Arthroscopic treatment of femoroacetabular impingement: early outcomes

Abstract

Objective: The aim of the study was to assess the early outcomes of the arthroscopic treatment of femoroacetabular impingement.
Methods: Forty-two femoroacetabular impingement (FAI) patients (mean age: 35.1 years, range: 16 to 52 years) treated arthroscopically between 2006 and 2011 in our clinic were retrospectively analyzed. Twenty-five patients had Cam, 6 Pincer and 11 combined femoroacetabular impingement. Mean followup time was 28.2 (range: 10 to 72) months. Patients were assessed clinically and functionally using the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Oxford Hip Score, WOMAC score, and Visual Analogue Scale (VAS) pain scores preoperatively and at the final follow-up.
Results: In clinical and functional assessments, there were increases of 24.8 points in mean NAHS, 23.3 in mHHS, 20.6 in WOMAC score and 9.6 in Oxford Hip Score. VAS pain score decreased by 4.9 points in comparison to the preoperative scores. There were no major complications. However, transient pudendal nerve neuropraxia was present in two patients, transient lateral femoral cutaneous nerve neuropraxia in one and asymptomatic heterotopic ossification in one patient.
Conclusion: Short-term clinical results of the arthroscopic treatment of the FAI appear to be satisfactory.

Keywords

• Arthroscopic treatment
• femoroacetabular impingement
• postoperative early term

Femoroasetabuler sıkışmanın artroskopik tedavisi: Erken dönem sonuçlar

Öz

Amaç: Bu çalışmamızda femoroasetabuler sıkışma tanısı konulan ve artroskopik cerrahi tedavi uygulanan hastaların erken dönem sonuçlarını değerlendirmeyi amaçladık. Çalışma planı: 2006-2011 tarihleri arasında femoroasetabuler sıkışma tanısıyla kliniğimizde artroskopik tedavi uygulanan 42 hasta (ortalama yaş: 35.1, dağılım: 16-52) retrospektif olarak değerlendirildi. Hastaların 25’inde Cam, 6’sında Pincer tipi ve 11’inde kombine femoroasetabuler sıkışma vardı. Ortalama takip süresi 28.2 (dağılım: 10-72) ay olarak kaydedildi. Hastalar cerrahi öncesi ve son kontrollerinde Artrozik Olmayan Kalça Skorlaması (Non-Arthritic Hip Score, NAHS), Modifiye Harris Kalça Skoru (modified Harris Hip Score, mHHS), Oxford Kalça Skoru, WOMAC skoru ve Görsel Analog Skala (Visual Analog Scale, VAS) ağrı skoruyla klinik ve fonksiyonel durumları değerlendirildi. Bulgular: Hastaların klinik ve fonksiyonel skorlamalarında, cerrahi öncesi skorlarla kıyaslandığında, ortalama NAHS’da 24.8, mHHS’da 23.3, WOMAC skorunda 20.6, Oxford Kalça Skorunda 9.6 puanlık artış bulunurken, ortalama VAS ağrı skorunda ise 4.9 puanlık bir azalma saptandı. Hasta serimizde majör komplikasyon olmamasına rağmen iki hastada geçici pudental sinir nöropraksisi, bir hastada geçici lateral femoral kutanöz sinir nöropraksisi, bir hastada da asemptomatik heterotopik ossifikasyon görüldü. Çıkarımlar: Femoroasetabuler sıkışma nedeniyle artroskopik tedavi uyguladığımız hastalarımızın erken dönem tedavi sonuçlarının tatmin edici olduğunu düşünüyoruz.

Anahtar Kelimeler

• Artroskopik tedavi; femoroasetabuler sıkışma; cerrahi sonrası erken dönem.

References

1. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003;(417):112-20.
2. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008;466:264-72.
3. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol 1965;38:810-24.
4. Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 1976;58:176-83.
5. Solomon L, Schnitzler CM, Browett JP. Osteoarthritis of the hip: the patient behind the disease. Ann Rheum Dis 1982;41:118-25.
6. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 1986;(213):20-33.
7. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 1999;(363):93-9.
8. Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 2001;15:475-81.

9. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119-24. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 2004;(418):67-73.
10. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 2006;88: 1448Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 2006;88: 925Clohisy JC, McClure JT. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J 2005;25:164
11. Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med 2006;25:299-308.
12. Beaulé PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am 2007;89:773-9.
13. Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res 2004;(429):178-81.
14. Bardakos NV, Vasconcelos JC, Villar RN. Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg Br 2008;90:1570-5.
15. Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 2009;467:739-46.
16. Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy 2009;25:369
17. As›k M, K›r MÇ. Hip arthroscopy. [Article in Turkish] Türkiye Klinikleri Ortopedi ve Travmatoloji Artroskopik Cerrahi Special Issue 2009;2:52-6.
18. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961;43-B:752–7.
19. Tönnis D, Itoh K, Heinecke A, Behrens K. The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings. [Article in German] Z Orthop Ihre Grenzgeb 1984;122:50-61.
20. Tönnis D, Heinecke A, Nienhaus R, Thiele J. Predetermination of arthrosis, pain and limitation of movement in congenital hip dysplasia (author’s transl). [Article in German] Z Orthop Ihre Grenzgeb 1979;117:808-15.
21. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am 2010;92: 1162Leunig M, Beaulé PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 2009;467:616-22.
22. Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at shortterm followup. Clin Orthop Relat Res 2010;468:504-10.
23. Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res 2010;468:555-64.
24. Stähelin L, Stähelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy 2008;24: 51Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy 2008;24:540-6.
25. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 2009;91: 16Horisberger M, Brunner A, Herzog RF. Arthroscopic treatment of femoroacetabular impingement of the hip: a new technique to access the joint. Clin Orthop Relat Res 2010; 468:182-90.
26. Johnston TL, Schenker ML, Briggs KK, Philippon MJ. Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy 2008; 24:669-75.
27. Meermans G, Konan S, Haddad FS, Witt JD. Prevalence of acetabular cartilage lesions and labral tears in femoroacetabular impingement. Acta Orthop Belg 2010;76:181-8.
28. Konan S, Rayan F, Meermans G, Witt J, Haddad FS. Validation of the classification system for acetabular chondral lesions identified at arthroscopy in patients with femoroacetabular impingement. J Bone Joint Surg Br 2011; 93:332-6.
29. Nepple JJ, Larson CM, Smith MV, Kim YJ, Zaltz I, Sierra RJ, et al. The reliability of arthroscopic classification of acetabular rim labrochondral disease. Am J Sports Med 2012;40:2224-9. Mast NH, Impellizzeri F, Keller S, Leunig M. Reliability and agreement of measures used in radiographic evaluation of the adult hip. Clin Orthop Relat Res 2011;469:188-99.
30. Werner CM, Copeland CE, Ruckstuhl T, Stromberg J, Turen CH, Kalberer F, et al. Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign. Acta Orthop Belg 2010;76: 166Grant AD, Sala DA, Schwarzkopf R. Femoroacetabular impingement: the diagnosis – a review. J Child Orthop 2012; 6:1Kappe T, Kocak T, Neuerburg C, Lippacher S, Bieger R, Reichel H. Reliability of radiographic signs for acetabular retroversion. Int Orthop 2011;35:817-21.
31. Kutty S, Schneider P, Faris P, Kiefer G, Frizzell B, Park R, et al. Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Int Orthop 2012;36:505-10.
32. Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy 2000;16:578-87.
33. McCarthy J, Barsoum W, Puri L, Lee JA, Murphy S, Cooke P. The role of hip arthroscopy in the elite athlete. Clin Orthop Relat Res 2003;406:71-4.
34. Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 2011;27:1453-98.
35. Smith CD, Masouros S, Hill AM, Amis AA, Bull AMJ. A biomechanical basis for tears of the human acetabular labrum. Br J Sports Med 2009;43:574-8.
36. Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy 2011;27:252
37. Botser IB, Smith TW Jr, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 2011; 27:270-8.