TP5.1 Acetabular Over-Coverage Predicts Revision After Femoroacetabular Impingement Surgery: Association of Static and Dynamic Lateral Center-Edge Angle Classification with Reoperation Risk

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ID: 331000
2026
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Abstract
Abstract Background Revision after primary hip preservation surgery for femoroacetabular impingement (FAI) is commonly regarded as treatment failure, yet whether radiographic patterns of acetabular coverage — particularly over-coverage — predict revision remains underexplored. We hypothesized that dynamic lateral center-edge angle (LCEA) classification during gait would outperform static radiographic classification in stratifying revision risk. Methods Data from 101 FAI patients (38 male / 63 female; mean age 31.1 ± 11.7 years; mean BMI 26.0 ± 4.8 kg/m2) who underwent primary hip arthroscopy for FAI were reviewed. Static LCEA was classified as dysplastic <20°, borderline 20–25°, normal 25–40°, or over-covered ≥40°. Dynamic LCEA was computed by adding coronal pelvic tilt during walking to static LCEA. Associations with revision were assessed using Welch’s t-test, Mann–Whitney U, Chi-square, Fisher’s exact, Cohen’s d, and Cramér’s V tests. Results Twenty-three of 101 patients (22.8%) underwent revision. Mean static LCEA was higher in revision patients (36.7 ± 7.0° vs. 32.0 ± 6.2°; Δ = 4.7°; Welch t = −2.9, p = 0.007; Cohen’s d = 0.7). Revision rates increased progressively across static LCEA classification groups: Borderline 1/17 (5.9%), Normal 16/69 (23.2%), and Over-coverage 6/15 (40.0%)(Chi2 = 5.3, p = 0.07, Cramér’s V = 0.2). The same pattern held for dominant dynamic classification during walking (Over-coverage 4/11, 36.4%; Normal 14/70, 20.0%; Borderline 1/11, 9.1%; Dysplasia 0/2, 0.0%) and operative-stance (Over-coverage 4/11, 36.4%; Normal 13/69, 18.8%; Borderline 2/12, 16.7%; Dysplasia 0/2, 0.0%), though neither static nor dynamic LCEA based measurements reached significance. Mean and median dynamic LCEA differences were non-significant (Δ = +2.7°; p > 0.12; Cohen’s d = 0.4). Revision patients spent approximately twice as much gait time in the over-coverage band (24.0% vs. 12.3%). Conclusion Both static and dynamic LCEA exhibited the same directional pattern in association with revision risk; however, static LCEA approached significance and showed a stronger association. Over-coverage (LCEA ≥40°) carried a roughly doubled revision rate relative to normal coverage, while only 1 of 17 borderline patients was revised. Dynamic classifications preserved the rank ordering but its detailed effect on prediction of revision risk needs clarification in larger studies.
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Authors Andrew Jimenez, Michael Cobo, Nils Becker, Lucas Kim, Renato Locks, Aidin Eslam Pour
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.162
URL
https://doi.org/10.1093/jhps/hnag043.162
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