title: The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery.
abstract: BACKGROUND
  The impact of proximal femoral and combined femoral and acetabular version on patient-reported outcomes after arthroscopic surgery for femoroacetabular impingement (FAI) remains undefined. The purpose of this study was to identify associations of proximal femoral version as well as combined version (McKibbin index) with disease-specific, validated, patient-reported outcomes following arthroscopic correction of symptomatic FAI.
  
  
  METHODS
  A prospective hip arthroscopy registry was utilized to evaluate 243 patients who underwent arthroscopic surgery to correct FAI. Femoral version and the McKibbin index were measured prospectively on preoperative computed tomography scans. Disease-specific, patient-reported outcomes included the modified Harris hip score (mHHS) and the Hip Outcome Score (HOS) ADL (Activities of Daily Living) and Sports subscales. Disease impact on quality of life was determined with use of the International Hip Outcome Tool (iHOT-33). Comparative analyses were used to evaluate the impact of femoral version on changes in patient-reported outcome scores; multiple regression was used to adjust for potential confounders.
  
  
  RESULTS
  The patient cohort contained 243 patients (123 female and 120 male) with a mean age of 29.2 years and a mean postoperative follow-up of twenty-one months (range, twelve to forty-two months). The cohort experienced significant improvements (p < 0.001) in all patient-reported outcome measures, with most patients improving by at least the minimal clinically important difference for all of these measures. The mean improvement was 20 points for the mHHS, 15 for the HOS ADL, 23 for the HOS Sports, and 23 for the iHOT-33. When stratified by femoral version, the postoperative improvements in patients with relative femoral retroversion (<5° anteversion) were clinically important but of significantly smaller magnitude than those in the other version groups. We did not find any associations between the McKibbin index and any patient-reported outcomes.
  
  
  CONCLUSIONS
  Although clinically important improvements can be expected after arthroscopic FAI surgery in all femoral version groups, patients with relative femoral retroversion (<5° femoral anteversion) may experience less improvement than those with normal or increased version.
authors.affiliation: Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant: FabricantP@hss.edu.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.affiliation: Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant: FabricantP@hss.edu.
authors.forename: Kara G
authors.initials: KG
authors.lastname: Fields
authors.affiliation: Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant: FabricantP@hss.edu.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant: FabricantP@hss.edu.
authors.forename: Erin
authors.initials: E
authors.lastname: Magennis
authors.affiliation: Domino's Farms, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Department of Orthopaedic Surgery (P.D.F.), Healthcare Research Institute (K.G.F), Sports Medicine and Shoulder Service (S.A.T. and B.T.K.), and Center for Hip Pain and Preservation (E.M. and B.T.K.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for P.D. Fabricant: FabricantP@hss.edu.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
mesh_terms: D000077:Acetabulum / Q000473:pathology*; D000203:Activities of Daily Living; D000328:Adult; D001182:Arthroscopy; D005260:Female; D057925:Femoracetabular Impingement / Q000601:surgery*; D005269:Femur / Q000473:pathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult