Clinical and objective gait outcomes remained stable seven years after total knee arthroplasty: A prospective longitudinal study of 28 patients.

BACKGROUND: There is a paucity of data on mid to long-term gait outcomes after total knee arthroplasty. The aims of this longitudinal study were: to assess the evolution of both clinical and gait outcomes before and up to seven years after primary total knee arthroplasty (TKA) in a cohort of patients with knee osteoarthritis. METHODS: This study included 28 patients evaluated before and up to seven years after primary TKA with both gait analysis and patient reported outcomes; of these, 20 patients were evaluated one year after surgery as well. Kinematic outcomes during gait (gait velocity, dimensionless gait veolicity, maximal knee flexion and knee range of motion), pain relief, Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life and patient satisfaction were assessed and compared at each visit with the paired Wilcoxon signed rank test (p < 0.05). RESULTS: The significant improvement achieved at one year after TKA was stable up to seven years after surgery, with all clinical and kinematic outcomes unchanged, except for gait velocity, with a significant decrease over time (1.3 (1.1-1.4) m/s one year after TKA versus 1.0 (0.9-1.1) m/s, p < 0.05 up to seven years after). CONCLUSION: Patients with knee osteoarthritis significantly improve their clinical and kinematic outcomes at one year postoperatively and maintain the gain up to seven years after primary TKA, except for gait velocity which decreases over time, most likely along with ageing.

History of previous surgery is associated with higher risk of revision after primary total knee arthroplasty: a cohort study from the Geneva Arthroplasty Registry.

Background and purpose - Prior to primary total knee arthroplasty (pTKA), 6-34% of patients have undergone surgical procedure(s) of their knee. We investigated whether history of previous surgeries influences the risk of revision of pTKA, the risk according to the type of previous surgery, and how previous surgery influences specific causes of revision and the time of revision.Patients and methods - This is a prospective cohort study from the Geneva Arthroplasty Registry. All pTKA between 2000 and 2016 were included and followed until December 31, 2019. Outcomes were risk of revision, evaluated using Kaplan-Meier survival and Cox and competing risks regression, the specific causes, and time of revision.Results - Of 3,945 pTKA included (mean age 71 years, 68% women), 21% had a history of previous surgery, with 8.3% revisions vs. 4.3%, at 3-20 years' follow-up (mean 8.6). 5- and 10-year cumulative failure by previous surgery (yes vs. no) were 6.6% (95% CI 5.1-8.5) vs. 3.3% (CI 2.7-4.0), and 8.4% (CI 6.6-10.6) vs. 4.5% (CI 3.8-5.4). Baseline differences explained only part of the higher risk (adjusted HR 1.5, CI 1.1-2.1). The risk of failure was higher for all causes of revision considered. Patients in the previous surgery group had a higher risk of an early revision.Interpretation - A history of previous surgery adversely affected the outcome with a 1.5 times higher cumulative risk of all-cause revision over the course of up to 20 years after index surgery. The increased risk was seen for all causes of revision and was highest in the first years.

Gait Analysis 1 Year after Primary TKA: No Difference between Gap Balancing and Measured Resection Technique.

Mechanical alignment in total knee arthroplasty (TKA) can be achieved using dependent bone cuts. The hypothesis is that patients have a better balanced TKA, as a result. The aim of this study was to determine if this technique is superior to an independent bone cut technique in terms of gait parameters, patient-reported outcome measures (PROMs), and satisfaction assessed before surgery and at 1-year follow-up. A total of 58 patients were evaluated before and 1 year following TKA, using the Press Fit Condylar (PFC) Sigma posterior stabilizer (PS) design; 39 (70 ± 8 years; 27 women) with independent bone cuts and 19 (71 ± 7 years; 12 women) with dependent bone cuts using the Specialist TRAM. Gait was evaluated with a three-dimensional motion analysis system for spatiotemporal and kinematics parameters. Pain and functional levels were assessed using the Western Ontario and McMaster Universities arthritis index (WOMAC); general health was assessed by the short form (SF)-12. Global satisfaction, as well as patient satisfaction, related to pain and functional levels were assessed using a five-point Likert's scale. No significant difference was found between both groups in terms of age, body mass index, pain, and functional levels at baseline. At 1-year follow-up, despite an overall improvement in gait, WOMAC, SF-12 physical score and pain, none of the patients showed gait parameters comparable to a healthy control group. No surgical technique effect was observed on gait, clinical outcomes, and satisfaction level. While observing an overall improvement at 1-year follow-up, we did not find any significant difference between the two surgical techniques in terms of gait parameters, patients' outcomes, and satisfaction.

