title: Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter?
abstract: BACKGROUND
  Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females.
  
  
  OBJECTIVE
  To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn't help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score.
  
  
  RESULTS
  All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol-5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = -0.16 to -0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and postoperative PROM values or subjective failure rates, but patients who objectively failed had lower Beighton scores than did nonfailures (1.6 vs 2.6; P = .049).
  
  
  CONCLUSIONS
  FAI surgery yielded favorable outcomes at short- to midterm follow-up. JH as assessed by the Beighton score was not consistently associated with subjective and objective results. Joint degeneration was the most important risk factor for conversion to THR. Although statistical significance was not reached, female patients with no joint degeneration, only mild FAI deformity, and higher Oxford scores at the time of surgery seemed to be at increased risk for subjective dissatisfaction.
authors.affiliation: Technical University of Munich, Munich, Germany.|Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Naal
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Aileen
authors.initials: A
authors.lastname: Müller
authors.affiliation: Department of Orthopaedic Surgery, Christian Medical Center, Vellore, India.
authors.forename: Viju D
authors.initials: VD
authors.lastname: Varghese
authors.affiliation: Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wellauer
authors.affiliation: Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Franco M
authors.initials: FM
authors.lastname: Impellizzeri
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Leunig
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods; D015331:Cohort Studies; D005260:Female; D057925:Femoracetabular Impingement / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: FAI; femoroacetabular impingement; hip impingement surgery; hypermobility; outcome; risk factors