23,24,35 When left untreated, FAIS has been shown to predispose the affected hip to premature hip osteoarthritis.^3,32,33 As a result, hip arthroscopy has become the primary treatment for painful FAIS, allowing for the treatment of intra-articular injuries to the cartilage and labrum in addition to the correction of osseous abnormalities, preventing further impingement.^16,20,28

In patients with symptomatic FAIS, bilateral hip pain has been reported to occur with high frequency.^{14,15,17,18,23} In a retrospective review of 133 patients who underwent bilateral hip arthroscopy in 2 high-volume hip preservation centers over an 8-year study period, Hassebrock et al¹⁸ found that 90% (n = 122) of patients presented with bilateral hip pain. Previous investigations have noted that patients undergoing staged bilateral hip arthroscopy experience significant improvement in patient-reported outcomes (PROs).^18,22 However, the number of patients who present with bilateral hip pain attributed to FAIS and require bilateral hip arthroscopy is highly variable, ranging from 3% to 90%.^8,18,19,21 Klingenstein et al²¹ indicated that male sex, younger age, greater alpha angle, and reduced acetabular anteversion were risk factors for patients developing contralateral hip pain that requires hip arthroscopy after the index surgery. However, variables that predict the need for bilateral hip arthroscopy in patients who present with bilateral hip pain related to FAIS are largely unknown.

The purpose of this investigation was to retrospectively review our hip arthroscopy database to determine (1) the incidence of bilateral hip arthroscopy in patients who present with bilateral hip pain related to FAIS, (2) the demographic and radiographic variables predictive of patients with bilateral hip pain that requires bilateral surgery, and (3) the PROs in patients undergoing bilateral arthroscopy with minimum 2-year follow-up when compared with patients undergoing unilateral surgery. We hypothesized that (1) there would be a high incidence of bilateral hip arthroscopy; (2) male sex, younger age, and increased alpha angle would be predictive of patients requiring bilateral surgery, based on previous investigations^1,21; and (3) patients would experience significant improvement in all PROs.

Methods

Patient Selection

After institutional review board approval, clinical data from a prospectively maintained surgical repository were queried for consecutive patients who had bilateral hip pain at initial evaluation secondary to FAIS and underwent primary hip arthroscopy. Clinical diagnosis of FAIS was defined using positive radiographic findings (lateral center-edge angle >30°, alpha angle >50°) and positive physical examination results (eg, pain on flexion, adduction, and internal rotation).^2,5,16 Patients were categorized according to the performance of unilateral hip arthroscopy versus subsequent arthroscopy on the contralateral hip after the index surgery. All surgery was performed by a single fellowship-trained surgeon between January 2012 and June 2018 (S.J.N.). Inclusion criteria consisted of clinical and radiographic diagnosis of symptomatic bilateral FAIS that failed nonoperative management and required unilateral or staged bilateral hip arthroscopy to address FAIS with minimum 2-year follow-up. Exclusion criteria consisted of revision surgery on either hip, hip arthroscopy for an indication other than hip pain and pathology related to FAIS, degenerative changes to the hip (Tönnis grade ≥2), hip dysplasia (lateral center-edge angle <20°), and a history of congenital hip disorders (eg, slipped capital femoral epiphysis, developmental hip dysplasia).

Radiographic Analysis

Preoperative and final follow-up radiographs consisting of standing anteroposterior (AP) pelvis, AP hip, false-profile, and Dunn lateral views were obtained and reviewed in all patients.³⁶ We measured the alpha angle and assessed the Tönnis grade on the AP pelvis, false-profile, and 45° Dunn lateral hip views.⁶ Acetabular inclination (Tönnis angle) and lateral center-edge angle of Wiberg were measured on the AP hip radiograph.⁶ The anterior center-edge angle (ACEA) was measured on the false-profile view.^7,27,37 All measurements were made on the initially operated hip and were performed by a single author (S.J.N.).