Walking Speed and Maximal Knee Flexion During Gait After Total Knee Arthroplasty: Minimal Clinically Important Improvement Is Not Determinable; Patient Acceptable Symptom State Is Potentially Useful.

BACKGROUND: Total knee arthroplasty (TKA) is the operation of choice in patients with end-stage knee osteoarthritis (OA). Up to 1 in 5 patients still encounter functional limitations after TKA, partly explaining patient dissatisfaction. Which gait ability to target after TKA remains unclear. To determine whether Minimal Clinical Important Improvement (MCII) or Patient Acceptable Symptom State (PASS) values could be derived from gait parameters recorded in patients with TKA. And, if so, to define those values. METHODS: In this ancillary study, we retrospectively analyzed gait parameters of patients scheduled for a unilateral TKA between 2011 and 2013. We investigated MCII and PASS values for walking speed and maximal knee flexion using anchor-based methods: 5 anchoring questions based on perceived body function and patients' satisfaction. RESULTS: Over the study period, 79 patients performed a clinical gait analysis the week before and 1 year after surgery, and were included in the present study. All clinical and gait parameters improved 1 year after TKA. Nevertheless, changes in gait outcomes were not associated with perceived body function or patients' satisfaction, precluding any MCII estimation in gait parameters. PASS values, however, could be determined as 1.2 m/s for walking speed and 50° for maximal knee flexion. CONCLUSION: In this study, we found that MCII and PASS values are not necessarily determinable for gait parameters after TKA in patients with end-stage OA. Using anchor questions based on perceived body function and patient's satisfaction, MCII could not be defined while PASS values were potentially useful. LEVEL OF EVIDENCE: Level III.

Associations between gait analysis parameters and patient satisfaction one year following primary total knee arthroplasty.

BACKGROUND: The purpose of this prospective study was to understand the relation between gait outcomes and patient satisfaction one year after total knee arthroplasty (TKA). METHODS: Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. Specific gait outcomes were analyzed: gait speed, stance phase, range of motion (ROM) knee flexion and maximal knee flexion. The parameters of interest selected for the statistical analysis were: gait speed and maximal knee flexion during gait. The Western Ontario and MacMaster Osteoarthritis Index (WOMAC) and patient satisfaction were also assessed. The satisfaction was evaluated using a questionnaire and was splited in five categories: very unsatisfied, unsatisfied, neutral, satisfied or very satisfied. To assess associations between patient satisfaction and maximal knee flexion during gait and gait speed, an unadjusted ordinal logistic regression analysis was used. The analysis was then adjusted for covariates: age and Body Mass Index (BMI) before surgery and WOMAC pain one year after surgery. RESULTS: All gait outcomes after TKA had significantly improved. The ordinal logistic regression analysis found significant associations between patient satisfaction and maximal knee flexion after TKA (unadjusted and adjusted) but not for gait speed. CONCLUSION: These findings show that all patients improved their gait outcomes one year after TKA but only a higher maximal knee flexion during gait may influence the level of patient satisfaction.

Total knee arthroplasty in achondroplasia without deformity correction: A case report with 11 years' follow-up.

Knee osteoarthritis in patients with achondroplasia is rare. Bowleg deformity is typical but corrective surgery is limited. Thus, primary total knee arthroplasty (TKA) might be challenging due to the particular anatomy. We report on a patient with 11 year's follow-up after a TKA performed maintaining bowleg alignment, using a posterior stabilized, fixed-bearing design. Sequential X-rays showed radiolucencies on the femoral component within two years postoperatively, slightly increasing over time but stable at last follow-up. The Oxford Knee Score showed an excellent result at 11 years. Despite the peculiarities of a case report, TKA without concomitant osteotomies might be an option for such patients. Nevertheless, a thorough discussion about pros and cons is paramount.

The impact of body-mass index on the frontal knee alignment estimation using three-dimensional reconstruction based on movement analysis.

BACKGROUND: We evaluated the influence of the body-mass index (BMI) on the estimation of the static frontal knee alignment (FKA) using three-dimensional (3D) reconstruction method based on movement analysis. METHODS: Two-hundred nineteen knees (120 individuals with end-stage osteoarthritis) were analyzed. The validity of the 3D method was evaluated under comparison with a reference method based on weight bearing full-leg length radiography. Extensive statistical analyses (Pearson's correlation, one-way ANOVA, linear regression, boxplot diagram) over four groups of BMI (normal, overweight, obese class I and obese classes II and III) were performed. RESULTS: For BMI below 25 kg/m2, the validity of the 3D method was confirmed. For BMI over 25 kg/m2, there was an increasing error of the 3D method, especially for the obese groups affected with a large varus alignment. CONCLUSIONS: In a biomechanical context of movement analysis, the results of the study suggest that the 3D method may represent a satisfying alternative to the full-leg radiograph method with limitations regarding to BMI over 25 kg/m2.

Symptoms of osteoarthritis influence mental and physical health differently before and after joint replacement surgery: A prospective study.

BACKGROUND: Patient-reported outcomes are increasingly used in evaluations of joint replacement surgery, but it is unclear if symptoms of osteoarthritis (i.e., pain and dysfunction) influence health perceptions similarly before and after surgery. METHODS: In this prospective study based on a hospital-based arthroplasty registry, patients with primary total hip or knee arthroplasty (THA, N = 990, and TKA, N = 907) completed the WOMAC Pain and Function scales, and the SF12 Physical and Mental Component Scores (PCS and MCS), before surgery and one year later. Associations between WOMAC and SF12 scales were examined using mixed linear regression models. RESULTS: All patient-reported outcomes improved following total joint arthroplasty, but the associations between symptom scales and global health perceptions were altered. Mental health scores at a given level of pain or function were lower after surgery than before, by about 4-5 points, a clinically meaningful and statistically significant difference. In contrast, the associations between WOMAC scales and the PCS remained stable. These findings were observed in both cohorts of patients. CONCLUSIONS: After total joint arthroplasty, mental health scores were lower than would have been expected given the symptomatic improvement. This suggests that relationships between patient-reported outcomes are context-dependent, and that care should be exerted when interpreting changes in patient-reported outcomes over time.

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty.

BACKGROUND: The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). METHODS: Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m2) and obese patients (BMI ≥30 kg/m2) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. RESULTS: At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). CONCLUSION: These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

BACKGROUND AND PURPOSE: Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. PATIENTS AND METHODS: We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years). RESULTS: 111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6). INTERPRETATION: BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

Influence of body mass index on revision rates after primary total knee arthroplasty.

PURPOSE: Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored. METHODS: We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38-203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan-Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis. RESULTS: Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI ≥ 35, a significant increase in revision was noted. Comparing BMI ≥ 35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2-3.3, p = 0.009], and the adjusted HR was 2.1 (95 % CI 1.2-3.6, p = 0.008). CONCLUSION: All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

Associations of diabetes mellitus with orthopaedic infections.

BACKGROUND: Clinical experience suggests that a high proportion of orthopaedic infections occur in persons with diabetes. METHODS: We reviewed several databases of adult patients hospitalized for orthopaedic infections at Geneva University Hospitals from 2004 to 2014 and retrieved 2740 episodes of infection. RESULTS: Overall, diabetes was noted in the medical record for 659 (24%) of these cases. The patients with, compared with those without, diabetes had more than five times more foot infections (274/659 [42%] vs 155/2081 [7%]; p < 0.01) and a significantly higher serum C-reactive protein level at admission (median 96 vs 70 mg/L; p < 0.01). Diabetic patients were older (median 67 vs 52 years; p < 0.01), more often male (471 [71%] vs 1398 [67%]; p = 0.04), and had more frequent polymicrobial infections (219 [37%] vs 353 [19%]; p < 0.01), including more gram-negative non-fermenting rods (90 [15%] vs 168 [9%]; p < 0.01). Excluding foot infections from these analyses did not change the statistically significant differences. Diabetes was present in 17% of all infected orthopaedic patients without foot involvement. In Geneva canton, the overall prevalence of diabetes is estimated at 5.1%, while we have found that the prevalence is 13% in our hospitalized adults. CONCLUSIONS: Diabetes is present in 24% of all adult patients hospitalized for surgery for an orthopaedic infection, a prevalence that is several times higher than for the general population and twice as high as that for the population of hospitalized patients. Compared with non-diabetics, patients with diabetes have significantly more infections that are polymicrobial, including gram-negative non-fermenting rods.

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results.

