title: Femoroacetabular Impingement: Have We Hit a Global Tipping Point in Diagnosis and Treatment? Results From the InterNational Femoroacetabular Impingement Optimal Care Update Survey (IN FOCUS).
abstract: This international survey was conducted to assess the perceptions of orthopaedic surgeons regarding the diagnosis and management of femoroacetabular impingement (FAI) as well as to explore the current demographic characteristics of surgeons performing FAI surgery.
  
  
  
  A survey was developed using previous literature, focus groups, and a sample-to-redundancy strategy. The survey contained 46 questions and was e-mailed to national orthopaedic associations and orthopaedic sports medicine societies for member responses. Members were contacted on multiple occasions to increase the response rate.
  
  
  
  Nine hundred orthopaedic surgeons from 20 national and international organizations completed the survey. Surgeons responded across 6 continents, 58.2% from developed nations, with 35.4% having sports fellowship training. North American and European surgeons reported significantly greater exposure to hip arthroscopy during residency and fellowship training in comparison to international respondents (48.0% and 44.5% respectively, v 25.6%; P < .001). Surgeons performing a higher volume of FAI surgery (> 100 cases per year) were significantly more likely to have practiced for more than 20 years (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.01 to 3.63), to be practicing at an academic hospital (OR, 2.25; 95% CI, 1.22 to 4.15), and to have formal arthroscopy training (OR, 46.17; 95% CI, 20.28 to 105.15). High-volume surgeons were over two-fold more likely to practice in North America and Europe (OR, 2.26; 95% CI, 1.08 to 4.72).
  
  
  
  The exponential rise in the diagnosis and surgical management of FAI appears to be driven largely by experienced surgeons in developed nations. Significant variability exists regarding the diagnosis and management of FAI. Our analysis suggests that although FAI management is early in the innovation cycle, we are at a tipping point toward wider uptake and use.
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Moin
authors.initials: M
authors.lastname: Khan
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Madden
authors.affiliation: MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Anil
authors.initials: A
authors.lastname: Ranawat
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.affiliation: Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Sancheti
authors.affiliation: Institute of Orthopedics and Traumatology, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Ejnisman
authors.affiliation: Academic Orthopaedic Department, Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D001182:Arthroscopy / Q000706:statistics & numerical data; D002983:Clinical Competence; D057925:Femoracetabular Impingement / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D000072161:Orthopedic Surgeons; D010808:Physical Examination; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires