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Previous Surgery For Femoroacetabular Impingement Does Not Compromise Total Hip Arthroplasty OutcomesLuke Spencer-Gardner MD, Christopher Camp MD, J. Ryan Martin MD, Bruce Levy MD, Rafael Sierra MD, Robert Trousdale MD, Aaron Krych MD.International Society for Hip Arthroscopy, Annual Meeting.Rio de Janeiro, Brazil. October 9-11, 2014.

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Disclosures• L. Spencer-Gardner MD,

C. Camp MD, J. R. Martin MD• There are no financial relationships

to disclose

• B. Levy• Royalty – VOT solutions, Arthrex• Consultant – Arthrex• Research – Arthrex, Biomet, Stryker

• R. Sierra• Royaly - Biomet• Consultant – Biomet• Research – Depuy, Zimmer, Stryker,

Biomet

• R. Trousdale• Royalty – Depuy, Wright Medical,

MAKO• Consultant – Depuy, Wright Medical,

MAKO

• A. Krych• Consultant – Arthrex, Depuy-Mitek• Research – Histogenics; Ceterix

Orthopedics, Inc.; Arthritis Foundation

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Background

• Hip arthroscopy (HA) and surgical hip dislocation (SHD) are accepted treatment options for FAI with comparable clinical and radiographic outcomes. [1-3]

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Background

• However, in one systematic review of the literature on the surgical treatment of FAI, conversion to THA was reported in 0%-26% of cases. [6]

• There is a paucity of data on the results of THA in patients that have undergone prior surgery for FAI.

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Background

• The purpose of this study is to assess patient reported outcomes of THA after open or arthroscopic treatment of FAI.

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Methods

• Case matched retrospective review comparing THA outcomes between three clinical scenarios.

• Group 1: Prior HA for FAI• Group 2: Prior SHD for FAI• Group 3: Matched controls with no prior hip surgery.

• Matched for age, sex, approach and implant

• The primary outcome measure was the Harris Hip Score (HSS).

• Operative time, blood loss and the presence of heterotopic ossification after THA were also compared between groups.

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Results: Demographics• Between 2004 and 2014:

• 14/482 (2.9%) required THA after HA.• 10/216 (4.6%) required THA after SHD.

• Mean age at HA was 44 years (27-68).

• Mean age at SHD was 34 years (19-48).

• The mean age at THA across all groups was 44 years (20-68).

• Mean time to THA:• 12 months (3-25) after HA.• 48 months (8-87) after SHD.

• The mean follow up after THA across all groups was 30 months (12-70).

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Results

T-TestMean Standard Deviation P Value (compared to

control group)HHS

Group 1 (HA) 93.3 9.1 0.457Group 2 (SHD) 91.4 13.6 0.431Group 3 (CTL) 95.2 6.5

Operative TimeGroup 1 75.6 16.8 0.105

Group 2 109.3 29.8 0.039*

Group 3 88.0 24.2Blood Loss

Group 1 296.4 143.4 0.871

Group 2 535.0 410.3 0.113

Group 3 304.2 136.1

Fisher’s Exact testRelative Risk 95% CI P Value

Heterotopic OssificationGroup 1 v 3 1.1 0.39-3.37 0.810Group 2 v 3 3.2 1.48-6.84 0.003*

Group 2 v 1 2.3 1.16-6.78 0.023*

Results of Total Hip Arthroplasty after Surgery for Femoroacetabular Impingement

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Results: Heterotopic Ossification

• HO Group 2• 7/10 after SHD • 8/10 after THA• There were 2 cases of

progression of preexisting HO after THA.

• 1/10 patients required HO excision at the time of THA.

• HO Group 1• 3/14 after HA• 4/14 after THA• There were no cases of

progression of preexisting HO after THA.

Brooker Classification0 1 2 3 4

Group 1HO after

HA11/14 3/14

HO after THA

10/14 3/14 1/14

Group 2HO after

SHD3/10 5/10 1/10 1/10

HO after THA

2/10 4/10 3/10 1/10

Incidence and Grade of HO

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Results: Reoperation

• Group 1• 1/14 patients underwent revision HA prior to THA.• 1/14 patients had a dislocation after THA that did not

require reoperation.

• Group 2 • 3/10 patients underwent reoperation for screw

removal prior to THA.• 7/10 patients underwent screw removal at the time

of primary THA.• 1/10 patients required revision THA 73 months after

primary THA.

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Discussion• Depending on patient age and degree of arthritis, a

subset of patients may require THA after surgery for FAI.

Author Approach Hips/Patients Mean Age Mean Follow up (years)

Conversion to THA

Beck[8] SHD 19/19 36 4-7 5/19 (26.3%)Murphy[9] SHD 23/23 35.4 5.2 7/23 (30.4%)Peters[10] SHD 30/29 31 2.7 4/30 (13.3%)*Beaule[11] SHD 37/34 40.5 3.1 0/37 (0%)Naal[12] SHD 30/22 19.7 3.7 0/30 (0%)Boone[13] SHD 22/21 44 3.2 6/22 (27.3%)Steppacher[14] SHD 97/75 32 6 7/97 (7.2%)Ilizaliturri[15] HA 19/19 34 2.4 1/19 (5.3%)Philippon[16] HA 112/112 40.6 2.3 10/112 (8.9%)Javed[17] HA 40/40 65 2.5 7/40 (17.5%)Philippon[5] HA 153/153 57 3 31/153 (20.3%)Byrd[18] HA 100/100 34 2 (minimum) 0/100 (0%)Palmer[19] HA 201/185 40 3.8 12/201 (6.0%)

Reported rates of conversion to THA after surgery for FAI

* Had or were expected to undergo THA

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Conclusions• In this retrospective matched cohort, patient

reported outcomes after THA are not affected by prior open or arthroscopic procedures for FAI.

• Increased THA operative times and an increased risk of heterotopic ossification were noted after SHD.

• This study provides data for surgeons when counseling their patients on the treatment options for FAI, and the effect that these options may have on subsequent THA.

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