Surgical Technique and Postoperative Rehabilitation

All hip arthroscopies were performed using well-described techniques by the senior author (S.J.N.).^11,34 Standard anterolateral and midanterior portals were established under traction using fluoroscopic guidance. An interportal capsulotomy was then created, and pathology was addressed in the central compartment using acetabuloplasty and labral repair as needed. Traction was then released, a T-capsulotomy was performed to access the peripheral compartment, and femoral osteochondroplasty was conducted to address cam morphology and restore femoral head-neck offset. Dynamic examination of the operative leg was then performed to confirm an appropriate resolution of impingement on completion. Last, the capsule was repaired using a suture shuttling system, with capsular plication performed depending on the degree of capsular laxity.

After surgery, all patients underwent previously described standard 4-phase rehabilitation protocol.²⁵ Patients were restricted to 20-lb (9-kg) flat-foot weightbearing using crutches for the first 3 weeks postoperatively. During this time, patients wore a hip orthosis that prevented active abduction, extension beyond neutral, external rotation, and hip flexion beyond 90°. Physical therapy began on postoperative day 1, focused on motion initiation, and occurred twice per week for 3 months. The first phase consisted of soft tissue mobilization, range of motion, and stretching, with the goal of symmetric range of motion between extremities by 6 to 8 weeks postoperatively. After 3 to 4 weeks postoperatively, patients could gradually stop using crutches and progress to full weightbearing as tolerated. More functional exercises in all planes were introduced and advanced with the goal of return to sports or activity in 4 to 6 months.

Functional Outcome Evaluation

In patients meeting inclusion criteria, records were retrospectively reviewed, and the following were recorded: sex, age at the time of the index surgery, body mass index, sports participation, duration of bilateral hip pain before the index surgery, workers’ compensation status, smoking status, previous spine surgery, back pain, anxiety or depression, previous narcotic use, and hip range of motion. Patients completed preoperative and minimum 2-year postoperative hip-specific PRO instruments, including the Hip Outcome Score (HOS)−Activities of Daily Living,²⁶ HOS−Sports Specific Subscale (HOS-SSS), the modified Harris Hip Score (mHHS),⁴ and International Hip Outcome Tool−12 (iHOT-12).³⁰ Pain was assessed using a visual analog scale (VAS) for satisfaction level and pain.

Bilateral Hip Arthroscopy

Contralateral hip arthroscopy was discussed with patients with persistent and/or worsening pain in the postoperative period. Patients whose nonoperative management failed elected to undergo surgery on the contralateral hip through a shared decision-making process. Patients were evaluated and indicated for surgery through the same protocol of the index hip.

Statistical Analysis

Frequency statistics were reported for all noncontinuous variables, while descriptive statistics (mean and standard deviation) were utilized for continuous variables. All variables were assessed for normality using a Shapiro-Wilk test. Paired samples t tests were used to compare preoperative and 2-year postoperative PRO scores. Fisher exact test or χ² test was used to compare categorical variables between patients who underwent unilateral and staged bilateral surgery. Continuous variables were assessed between the groups using an independent samples t test. Bivariate correlations were performed to assess for patient-specific variables predicting the need for bilateral hip arthroscopy. Variables with significant correlations were added into a multivariate regression, where a binary logistic regression was performed to determine variables predictive of patients undergoing contralateral hip arthroscopy. Statistical significance was set at an α≤ .05. All statistical analysis was performed using the SPSS (Version 26; IBM Corp).

