EP6.8 Do sagittal spinopelvic parameters impact outcomes following arthroscopic surgery for femoroacetabular impingement? - A systematic review

Abstract Background: Femoroacetabular impingement (FAI) is a prevalent cause of hip pain in young adults, with 10-20% of patients expressing dissatisfaction after surgery. Stemming from arthroplasty literature, recent studies have examined the influence of spinopelvic balance and its related parameters on postoperative outcomes in FAI, encountering mixed results and using diverse terminology. Purpose: To assess the relationship between spinopelvic parameters and outcomes six months or more after hip arthroscopic surgery for FAI. Methods: A systematic search was conducted across PubMed, EMBASE, and Scopus from their respective inception dates up to January 11, 2024. This search targeted articles with a level of evidence 4 or higher that assessed the relationship between static or dynamic spinopelvic parameters and postoperative outcomes in hip arthroscopic surgery for FAI. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, two reviewers independently screened the articles for eligibility, extracted relevant data for analysis, and assessed their methodological quality using the Methodological Index for Non-Randomized Studies (MINORS) score. A descriptive and qualitative analysis of the results was conducted. Results: Of the 1609 articles screened, 6 studies involving 531 patients (mean 88.5; range 35 to 200) were included in this review. The mean age of participants was 33.83 (range 30.2 to 39.4) years, with 54.3% (range 26.20 to 68.50%) male, over an average follow-up of 13.12 (range 6 to 27.6) months. All included studies had a level of evidence of III or IV. Four studies examined static and two assessed dynamic spinopelvic parameters. Two studies reported statistically worse outcomes after FAI surgery in at least one patient reported outcome score or category in patients with greater anterior pelvic tilt. No statistically significant relationship was observed with pelvic incidence, lumbar lordosis or sacral slope. One study found that patients with restricted pelvic-lumbar mobility, as measured with a physical examination maneuver, had worse absolute postoperative outcomes. Conclusion: Increased anterior pelvic tilt may correlate with marginally poorer postoperative outcomes in FAI surgery. This review underscores the potential benefits of assessing spinopelvic balance to enhance surgical results, although evidence remains sparse, highlighting the need for further research.