Presence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up

doi:10.1016/j.arth.2022.04.002

The Journal of Arthroplasty

Volume 37, Issue 8, August 2022, Pages 1520-1525

https://doi.org/10.1016/j.arth.2022.04.002 Get rights and content

Abstract

Background

Acetabular retroversion may predispose to more severe femoroacetabular impingement syndrome (FAIS) and early labral damage given impaction of the femoral head-neck junction on the retroverted acetabular rim. The cross-over sign (COS), posterior wall sign (PWS), and ischial spine sign (ISS) are markers of acetabular retroversion (AR) on plain radiographs.

Methods

Patients who underwent primary hip arthroscopy for FAIS from January 2012 to December 2018 with a positive PWS were matched in a 1:1 ratio by age, gender, and body mass index (BMI) to controls with a negative PWS. Preoperative and postoperative patient-reported outcomes (PROs; HOS-ADL, HOS-SS, mHHS, and iHOT-12) were compared using independent t-tests. Achievement of a Patient Acceptable Symptom State (PASS) or Minimal Clinically Important Difference (MCID) was compared using Fisher’s exact test.

Results

Two hundred and seventy five patients with a positive PWS and 275 controls were included in the final analysis. Most patients (64%) were female, with average age, and BMI of 37.6 (SD 8.6) and 25.1 (SD 4.4), respectively. PROs improved significantly for both groups from preoperatively to 2 years postoperatively. There were no statistically significant differences (P ≥ .05) in PROs or achievement of MCID or PASS. On a subgroup analysis, patients with all three positive signs had significantly lower postoperative PROs and lower rates of achievement of MCID and PASS.

Conclusion

Patients with an isolated PWS achieve similar outcomes following hip arthroscopy at 2 years. However, patients with a concomitant PWS, ISS, and COS demonstrate less favorable outcomes, suggesting the need for increased perioperative counseling and potential evaluation for planned concurrent or serial open procedures such as periacetabular osteotomy.

Section snippets

Patient Selection

After obtaining an approval from the local institutional review board, a prospectively maintained single institutional database was queried for patients who underwent hip arthroscopy by the senior author from January 2012 to December 2018. Patients were eligible for inclusion if they had a positive PWS on preoperative plain radiographs. Additional inclusion criteria included preoperative PRO scores, a minimum of 2 years of follow-up with completion of at least 1 PRO at 2 years postoperatively

Results

A total of 275 patients with positive PWS and 275 controls with negative PWS on preoperative radiographs were included in the final analysis. A majority of patients in the positive PWS group (64.4%) were female with an average age and BMI of 37.6 (SD 8.6) and 25.1 (SD 4.4), respectively (Table 1). Similarly, a majority of controls (64%; P = 1.00) were female with an average age and BMI of 37.7 (SD 8.7, P = .89) and 25.0 (SD 4.2, P = .89), respectively. There was no statistically significant

Discussion

The purpose of this study was to examine the PROs following an isolated hip arthroscopy using modern surgical techniques [24] in patients with radiographic evidence of a PWS at a minimum of 2 years of follow-up. We found that patients with and without a PWS were able to reach statistically significant improvements in PROs at a minimum of 2 years of follow-up. When compared as a whole, there were no statistically significant differences in preoperative, postoperative, or change in PRO scores

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Cited by (2)

Patients With Low-Grade Lumbosacral Transitional Vertebrae Demonstrate No Difference in Achievement of Clinical Thresholds After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
To compare clinical outcomes at 2 years following primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) between patients with and without low-grade lumbosacral transitional vertebra (LSTV).
We performed a retrospective matched-cohort analysis of patients who underwent primary HA for FAIS from 2011 to 2018 with minimum 2-year follow-up. LSTV was graded on preoperative radiographs using the Castellvi classification. Patients with grades I and II LSTV were matched 1:1 with controls on age, sex, and body mass index. Radiographic markers of FAIS morphology were measured. Pre- to postoperative improvement in the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) as well as 2-year achievement rates for the minimum clinically-important difference, substantial clinical benefit, and patient acceptable symptom state were compared between patients with versus without LSTV. The Wilcoxon signed-rank test was used for intergroup mean comparisons and the Cochran–Mantel–Haenszel test for categorical variables.
In total, 58 patients with LSTV were matched to 58 controls. Among LSTV patients, 48 were Castellvi type 1 (82.8%) and 32 (55.2%) had bilateral findings. No significant differences were found between groups with respect to radiographic markers of FAIS, including alpha angle (P = .88), lateral center edge angle (P = .42), or crossover sign (P = .71). Although patients with LSTV had greater improvement in NAHS at 2-year follow-up compared with control patients (P = .04), there were no significant differences in modified Harris Hip Score improvement (P = .31) or achievement of the minimum clinically-important difference (P = .73), substantial clinical benefit (P = .61), or patient acceptable symptom state (P = .16).
Patients with low-grade LSTV had greater 2-year improvement in NAHS than controls, whereas no significant differences were observed in achievement of clinical thresholds at 2-year follow-up. There were no differences between groups with respect to any measured radiographic markers of FAIS morphology. Importantly, the findings of this study are underpowered and should be viewed with caution in the greater context of the LSTV literature.
Level III; retrospective comparative study.
Radiographic evaluation of femoral acetabular impingement
2023, Chinese Journal of Orthopaedics

: Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

: Declaration of Competing Interests: Co-authors Dr Lakshmanan Sivasundaram, Morgan Rice, Dr Mario Hevesi, and Christopher Ephron have no interests to disclose. Dr Shane Nho reports the following interests: nonfinancial support from Allosource, other from American Orthopaedic Association, other from American Orthopaedic Society for Sports Medicine, nonfinancial support from Arthrex, Inc, other from Arthroscopy Association of North America, nonfinancial support from Athletico, nonfinancial support from DJ Orthopedics, nonfinancial support from Linvatec, nonfinancial support from MIOMED, personal fees from Ossur, nonfinancial support from Smith & Nephew, personal fees from Springer, and personal fees from Stryker, outside the submitted work.

: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.04.002.

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Joint Preservation and Non ArthroplastyPresence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up

Abstract

Background

Methods

Results

Conclusion

Section snippets

Patient Selection

Results

Discussion

Lancet

Arthroscopy

Arthrosc Sports Med Rehabil

Arthroscopy

J Arthroplasty

Arthroscopy

Arthroscopy

J Orthop

Primary hip arthroscopy and conversion to total hip arthroplasty: trends and survival analysis in the Medicare population

Hip Int

Hip arthroscopy: patient assessment and indications

Instr Course Lect

Risk factors for 30-day readmission following hip arthroscopy

Knee Surg Sports Traumatol Arthrosc

Patient-related risk factors associated with less favourable outcomes following hip arthroscopy

Bone Joint J

The role of arthroscopy in the dysplastic hip-a systematic review of the intra-articular findings, and the outcomes utilizing hip arthroscopic surgery

J Hip Preserv Surg

Clinical outcomes of hip arthroscopy in radiographically diagnosed retroverted acetabula

Am J Sports Med

Do patients with borderline dysplasia have inferior outcomes after hip arthroscopic surgery for femoroacetabular impingement compared with patients with normal acetabular coverage?

Am J Sports Med

Are results of arthroscopic labral repair durable in dysplasia at midterm follow-up? A 2-center matched cohort analysis

Am J Sports Med

Addressing intraarticular pathology at the time of anteverting periacetabular osteotomy for acetabular retroversion is associated with better short-term patient-reported outcomes

J Hip Preserv Surg

Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know

AJR Am J Roentgenol

Joint Preservation and Non Arthroplasty
Presence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up