Results

A total of 2109 patients underwent primary hip arthroscopy for the treatment of FAIS during the study period. Of those, 132 (6.3%) undergoing primary hip arthroscopy during the study period met the inclusion criteria and reported bilateral hip pain at the time of the index surgery (Figure 1). Minimum 2-year follow-up data were available in 82% (n = 108 of 132) of patients, of whom 65% (n = 70) were female. The mean age at the time of the index surgery was 29.0 ± 11.9 years, and the mean body mass index was 25.4 ± 5.6. Forty-two percent (n = 45 of 108) of patients underwent subsequent contralateral hip arthroscopy at a mean 6.0 months ± 5.6 (range, 1-17 months) after the index procedure. Patients who underwent bilateral surgery experienced worsening contralateral hip pain at a mean of 4.3 ± 3.8 months after the index procedure. When compared with patients who had unilateral surgery, those requiring bilateral hip arthroscopy were significantly younger at the time of the index surgery (P = .004) (Table 1). No significant differences were appreciated between the groups based on remaining descriptive data, preoperative hip range of motion, or preoperative PROs. Although the difference was not significant, patients electing to undergo surgery on the contralateral hip had greater VAS pain at the time of the index procedure than did those who did not (68.1 ± 17.5 vs 59.3 ± 20.8; P = .056).

Table 1

Descriptive Data and Comparison of Patients Undergoing Unilateral vs Bilateral Hip Arthroscopy With Minimum 2-Year Follow-up^a

	Unilateral (n = 63)	Bilateral (n = 45)	P Value
Age, y	31.7 ± 12.1	25.2 ± 10.5	.004
Body mass index	26.0 ± 5.8	24.6 ± 5.2	.244
Female sex	41 (65.1)	29 (64.4)	.961
Workers’ compensation	00 (0.0)	1 (2.2)	.413
Sports participation	43 (68.3)	32 (74.4)	.595
Smoking	5 (7.9)	2 (4.4)	.696
Previous spine surgery	8 (12.7)	1 (2.2)	.077
Active back pain	12 (19.0)	6 (13.3)	.448
Anxiety or depression	10 (15.9)	8 (17.8)	.601
Previous narcotic use	11 (17.5)	4 (8.9)	.212
Chronic pain preoperatively	32 (50.8)	16 (35.6)	.170
Preoperative hip ROM, deg
Flexion	108.9 ± 1.0	111.5 ± 17.1	.368
External rotation	39.3 ± 10.2	42.8 ± 13.6	.160
Internal rotation	14.4 ± 9.4	13.2 ± 10.2	.555
Preoperative PRO
HOS-ADL	66.4 ± 17.4	66.1 ± 20.6	.945
HOS-SSS	41.3 ± 19.7	43.9 ± 24.6	.598
mHHS	58.1 ± 12.4	58.6 ± 12.7	.868
iHOT-12	34.6 ± 20.3	37.6 ± 22.2	.619
VAS pain	59.3 ± 20.8	68.1 ± 17.5	.056

Values are presented as mean ± SD or No. (%). Bold indicates P≤ .05. HOS-ADL, Hip Outcome Score−Activities of Daily Living; HOS-SSS, Hip Outcome Score−Sports Specific Subscale; iHOT-12, International Hip Outcome Tool−12; mHHS, modified Harris Hip Score; PRO, patient-reported outcome; ROM, range of motion; VAS, visual analog scale.

Radiographically, patients who underwent bilateral surgery possessed a significantly greater ACEA (P = .038) (Table 2). On bivariate analysis, younger age (r = −0.272; P = .005) and preoperative ACEA (r = 0.249; P = .016) were significantly correlated with patients undergoing bilateral surgery. In multivariate analysis, age remained a significant predictor for patients who had bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). For every year of younger age, patients were 5% more likely to undergo bilateral hip arthroscopy.

Table 2

Radiographic Parameters of the Index Hip of Patients Undergoing Unilateral vs Bilateral Hip Arthroscopy^a

	Unilateral	Bilateral	P Value
Alpha angle, deg
Anterior-posterior	70.3 ± 19.0	65.6 ± 17.8	.231
Dunn	61.4 ± 13.5	60.1 ± 13.9	.648
False profile	61.2 ± 13.5	61.4 ± 15.5	.956
Center-edge angle, deg
Lateral	29.2 ± 6.0	30.6 ± 6.8	.326
Anterior	31.1 ± 6.8	36.1 ± 7.6	.038
Tönnis
Angle, deg	7.3 ± 4.2	6.4 ± 4.5	.354
Grade 0, %	87.3	91.1	.541

Values are presented as mean ± SD unless noted otherwise. Bold indicates P≤ .05.

