Abstract
Background
The degree to which patient characteristics, clinical outcomes, and the nature, severity, and corresponding treatment of chondrolabral injury in femoroacetabular impingement (FAI) is associated with failure after surgery is incompletely understood.
Questions/purposes
(1) Are patient factors associated with failure (age, sex, body mass index, and preoperative modified Harris hip score [mHHS]) in the open surgical treatment of FAI? (2) Is the nature of chondrolabral injury associated with failure? (3) Are any specific chondrolabral injury treatment methods superior?
Methods
Between 2000 and 2008, 172 open surgical procedures in 167 patients were performed for the treatment of FAI by two surgeons at two separate academic medical centers. Ultimately, 142 patients were included in this retrospective study. Mean followup was 3 years (range, 1–12 years). Patient and clinical factors along with the nature, severity, and treatment of chondrolabral injuries were assessed for an association with failure, defined as conversion to THA or the inability to achieve the minimum clinically important difference of the mHHS. Thirty-two percent (45 of 142) of patients failed open surgical treatment of FAI.
Results
Patient factors associated with failure included age (odds ratio [OR], 1.04; p = 0.036) and preoperative mHHS (OR, 4.42; p = 0.033). Neither the nature of the labral lesion nor the severity of the chondral lesion demonstrated a relationship with failure (p > 0.05). Surgically, labral refixation was associated with a decrease in the risk of failure (OR, 0.31; p = 0.039).
Conclusions
We were unable to identify an increased risk of poor outcomes based on sex, body mass index, or severity of chondrolabral lesions. We did find an increased risk of poorer outcomes associated with age. Labral refixation was associated with a decrease in the risk of failure indicating that treatment methodology, rather than the nature of the chondrolabral injury, may be associated with clinical failure. Future studies will be needed to help determine optimal treatment strategies for chondrolabral injuries.
Level of Evidence
Level IV, therapeutic study.
Similar content being viewed by others
References
Anderson LA, Crofoot CD, Erickson JA, Peters CL. Staged surgical dislocation and redirectional periacetabular osteotomy: a report of five cases. J Bone Joint Surg Am. 2009;91:2469–2476.
Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR. Acetabular cartilage delamination in femoroacetabular impingement. Risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am. 2009;91:305–313.
Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.
Beaule PE, Zaragoza E, Copelan N. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination. A report of four cases. J Bone Joint Surg Am. 2004;86:2294–2298.
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.
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.
Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–587.
Chahal J, Van Thiel G, Mather R, Lee S, