ABSTRACT
The original version of this article, published on 14 May 2020, unfortunately contained a mistake.
ABSTRACT
OBJECTIVES: Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS: A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS: Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION: Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS: ⢠FAI imaging literature is extensive although often of low level of evidence. ⢠Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. ⢠MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
Subject(s)
Consensus , Femoracetabular Impingement/diagnosis , Magnetic Resonance Imaging/methods , HumansABSTRACT
PURPOSE: The purpose of this study was to determine if there were significant differences between patients submitted to hip arthroscopy (HA) and surgical hip dislocation (SHD) to treat femoro-acetabular impingement (FAI), which variables were significantly associated with hip function before surgery and those predictive of the applied functional outcome scale and its variation rate after surgery. METHODS: We selected 198 patients treated with HA or SHD with a mean follow-up of 59 months. Inclusion criteria were ages 18-50 years, isolated FAI cam morphology and complete clinical and radiologic documentation. The subjective outcome measure used was the nonarthritic hip score (NAHS). We compared pre-operative and post-operative NAHS, alpha angles and complication rates. Multiple linear regression analyses were performed to find which variables could influence NAHS values. RESULTS: The mean alpha-angle value improved from 71.5° to 40.8°, and mean NAHS improved from 50 to 83 points, with no difference between groups (HA/SHD). We found only a 16.9% influence rate on the pre-operative score, explained by variables of gender/pre-operative alpha angle and presence of degenerative changes/age. The influence rate on the NAHS variation ratio after surgery was 62.8%, explained by the variables of pre-operative score, type of surgery and type of surgery/alpha angle. The complication rate was 7%. CONCLUSIONS: FAI surgery can be considered effective in improving patient symptoms. There were no differences in clinical or radiographic results between techniques. We could more accurately predict the variation ratio of NAHS after surgery than its pre-operative value.