The procedure performed during index hip arthroscopy was not predictive of patients undergoing unilateral versus bilateral hip arthroscopy (Table 3).

Table 3

Intraoperative Procedures Performed During Index Surgery in Patients Undergoing Unilateral vs Bilateral Hip Arthroscopy^a

	Unilateral	Bilateral	P Value
Labral repair	58 (92.1)	42 (93.3)	.983
Acetabular rim trimming	52 (82.5)	42 (93.3)	.066
Femoral osteochondroplasty	63 (100.0)	45 (100.0)	≥.999
Synovectomy	63 (100.0)	45 (100.0)	≥.999
Capsular plication	63 (100.0)	45 (100.0)	≥.999
Trochanteric bursectomy	3 (4.8)	1 (2.2)	.237
Microfracture	00 (0.0)	00 (0.0)	≥.999

Values are presented as No. (%).

In patients who underwent bilateral hip arthroscopy, significant improvements in all PROs at minimum 2-year follow-up were reported when compared with preoperative values (Table 4). Patients who underwent bilateral hip arthroscopy had significantly greater HOS-SSS scores (P = .037) than did patients who underwent unilateral surgery (Table 5).

Table 4

Pre- and Postoperative Patient-Reported Outcomes of Patients Undergoing Bilateral Surgery (n = 45)^a

	Preoperative	Postoperative
HOS-ADL	66.1 ± 20.6	84.7 ± 15.5
HOS-SSS	44.7 ± 24.7	74.5 ± 24.1
mHHS	58.6 ± 12.9	78.0 ± 18.8
iHOT-12	37.6 ± 22.2	66.5 ± 31.8
VAS pain	68.2 ± 17.7	27.4 ± 29.2

Values are presented as mean ± SD. Each row: P < .001. HOS-ADL, Hip Outcome Score−Activities of Daily Living; HOS-SSS, Hip Outcome Score−Sports Specific Subscale; iHOT-12, International Hip Outcome Tool−12; mHHS, modified Harris Hip Score; VAS, visual analog scale.

Table 5

Two-Year Postoperative Patient-Reported Outcomes of Patients Undergoing Unilateral and Bilateral Surgery^a

	Unilateral	Bilateral	P Value
HOS-ADL	82.9 ± 15.7	83.3 ± 17.7	.915
HOS-SSS	65.4 ± 25.6	76.1 ± 22.5	.037
mHHS	79.7 ± 15.4	77.2 ± 19.4	.492
iHOT-12	66.2 ± 24.7	62.8 ± 31.1	.616
VAS pain	24.4 ± 24.9	27.4 ± 30.0	.602

Values are presented as mean ± SD. Bold indicates P≤ .05. HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SSS, Hip Outcome Score–Sports Specific Subscale; iHOT-12, International Hip Outcome Tool−12; mHHS, modified Harris Hip Score; VAS, visual analog scale.

Table 6 displays the percentage of patients presenting with bilateral hip pain who went on to have bilateral hip arthroscopy in other studies published on the matter.^18,19,22 The percentage of patients who underwent bilateral hip arthroscopy who had bilateral hip pain ranged from 55% to 90%.

Table 6

Studies Examining Bilateral Hip Arthroscopy That Reported the Percentage of Patients Who Had Bilateral Hip Pain

First Author	Patients, %
Kuhns²²	65
Hassebrock¹⁸	90
Haviv¹⁹	55

Discussion

The main findings from this investigation were that in 108 patients presenting with bilateral hip pain who underwent hip arthroscopy, 42% (n = 45) elected to undergo contralateral hip arthroscopy at a mean of 6.0 months (range, 1-17 months) after the index surgery. When compared with patients requiring only unilateral surgery, patients who had bilateral surgery were significantly younger at the time of the index surgery and possessed greater ACEA values. Patients who underwent bilateral hip arthroscopy reported significant improvement in PROs at minimum 2-year follow-up, with significant improvement in HOS-SSS when compared with patients who underwent unilateral surgery.

