The Radiographic Femoroepiphyseal Acetabular Roof Index Is a Reliable and Reproducible Diagnostic Tool in Patients Undergoing Hip-Preservation Surgery: A Systematic Review.

Dan Cohen Muyiwa Ifabiyi Graeme Mathewson Nicole Simunovic Marie-Lyne Nault Marc R Safran Olufemi R Ayeni

Arthroscopy

Division of Orthopaedic Surgery, Department of Surgery, and McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address:

Published: April 2023

The study evaluates the effectiveness of the femoroepiphyseal acetabular roof (FEAR) index as a diagnostic tool for hip-preservation surgery, analyzing various research articles.
The review included 11 studies with 1,458 patients, showing high reliability in both intraobserver and interobserver agreement for the FEAR index, indicating it is a trustworthy measurement.
While the FEAR index shows promise in guiding treatment decisions, the lack of a universally accepted cutoff value highlights the need for further standardization in its application.

Purpose: To assess the utility of the femoroepiphyseal acetabular roof (FEAR) index as a diagnostic tool in hip-preservation surgery.

Methods: MEDLINE, EMBASE, and PubMed were searched from database inception until May 2022 for literature addressing the utility of the FEAR index in patients undergoing hip-preservation surgery, and the results are presented descriptively.

Results: Overall, there were a total of 11 studies comprising 1,458 patients included in this review. The intraobserver agreement for the FEAR index was reported by 3 of 11 studies (intraclass correlation coefficient range = 0.86-0.99), whereas the interobserver agreement was reported by 8 of 11 studies (intraclass correlation coefficient range = 0.776-1). Among the 5 studies that differentiated between hip instability and hip impingement, the mean FEAR index in 319 patients in the instability group ranged from 3.01 to 13.3°, whereas the mean FEAR index in 239 patients in the impingement group ranged from -10 to -0.77° and the mean FEAR index in 105 patients in the control group ranged from -13 to -7.7°. Three studies defined a specific cutoff value for the FEAR index, with 1 study defining a cutoff value of 5°, which correctly predicted treatment decision between periacetabular osteotomy versus osteochondroplasty 79% of the time with an AUC of 0.89, whereas another defined a cutoff of 2°, which correctly predicted treatment 90% of the time and the last study set a threshold of 3°, which provided an AUC of 0.86 for correctly predicting treatment decision.

Conclusions: This review demonstrates that the FEAR index has a high agreement and consistent application, making it a useful diagnostic tool in hip-preservation surgery particularly in patients with borderline dysplastic hips. However, given the variability in FEAR index cutoff values across studies, there is no absolute consensus value that dictates treatment decision.

Level Of Evidence: Level IV; Systematic Review of Level II-IV studies.

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http://dx.doi.org/10.1016/j.arthro.2022.11.041	DOI Listing

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