Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger

Aguilera-Bohórquez, Bernardo; Brugiatti, Miguel; Coaquira, Ruddy; Cardozo, Orlando; Cantor, Erika

doi:10.1055/s-0040-1708515

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Sumário

Original Article, Hip • Rev. bras. ortop. 55 (6) • Nov-Dec 2020 • https://doi.org/10.1055/s-0040-1708515 copy

Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger^* * Work performed in the Hip Preservation Unit of the Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger.

Methods

This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed.

Results

Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up (p > 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1^st postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage.

Conclusion

In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.

Keywords
hip; arthroscopy; femoroacetabular impingement

Variables	≤ 40 Years n = 34	> 60 Years n = 34	P-value
Gender, n (%)
Female	23 (67.6%)	23 (67.6%)	-
Male	11 (32.4%)	11 (32.4%)	-
Age (years)
Mean ± SD	30.6 ± 6.9	65.6 ± 4.6	-
Range	18-40	61-76	-
Traction time (Min)
Mean ± SD	59.1 ± 41.1	57.9 ± 29.6	0.55
Range	16-182	6-131	0.55
Laterality n (%)
Right	19 (55.9%)	18 (52.9%)	-
Left	15 (44.1%)	16 (47.1%)	-
FAI, n (%)
Cam	3 (8.8%)	3 (8.8%)	-
Pincer	4 (11.8%)	4 (11.8%)
Mixed	27 (79.4%)	27 (79.4%)
Inguinal pain, n (%)	27 (79.4%)	30 (88.2%)	0.54
Pain sitting down, n (%)	27 (79.4%)	31 (91.2%)	0.28
Pain at entering/exiting car, n (%)	22 (64.7%)	27 (79.4%)	0.17

Variables	≤ 40 years n = 34	> 60 years n = 34	P-value
Flexion
Mean ± SD	121.1º ± 9.1º	119.7º ± 10.9º	0.58
Range	90º-140º	90-135	0.58
External rotation
Mean ± SD	49.7º ± 18.9º	47.1º ± 17.3º	0.45
Range	10º-80º	20º-80º	0.45
Internal rotation
Mean ± SD	29.5º ± 20.6º	22.4º ± 14.7º	0.04^* * P-value < 0.05.
Range	-20º-70º	-10º-45º	0.04^* * P-value < 0.05.
Alpha angle
Mean ± SD	64.4º ± 12.3º	64.8º ± 9.4º	0.84
Range	42º-86º	50º-86º	0.84
LCE angle
Mean ± SD	38.8º ± 6.8º	42.1º ± 7.3º	0.04^* * P-value < 0.05.
Range	28º-53º	30º-60º	0.04^* * P-value < 0.05.

WOMAC	Group	Preoperative			1 year postoperative			∆ Before-After
WOMAC	Group	Mean ± SD	Median (range)	P-value^a a Preoperative difference between groups.	Mean ± SD	Median (range)	P-value^b b 1-year follow-up differences between the groups.	Mean ± SD	95% CI	P-value^c c Change differential between both groups.
Pain	≤40 years	8.6 ± 4.9	8.5 (0-18)	0.084	1.8 ± 2.5	0.5 (0-11)	0.006^* * P-value < 0.05.	6.8 ± 4.6	-1.65-3.65	0.448
Pain	> 60 years	10.7 ± 5.4	11 (0-23)	0.084	5.1 ± 5.2	3 (0-20)	0.006^* * P-value < 0.05.	5.5 ± 5.6		0.448
Stiffness	≤40 years	3.1 ± 2.3	3 (0-7)	0.850	0.6 ± 1.2	0 (0-6)	0.000^* * P-value < 0.05.	2.5 ± 2.4	0.25-2.36	0.017^* * P-value < 0.05.
Stiffness	> 60 years	3.2 ± 2.3	3 (0-8)	0.850	2.0 ± 2.0	2 (0-8)	0.000^* * P-value < 0.05.	1.1 ± 2.6		0.017^* * P-value < 0.05.
Functionality	≤40 years	26.3 ± 17.2	29 (0-59)	0.114	4.8 ± 8.2	3 (0-45)	0.001^* * P-value < 0.05.	21.5 ± 16.0	-3.57-10.72	0.315
Functionality	> 60 years	32.4 ± 19.4	30 (0-66)	0.114	15.0 ± 15.1	10.5 (0-63)	0.001^* * P-value < 0.05.	16.9 ± 16.7		0.315
Total	≤40 years	38.1 ± 23.3	40.5 (0-79)	0.112	7.2 ± 11.5	4 (0-62)	0.001^* * P-value < 0.05.	30.8 ± 21.6	-3.92-15.68	0.230
Total	> 60 years	46.3 ± 25.6	43 (0-93)	0.112	22.0 ± 21.4	17 (0-89)	0.001^* * P-value < 0.05.	23.6 ± 22.7		0.230

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[1] Address for correspondence Bernardo Aguilera-Bohórquez, MD, Centro de Preservación de Caderas del Instituto de Enfernedades Osteoarticulares, Centro Médico Imbanaco, Carrera 38A, N° 5ª -100 Tower A Office 105, Cali, Colombia (e-mail: baguilera@imbanaco.com.co).

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Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger* * Work performed in the Hip Preservation Unit of the Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.

Abstract

Objective

Methods

Results

Conclusion

Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger^* * Work performed in the Hip Preservation Unit of the Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.