UNLABELLED: Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. METHODS: Case-control study of adult patients hospitalized with orthopedic infections. RESULTS: Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ²-test, p = 0.01) and skin commensals (17/74 vs. 274/2350; p = 0.01) compared to episodes without preceding prophylaxis. CONCLUSIONS: Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals.

No regeneration of the human acetabular labrum after excision to bone.

BACKGROUND: Treatment options for a symptomatic, torn, irreparable, or completely ossified acetabular labrum are limited to either excision and/or reconstruction with grafts. In a previous animal model, regeneration of the acetabular labrum after excision to the bony rim has been shown. In humans, less is known about the potential of regeneration of the labrum. Recent studies seem to confirm labral regrowth, but it is still unclear if wide excision might be a surgical option in cases where repair is not possible. QUESTIONS/PURPOSES: The purposes of this study were (1) to determine the extent of acetabular labrum regeneration after excision to the bony rim; and (2) to determine whether this procedure results in higher hip scores. METHODS: We reviewed all patients treated with surgical dislocation for symptomatic femoroacetabular impingement by a single surgeon at one institution between 2003 and 2008, of whom 14 underwent wide labral excision (of at least 60°) down to bone; we used this approach when there was an absence of reparable tissue. Of these 14, nine were available for voluntary reexamination. The mean age at surgery was 38 ± 9 SD years and the mean followup was 4 ± 1 SD years. All patients consented to a physical examination and an MRI arthrogram, which was evaluated for evidence of new tissue formation by four observers. A modified Harris hip score and the UCLA were recorded. RESULTS: Regrowth of a structure equivalent to normal labrum was not observed on the MRI arthrograms. Six of nine hips had segmental defects, bone formation was found in five, and the capsule was confluent with the new tissue in six. The mean Harris hip score at latest followup was 83 ± 14, and the mean UCLA score was 6 ± 2. CONCLUSIONS: Resection of a nonreparable acetabular labrum down to a bleeding bony surface does not stimulate regrowth of tissue that appears to be capable of normal function by MR arthrography, and patients who underwent this procedure had lower hip scores at midterm than previously reported from the same institution for patients undergoing labral repair or sparse débridement. Based on these results, we believe that future studies should evaluate alternatives to reconstructing the labrum, perhaps using ligamentum teres, because resection seems neither to result in regrowth nor the restoration of consistently high hip scores.

Sports and Activity Levels After Open Surgical Treatment of Femoroacetabular Impingement.

BACKGROUND: Several studies indicate that professional athletes can successfully return to competition after surgical treatment of femoroacetabular impingement (FAI). However, little is known about sports and activity levels after FAI surgery in the general patient population. HYPOTHESIS/PURPOSE: The purpose was to determine the sports behavior, satisfaction with sports ability, and activity levels in a consecutive cohort of patients with FAI who were treated by surgical hip dislocation. The hypothesis was that the majority of patients (>75%) would be active in sports at follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This retrospective study included 153 patients (mean age, 30.0 years; 40.5% female) with 192 hips treated. Sports behavior and satisfaction were determined at a mean follow-up of 59.4 months with the use of a questionnaire. Activity levels at follow-up were assessed by the Hip Sports Activity Scale (HSAS) and the University of California, Los Angeles (UCLA) activity scale. RESULTS: Of 126 patients who were regularly active in sports before surgery, 107 (85%) were so at follow-up. Nineteen patients (12.4%) stopped participating in regular sports, and 8 (5.2%) commenced with sports after the operation. The most popular activities before surgery were skiing (22%), cycling (22%), jogging (20%), and soccer (13%). At follow-up, most patients were engaged in cycling (23%), fitness/weight training (20%), skiing (18%), and jogging (11%). Of all patients, 75% were satisfied with their sports ability, and 25% were not. Moreover, 60.3% stated that their sports ability had improved after surgery, 20.5% declared no change, and 19.2% were subjectively deteriorated. The mean pain level during sports was rated to be 2.1 according to the visual analog scale. The mean HSAS score was 3.5 (range, 0-8), and the mean UCLA score was 7.7 (range, 3-10); male patients reported significantly higher scores than did female patients on the HSAS (4.1 vs 2.7, respectively) and UCLA scale (8.2 vs 7.0, respectively). CONCLUSION: The vast majority of patients with FAI who are treated by surgical hip dislocation return to sports activities, and most patients are satisfied with their sports ability at midterm follow-up. Activity levels are significantly higher in male patients, but this does not yield higher satisfaction rates.

