EFFECT OF SACROILIAC JOINTPAIN ON OUTCOMES IN PATIENTS UNDERGOING HIP ARTHROSCOPY FOR THE TREATMENT OF FEMOROACETABULAR IMPINGEMENT SYNDROME…
Figure 2 - PRO scores for patients with sacroiliac joint pain preoperatively including baseline preoperative scores shown by the dark gray bars, 2-year postoperative scores shown by light gray bars, and delta (postoperative – preoperative) scores shown by diagonal line bars. *Statistically significant improvement (P < .05) from preoperative to 2 years postoperative. HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SS, Hip Outcome Score–Sports Subscale; iHOT-12, International Hip Outcome Tool–12; mHHS, modified Harris Hip Score; PRO, patient-reported outcome
Background:
Patients with femoroacetabular impingement syndrome (FAIS) may frequently have co-existing sacroiliac joint (SIJ) pain. It is known that patients with lower back pain undergoing total hip arthroplasty (THA) have inferior outcomes; however, it is unclear what the effect of SIJ pain is on outcomes after hip arthroscopy.
Purpose:
To determine whether patients undergoing hip arthroscopy with SIJ pain either subjectively or on physical examination achieve similar postoperative improvement in patient-reported outcomes (PROs) compared with patients without SIJ pain at 2-year follow-up.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients with a minimum 2-year follow-up who underwent primary hip arthroscopy for FAIS with SIJ pain were matched in a 1:2 ratio to controls without SIJ pain. Baseline demographics, as well as postoperative PROs and rates of achievement of the minimal clinically important difference (MCID) or Patient Acceptable Symptom State (PASS) at 2-year follow-up were compared between the 2 groups.
Figure 3 - PRO scores for controls without sacroiliac joint pain preoperatively including baseline preoperative scores shown by the dark gray bars, 2-year postoperative scores shown by light gray bars, and delta (postoperative – preoperative) scores shown by diagonal line bars. *Statistically significant improvement (P < .05) from preoperative to 2 years postoperative. HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SS, Hip Outcome Score–Sports Subscale; iHOT-12, International Hip Outcome Tool–12; mHHS, modified Harris Hip Score; PRO, patient-reported outcome.
Results:
A total of 73 patients (75 hips) with SIJ pain were matched to 150 control patients (150 hips) without SIJ pain. Both groups demonstrated statistically significant improvement in all PROs at 2 years (P < .05 for all). Patients with SIJ pain had significantly lower postoperative PRO scores for the Hip Outcome Score–Activities of Daily Living (HOS-ADL) (SIJ pain: 80.4 ± 22.4 vs no SIJ pain: 88.0 ± 15.1; P = .006), modified Harris Hip Score (mHHS) (SIJ pain: 73.2 ± 22.8 vs no SIJ pain: 80.0 ± 17.3; P < .001), and International Hip Outcome Tool–12 questionnaire (iHOT-12) (SIJ pain: 61.7 ± 25.9 vs no SIJ pain: 73.7 ± 23.7; P = .008). There were no statistically significant differences in improvement (delta) in PRO scores between the 2 groups (P > .05 for all). The SIJ pain group had significantly lower achievement of MCID for the HOS-ADL (SIJ pain: 65.2% vs no SIJ pain: 80.5%; P = .044) but not HOS-SS, mHHS, or iHOT-12 (P > .05 for all). The SIJ pain group had significantly lower achievement of PASS for the mHHS (SIJ pain: 27.5% vs no SIJ pain: 45.3%; P = .030) and iHOT-12 (SIJ pain: 31.0% vs no SIJ pain: 56.0%; P = .010) but not the HOS-ADL and HOS-SS (P > .05 for both). Only 4.1% of patients with SIJ pain and 2.4% of controls required revision surgery or converted to THA at the time of final follow-up (P = .69).
Conclusion:
Patients with FAIS and SIJ pain on history or physical examination experience significant improvement in PROs at 2 years after hip arthroscopy. However, they may be less likely to achieve the MCID or PASS and have significantly lower postoperative PROs compared with a matched cohort of patients without SIJ pain. Overall rates of revision and conversion to THA were similarly low in both groups.
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Published July 21, 2022 in the Journal of the American Academy of Orthopaedic Surgeons (Volume 50 - Issue 10).