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Factors Associated with Initial Interest and Treatment Selection in Patients with Femoroacetabular Impingement Syndrome
Author(s) -
Glaws Kathryn,
BrownTaylor Lindsey,
Pomeroy Matthew,
Di Stasi Stephanie,
Fritz Julie M.,
Ryan John,
Walrod Bryant,
Vasileff William K.
Publication year - 2020
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1002/pmrj.12344
Subject(s) - medicine , orthopedic surgery , confidence interval , physical therapy , logistic regression , prospective cohort study , univariate analysis , femoroacetabular impingement , surgery , multivariate analysis
Background Outcomes for operative and nonoperative management of femoroacetabular impingement syndrome (FAIS) are variable. Understanding factors that inform patients' treatment decisions may optimize their outcomes. Objective To identify factors that predict which patients with FAIS proceed to surgery within 90 days of their initial evaluation by an orthopedic surgeon. The study explored potential predictors of surgical intervention, including demographic factors, activity level, symptom duration, previous treatment, hip function, pain, presence of labral tear, and patient interest in surgical and physical therapy (PT) treatment. Design Prospective cohort. Setting Single‐site academic medical center. Patients Seventy‐seven individuals with FAIS. Intervention After evaluation in a hip preservation clinic, participants reported activity level, symptom duration, treatment history, hip function [Hip Outcome Score Activities of Daily Living(HOS‐ADL)], pain severity and location, and treatment interests. These variables were evaluated based on univariate analysis for entry into a multiple binomial logistic regression to identify predictors of surgery within 90 days. Adjusted marginal prevalence ratios and 95% confidence interval estimates (PR [95% CI]) were reported ( P ≤ .05). Main Outcome Measure(s) Ninety‐day treatment (surgery or not). Results Participants indicated initial interest in surgery (n = 27), PT (n = 22), both (n = 18), or neither (n = 10). Those only interested in PT had lower prevalence of diagnosed labral tear ( P < .001) and previous PT for the hip ( P < .001). Prevalence of previous injection was higher for those only interested in surgery than for those with any interest in PT ( P < .001). Thirty‐six of 77 participants (46%) underwent surgery within 90 days. Surgical interest (3.56 [1.57, 5.46]), previous hip injection (3.06 [1.73, 3.89]), younger age (0.95 [0.92, 0.98]), and worse hip function (0.97 [0.95, 0.99]) were significant ( P ≤ .02) predictors of surgery. Conclusions Treatment interest and history, patient function, and age were significantly related to participants' decision to pursue surgical intervention within 90 days. Patient engagement in the decision‐making process should include considerations of patient knowledge of, and experience with, the various treatment options.