[Management of malignant bone tumors around the knee]. / Prise en charge des tumeurs osseuses malignes autour du genou.

Primary bone tumors arise mostly around the knee. A treatment strategy issued from a multidisciplinary team is the key factor for an optimal management of such patients. Many durable options for reconstructing a functional limb are available, as an alternative to amputation, without lowering patients' survival. Nevertheless complications are frequent and any decision for one technique or the other should be made with the patient, appreciating the specificity of each single case. We discuss here the different techniques with their advantages and drawbacks, including long term results.

The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement.

PURPOSE: To develop and validate a sports activity scale for patients with a diagnosis of femoroacetabular impingement (FAI).
 METHODS: A nine level Hip Sports Activity Scale (HSAS) was constructed both in German and English languages. Fifty-nine consecutive patients undergoing surgical treatment for FAI at two centers in Switzerland and in the US completed a questionnaire set consisting of the HSAS, the University of California at Los Angeles (UCLA) activity scale and different hip joint-specific and generic outcome tools. For reliability assessment, the HSAS was completed twice about nine days apart. Evidence of reliability, validity and responsiveness was investigated by classical psychometric analyses.
 RESULTS: Reliability was excellent for both the German and the English versions with intraclass correlation coefficients of 0.94 and 0.96, respectively. Evidence of convergent validity was supported by moderate to high correlations with the UCLA activity scale and with the joint-specific measures used. Evidence of divergent validity was supported by low correlations with the SF-12 Mental Component Scale and the WOMAC stiffness subscale. The standardised response mean was 0.69.
 CONCLUSIONS: The HSAS is a reliable and valid tool to determine sports levels in patients suffering from FAI. Its use in future studies investigating outcomes in young patients with hip disease can be recommended.
 LEVEL OF EVIDENCE: Level III, Diagnostic Studies - An independent, masked comparison with an appropriate population of patients, but reference standard not applied to all study patients.

Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement.

BACKGROUND: Surgical treatment of femoroacetabular impingement (FAI) includes both open and arthroscopic procedures. Encouraging results have been reported for the majority of patients after surgical hip dislocation; however, most of these reports were short term and included only small cohorts. PURPOSE: To determine the results of surgical hip dislocation in a large cohort of FAI patients at a midterm follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective study including 185 consecutive patients (mean age, 30 years; 40% female) with 233 hips treated was conducted. We determined clinical outcomes in terms of range of motion and analyzed radiographs for several criteria including the alpha angle preoperatively and at 1 year postoperatively. At latest follow-up, on average 61 months postoperatively, patient satisfaction, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip Outcome Score, SF-12, and University of California, Los Angeles (UCLA) activity scale scores were determined. All revisions and conversions to total hip arthroplasty (THA) were recorded. RESULTS: Both hip flexion and internal rotation improved from preoperatively to postoperatively. Alpha angles decreased from 65.1° ± 14.2° to 42.4° ± 4.9°. At 5 years, 82% of the patients were satisfied or very satisfied with the results of surgery, and 81% would undergo the same surgery again. There were 83% who rated their overall hip function as normal or nearly normal. Mean scores for the WOMAC pain, stiffness, and function subscales were 10.3 ± 15.8, 15.9 ± 17.4, and 9.6 ± 13.0 points; for Hip Outcome Score activities of daily living and sport subscales were 89.0 ± 13.1 and 75.6 ± 23.0 points; and for the SF-12 Physical Component Scale and Mental Component Scale were 47.4 ± 6.3 and 52.3 ± 7.4 points, respectively. The mean UCLA activity level was 7.7 ± 1.9. Conversion to THA was performed in 7 hips (3%). Seven hips (3%) underwent other major revisions, and 11 (4.7%) underwent minor revisions. Female patients had a significantly increased risk for conversion to THA (odds ratio, 13.3; 95% confidence interval [CI], 1.3-92.6) and major revision (odds ratio, 19.2; 95% CI, 2.4-152.9). The mean body mass index was significantly lower in those patients who underwent conversion to THA. The need for microfracture because of residual full-thickness cartilage defects after rim trimming was a significant (P = .04) predictor of subjective dissatisfaction. CONCLUSION: This study demonstrates that surgical hip dislocation is a successful procedure for the treatment of FAI. A majority of patients were satisfied with the results of surgery at a midterm follow-up. Older and slim female patients were at an increased risk for a less successful outcome in terms of conversion to THA and revision surgery.