I'd like to acknowledge my co-authors, especially John Cloese, so here are my disclosures. So FAI is now well accepted as a standard for improving patient symptoms and patient reported outcomes. A large body of literature supports the association of CAM-type FAI with arthritis, but we really have limited data connecting our surgeries to changing the natural history of this disease. So how important is femoral correction in FAI? The literature is a little bit mixed. We have better studies, level one evidence, comparing our surgeries to PT or sham-slash-laboral surgery. Femi-Aiene in the first study group showed labral treatment with and without CAM treatment, subtle differences in re-operation rate, but no difference in PROs. How much does femoral correction matter? Multiple studies really not showing your correction at the time of surgery correlates with early outcomes. Mike Terry in Chicago's group, pincer treatment, leaving the CAM alone, even that had pretty good outcomes that short term. In 2009, we published a study comparing hip arthroscopy with and without bony correction when bony correction was implemented at Wash U. This compared 23 in 25 hips at a minimum one year. At that time, we saw small differences favoring the bony correction, but relatively mild. So the purpose of the current study was to reinvestigate this group relative to outcome survivorship and PROs with and without femoral osteoplasty at a minimum of 15 years follow-up. So we utilized this previously established cohort. These are CAM type FAI with an alpha angle above 50, excluding pincer or combined type or any component of dysplasia. The surgeries were back between 2000 and 2005, a time period with labral debridement and no capsular closure. This was before and after the implementation of femoral osteoplasty with Dr. Klosy was performed through a mini open approach as previously published. We looked at outcomes with the modified Harris hip score utilizing MCID and PASS as well as endpoints for revision hip surgery or total hip. And we combined these two with a composite outcome being any reoperation or a clinical failure not reaching either MCID or PASS. So we looked at these at 15 years. We were able to find these patients at a mean of 19 and 16 years after their initial surgery. The analysis was done with basic univariate as well as Kaplan-Meier survivorship to normalize the length of follow-up. So here are our baseline characteristics, no significant differences, but the hip scope alone group was slightly more female and slightly older. The hip scope osteoplasty group tended to have a little more tonus II arthritis on radiographs as well as a slightly higher alpha angle. If we look at the intraoperative findings, these are a little bit sicker hips than we might choose for our surgeries today. The hip scope osteoplasty group had a slightly higher rate of vestibular grade IV chondromalacia while the opposite was true for the hip scope alone group, slightly higher on the femoral head. So when we look at our outcomes states, reoperation was significantly lower in the bony resection group, 24% versus 0%. The rate of total hip arthroplasty was dramatically different as well, 59% versus 22%. So any reoperation ends up combining those two to 71% versus 22%. PROs were significantly different as well, greater than 15 years out, 65% for a Harris hip compared to 83%. When we combine these two for a composite outcome, we have a 77% rate of ultimate failure in the isolated hip scope group compared to 35% with the hip scope and bony resection. So here's the Kaplan-Meier curves. I think this is interesting that at five years, these are almost the same. It really takes 10 to 15 years to find our differences. So this is any reoperation with an estimated 80% survivorship in the bony resection compared to 30% without bony resection. If we add just total hip, the numbers overall are fairly similar, similarly not diverging until after five years. If we look at confounding factors, TANUS-20A, the bony resection group seemed to convert to a total hip with a lower rate, even in the sicker hips, 12% versus 56%. With grade 3 or 4 chondromalacia of the astabulum or femur, all of the hip scope alone group converted to a total hip, whereas only 25% of those with bony procedures. So here are a couple case examples, 35-year-old and a 29-year-old that had hip scope alone ended up having arthroplasty. Here's a 17-year-old that had a similar procedure, got a little bit better, maybe not ever perfect. He develops increasing symptoms 10 years out, isn't arthritic at this point, so has subsequent labral repair and bony procedure, and seven years out from that revision surgery has a Harris hip that's perfect. So limitations, patient selection in this cohort has obviously changed and is different from what we do today. These are sicker hips. Similarly, FAI surgery also, this is a moving target. These are labral debridements, not capsular closure, but the results are relatively encouraging. These are small cohorts, but yet we were able to detect fairly large differences between the two. So in summary, femoral osteoplasty appears to play a substantial role in the long-term outcome of FAI surgery, increasing the rate of THA-free survivorship. These effects aren't really seen in the first five years after surgery. Future longer prospective studies remain important to support the ability of our surgeries to be truly hip-preserving and alter the natural history of FAI. Thank you.

Femoroacetabular Impingement

Femoral correction

Surgical treatment

Femoral osteoplasty

Long-term outcomes