High Survivorship and Comparable Patient-Reported Outcomes at a Minimum 5 Years After Hip Arthroscopic Surgery in Patients With Femoroacetabular Impingement, With and Without Lateral Rim Dysplasia
Bibliographic record
Abstract
Background:Femoroacetabular impingement (FAI) in patients with dysplasia presents a unique challenge to surgeons. Short-term outcomes are conflicting, while longer term follow-up data are only emerging.Purpose:To quantify midterm (minimum 5-year follow-up) outcomes after the arthroscopic correction of FAI in the presence of lateral rim dysplasia compared with a matched control group with FAI with normal acetabular coverage.Study Design:Cohort study; Level of evidence, 3.Methods:Prospective outcome data, collected in a consecutive series of patients undergoing arthroscopic FAI correction with lateral rim dysplasia (lateral center-edge angle [LCEA] of 13°-25°), were reviewed (N = 75 cases). An age- and sex-matched control group of 120 cases was also formed (LCEA >25°). Survivorship was defined as the avoidance of total hip replacement and assessed using a Kaplan-Meier curve with the log-rank test. Survival rates and patient-reported outcome measure (PROM) scores (modified Harris Hip Score [mHHS], University of California, Los Angeles [UCLA], 36-Item Short Form Health Survey [SF-36], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] preoperatively and at 5 years postoperatively) were compared between the groups. The proportion of patients across groups achieving the minimal clinically important difference (MCID) was compared for each PROM. The dysplasia group was also analyzed independently to identify any factors that may indicate a less favorable outcome using regression analysis. The group was divided into 2 subgroups: borderline dysplasia (LCEA of 20°-25°) and severe dysplasia (LCEA <20°).Results:The survival rate in the dysplasia group was 97%. There was no statistical difference with respect to survival rates or any PROM scores (<i>P</i> > .05 for all) between the groups. There were similar rates of achieving the MCID between the groups for the mHHS, UCLA, and WOMAC. The FAI control group had a higher rate of achieving the MCID for the SF-36 (<i>P</i> = .012; effect size = 0.274 [small]). Subgroup analysis indicated a lower survival rate (78% vs 100%, respectively; <i>P</i> < .001) in female cases in the dysplasia group (n = 9) compared with male cases in the dysplasia group (n = 66). The UCLA score in female cases in the dysplasia group at 5 years was statistically lower compared with that in male cases in the dysplasia group (6 vs 10, respectively; <i>P</i> = .003; effect size = 0.378 [medium]), but no other outcome revealed any differences between the sexes. There were also no variables identified on regression analysis that accurately predicted a poorer outcome in the dysplasia group. When stratified by severity, there was no difference in survivorship or outcomes between those with severe dysplasia (LCEA <20°; n = 11) and those with borderline dysplasia (LCEA of 20°-25°; n = 64).Conclusion:An arthroscopic intervention was a successful treatment option for FAI in the presence of lateral rim dysplasia at midterm follow-up. Irrespective of the severity of dysplasia, patients can expect similar improvements to those in patients with normal femoral head coverage.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".