Patients presenting with bilateral hip pain related to FAIS are at high risk of requiring bilateral hip arthroscopy. As noted, of the 108 patients presenting with bilateral hip pain attributed to FAIS in our investigation, 42% (n = 45) elected to undergo bilateral hip arthroscopy, performed at a mean of 6.0 ± 5.6 months after the initial surgery. Other investigations have similarly noted high rates of bilateral hip arthroscopy in patients presenting with bilateral hip pain related to FAIS. In a retrospective review of patients who underwent bilateral hip arthroscopy (4.6%; n = 133 of 2838), Hassebrock et al¹⁸ reported that 90% (n = 120) initially had symptoms of bilateral hip pain. Meanwhile, in a cohort study, Kuhns et al²² stated that 65% (n = 28 of 43) of patients presenting with bilateral hip pain required bilateral hip surgery. As such, patients presenting with bilateral hip pain secondary to FAIS should be counseled regarding the increased risk of requiring bilateral hip arthroscopy, and when bilateral hip arthroscopy is proposed, the timing of the second procedure should be considered. In our cohort, the contralateral surgery was performed at a mean of 6 months after the first surgery. In a recent systematic review, the timing of the second procedure ranged from 3 weeks to 58 months (mean, 7.7 months), with favorable results seen regardless of the timing of the second procedure.¹⁰ However, Kuhns et al demonstrated that patients who underwent the second operation before 10 months after the index hip had greater HOS–Activities of Daily Living and HOS-SSS scores as well as lower VAS pain scores when compared with patients who underwent the contralateral surgery after the 10-month period.

Moreover, a high degree of suspicion for the development of contralateral hip pain must be exercised in patients presenting with unilateral hip pain related to FAIS, owing to the high rate of radiographic evidence of bilateral FAIS despite the absence of bilateral symptoms. Allen et al¹ found that in 113 patients aged 16 to 55 years, bilateral cam deformity was present in 78% (n = 88); however, only 26% (n = 23 of 88) of patients reported bilateral hip pain. Similarly, Haviv and O’Donnell¹⁹ stated that in 82 patients who underwent bilateral surgery for FAIS, 45% (n = 37) initially had unilateral symptoms, with patients developing contralateral symptoms at a mean of 9.9 months (range, 3.1-30 months) after the index surgery. In a study by Kuhns et al,²² 35% of patients undergoing bilateral hip arthroscopy had unilateral pain, with the authors noting contralateral symptoms beginning at a mean of 4.9 ± 3.2 months. In patients with evidence of bilateral FAIS on radiography presenting with unilateral symptoms, multiple investigations have reported that 5% to 20% of patients develop contralateral symptoms requiring staged bilateral hip arthroscopy.^18,21,22 Although all of the patients in the current study had bilateral hip pain, it is imperative that patients presenting with unilateral hip pain secondary to FAIS be screened for bilateral FAIS and closely monitored for the development of contralateral hip pain necessitating further surgery given the results of the aforementioned studies. In addition, future studies are warranted to establish clinical and radiographic predictors for patients presenting with unilateral hip pain with radiographic evidence of bilateral FAIS that will require hip arthroscopy to the contralateral hip.

