title: Factors Associated With the Failure of Surgical Treatment for Femoroacetabular Impingement: Review of the Literature.
abstract: BACKGROUND
  With the recent increased recognition of femoroacetabular impingement (FAI) as a cause of hip pain and early osteoarthritis, surgical treatment has proliferated. There is a growing body of literature on outcomes of surgical intervention for FAI, but factors associated with inferior surgical outcomes have not been reviewed systematically.
  
  
  OBJECTIVE
  To review the available literature and identify factors associated with the failure of open or arthroscopic surgery for FAI.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Using the PubMed database, we searched for relevant English-language articles published from January 1966 through August 2012. Inclusion criteria were a primary focus on the surgical treatment of FAI, measurement of functional or pain outcomes, identification of treatment failures, and statistical analysis of factors leading to failure. Exclusion criteria were review articles, technique-only articles, and studies of nonoperative management. Two definitions of failure were considered: (1) a lack of statistically significant improvement in validated measures of pain, function, or satisfaction postoperatively; and (2) revision surgery or conversion to hip arthroplasty because of persistent symptoms. The consistency of association between preoperative variables and clinical outcomes was reported across all studies.
  
  
  RESULTS
  Thirteen studies were included. Three were retrospective; there were no randomized controlled trials. Many studies had important methodological limitations. Preoperative cartilage damage or osteoarthritis had the strongest and most consistent relationship with conversion to hip arthroplasty and with a lack of improvement in pain or function. Greater age at the index operation, worse preoperative modified Harris Hip Score, and longer duration of symptoms preoperatively (>1.5 years) were associated with conversion to hip arthroplasty.
  
  
  CONCLUSIONS
  Older age, presence of arthritic changes, longer duration of symptoms, and worse preoperative pain and functional scores are associated with poor outcomes of surgery for FAI. Incorporation of these data into discussions with patients may facilitate informed, shared decision making about the surgical treatment of FAI.
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, Massachusetts Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Saadat
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Martin
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Thornhill
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D018771:Arthralgia / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D001182:Arthroscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D057925:Femoracetabular Impingement / Q000473:pathology / Q000601:surgery*; D006615:Hip / Q000601:surgery; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D010147:Pain Measurement; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: femoroacetabular impingement; hip; outcomes; predictors; treatment