So next, we'll have Dr. Al-Habadi telling us about how combined version affects outcomes in FAI surgery. Thank you for this opportunity. I'm excited to present our study evaluating combined version and its impact, or lack thereof, on outcomes at midterm follow-up after hip arthroscopy. Traditionally, two-dimensional measurements, such as alpha angle and lateral center edge angle, have been assessed after hip arthroscopy. But as we all know, the femoral acetabular articulation is quite complex. And more recently, studies have evaluated 3D measures, including acetabular aversion, femoral aversion, and combined aversion, otherwise known as the McKibbin Index. And it's been known for quite some time that abnormalities in aversion can contribute to pain and worse long-term hip health. For example, femoral retroversion can cause increased acetabular contact. Anteversion may increase instability. And acetabular retroversion may increase contact pressures and degenerative changes. And with this, there have been increasing studies in the literature evaluating version in both the dysplastic patient population undergoing PAO and those undergoing hip arthroscopy. In 2015, Fabrikant et al. described a cohort of 243 patients undergoing hip arthroscopy and found that while all patients improved at 21-month follow-up, those with femoral retroversion less than 5 degrees had less improvement. And it's not well described if these abnormalities on the femoral side could be compensated by those on the acetabular side and vice versa. A recent systematic review also found mixed results with version changes in the femur and suggesting overall possible worse outcomes with anteversion, but there still remains literal overall known about how version abnormalities may impact even longer-term outcomes. Therefore, the purpose of our study, the primary purpose was to evaluate if combined version abnormalities affected PROs at midterm follow-up. The second aim was to evaluate the relative contributions of femoral and acetabular aversion to the combined version calculation. And finally, we sought to evaluate how femoral and acetabular aversion individually affected outcomes. So we performed a retrospective study from 2012 to 2017 with five-year follow-up and patients were required to have CT scans for version assessment. Patients with more severe dysplasia than borderline and tonic-grade 2 were excluded. And we evaluated PROs. And these were used to calculate MCID and PAS achievement rates. And we also calculated the acetabular version, femoral version, and combined version. We defined our subgroups as retroverted, anterverted, and normal version. And we used linear regression to evaluate these aversion abnormalities on PROs. We defined acetabular version as the angle between the anterior and posterior rim of the acetabulum in a perpendicular line along the posterior ischia. And femoral version was defined as the angle between the femoral neck axis and the transcondylar axis. And we defined normal version based on previously published ranges with 10 to 25 for acetabular, 5 to 20 for femoral, and 15 to 45 for combined. And retroversion was any value less than that. And anterversion was any value greater. In total, we had 338 patients with over five-year follow-up, of which approximately 68% were female. These are just general demographic differences. And the mean combined version was 29.5 degrees. The distribution of version by subgroups is shown here, which generated a fairly uniform histogram. And in this chart, blue represents normal combined version. Red are those with combined retroversion. And yellow-orange is those with combined anterversion. And you can see the majority of our patients had normal acetabular version, normal femoral version, and normal combined version. The next largest section had normal acetabular version, and acetabular version abnormalities were in a much smaller population. And about 2% of the population had compensated acetabular and femoral version abnormalities with the normal combined version. Ultimately, we found that combined version by any subgroup did not influence the achievement of, did not influence any PRO scores at any time point. And furthermore, combined version did not impact any achievement of MCID or PASS in any of the outcomes that we evaluated. When looking at the contributions to combined version, femoral version was found to be the primary driver of combined version, with a correlation coefficient of 0.88 compared to that of acetabular version of 0.58. And similar to combined version, femoral version in this study on its own did not impact outcomes and also did not influence MCID or PASS rate achievement. Acetabular version also did not significantly influence outcomes. The only significant postoperative difference we found was in five-year PASS achievement rate for VAS pain, but otherwise all outcomes in PASS and MCID did not differ by group. In conclusion, we found that combined version in our nondysplastic population did not influence midterm outcomes or achievement of MCID or PASS. And we found that femoral version provided a much stronger correlation to combined version than acetabular version did. But neither femoral nor acetabular version had a substantial impact on outcomes. Our ongoing research is looking at seeing if we can model these variables as continuous variables to see if that may influence outcomes as opposed to grouping people into separate buckets by predefined groups. Thank you.

hip arthroscopy

combined version abnormalities

midterm follow-up

3D measures

patient-reported outcomes (PROs)