Younger patient age at the time of the index surgery and greater ACEA were predictive of patients who had bilateral hip pain requiring bilateral hip arthroscopy. This combination of findings, as well as the presence of cam deformities in our cohort of patients, may reflect the development of FAIS morphology in response to increased athletic activity performed during childhood.^13,29,31 Klingenstein et al²¹ examined demographic and radiographic findings predictive for identifying patients requiring bilateral surgery for FAIS. Their cohort comprised 646 patients undergoing hip arthroscopy, which included 20.4% (n = 132) treated using bilateral hip arthroscopy. Using multivariable logistic regression, the authors found that male sex, younger age at index surgery (27.6 ± 9.7 vs 30.3 ± 10.7 years; P = .010), greater alpha angle (63.8° vs 59.8°; P = .004), and less acetabular anteversion at the 3-o’clock position (13.0° vs 15.9°; P < .001) were risk factors for patients ultimately developing contralateral hip pain requiring bilateral surgery. Furthermore, for every 5 years of younger age, 5° of alpha angle, and 5° decrease in 3-o’clock acetabular version, patients were 13.5%, 14.5%, and 25.5% more likely to undergo bilateral treatment for FAIS, respectively. While ACEA was not a predictor for bilateral surgery in the Klingenstein et al study, anterior overcoverage has been reported to be significantly greater in younger patients, reflective of their high rate of FAIS-related morphology.²³ This may represent more severe impingement and therefore worse symptoms, as patients electing to undergo surgery on the contralateral hip had greater, although not significant, VAS pain at the time of the index procedure. In patients presenting with bilateral symptomatic FAIS, younger age and radiographic findings of increased anterior coverage of the femoral head warrant discussion regarding the likelihood of patients requiring bilateral hip arthroscopy. For every year younger, patients were 5% more likely to undergo hip arthroscopy of the contralateral hip after the index procedure. This knowledge can help facilitate patient discussion and manage expectations.

In patients presenting with bilateral hip pain, those who underwent bilateral hip arthroscopy reported significant improvement in all PROs, with comparable improvement in PROs at 2-year follow-up as compared with patients who had unilateral surgery. Our findings are similar to those of Essilfie et al⁹ when comparing equal groups of 84 patients undergoing unilateral versus staged bilateral hip arthroscopy at 2-year follow-up. In that study, both groups experienced significant improvements in mHHS and the Non-arthritic Hip Score, with the patient acceptable symptomatic state achieved in 68% of hips in the bilateral group and 74% in the unilateral group (P = .4). These findings are contrary to those in the age- and sex-matched cohort study of Kuhns et al,²² who compared 43 patients who underwent bilateral hip arthroscopy with 86 patients who had unilateral surgery, with the former having lower mHHS and pain scores. The authors attributed these inferior outcomes to the presence of increased chondral delamination and wear appreciated during the primary surgical procedure in patients who had bilateral surgery. In addition, patients who underwent 2 separate procedures required several years to complete 2 full rehabilitation periods, likely affecting patient satisfaction levels when compared with their unilateral counterparts. As such, when compared with the results of patients requiring unilateral surgery, outcomes in patients undergoing bilateral hip arthroscopy were equivocal and warrant further investigation with long-term follow-up.

Limitations

This study is not without limitations. Based on the 2-year follow-up period, patient outcomes were limited to short-term data, warranting longer follow-up to better appreciate the mid- and long-term outcome differences between the groups. Furthermore, acetabular version and femoral torsion were not assessed in these patients, which limits our comparison with the study of Klingenstein et al.²¹ In addition, we analyzed morphologic parameters of the index hip but not the contralateral hip, which may have revealed other predictive factors. While participation in sports was evaluated, activity level was not recorded and may be relevant to the results. All procedures were performed using the same general procedure by a single high-volume hip arthroscopic surgeon, limiting the generalizability of these results to procedures performed by other surgeons at different institutions.

Conclusion

Subsequent contralateral hip arthroscopy was performed in 42% of patients presenting with bilateral hip pain, with younger patient age at the time of the index surgery and greater ACEA predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significant improvement in PROs at minimum 2-year follow-up.

Footnotes

Submitted August 26, 2020; accepted February 7, 2021.

One or more of the authors has declared the following potential conflict of interest or source of funding: S.J.N. has received research support from Allosource, Arthrex, Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, and Stryker; consulting fees from Stryker; and royalties from Ossur and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain

Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Methods

Patient Selection

Radiographic Analysis

Surgical Technique and Postoperative Rehabilitation

Functional Outcome Evaluation

Bilateral Hip Arthroscopy

Statistical Analysis

Results

Discussion

Limitations

Conclusion

Footnotes

References