Preoperative computed tomography in femoroacetabular impingement is associated with increased risk of malignancy and other radiation-associated pathologies.
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PURPOSE: Femoroacetabular impingement (FAI) primarily affects young, active adults, many of whom undergo hip arthroscopy at an age when sensitivity to ionizing radiation is greatest. Routine use of computed tomography (CT) in preoperative planning remains controversial due to concerns about radiation exposure and long-term oncogenic risk. The hypothesis was that CT imaging before FAI surgery would be associated with increased risk of malignancy. METHODS: A retrospective comparative cohort study with 1:1 propensity score matching was performed using the TriNetX Research Network. Patients undergoing hip arthroscopy with or without a preoperative CT scan were identified using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. The primary outcome was incident malignant neoplasm diagnosis following hip arthroscopy. Secondary outcomes included benign neoplasms, endocrine disorders, blood dyscrasias, infertility, testosterone use and cardiovascular disease. Risk was compared with log-rank, and significance was set at p < 0.05. RESULTS: After matching, 9127 patients remained in each cohort. Mean follow-up was 1345 days in the CT cohort and 1275 days in the non-CT cohort. The CT cohort had higher rates of benign neoplasms (odds ratio [OR] = 1.41, p < 0.001), malignant neoplasms (OR = 1.33, p = 0.023), and solid malignancies (OR = 1.38, p = 0.008), while haematologic malignancies occurred at similar rates. Blood dyscrasias (OR = 1.78, p < 0.001), endocrine disorders (OR = 1.47, p < 0.001) and gonadal disorders (OR = 1.28, p = 0.032) were increased in the CT cohort. There was no difference in rates of infertility or cardiovascular disease between cohorts. CONCLUSION: In a large, propensity-matched cohort of patients undergoing hip arthroscopy for FAI, preoperative CT imaging was associated with higher long-term rates of benign and malignant pathologies, blood dyscrasias, endocrine disorders and heart disease. These findings indicate that radiation exposure in this young population may confer long-term risks which warrant judicious use of CT. LEVEL OF EVIDENCE: Level III retrospective.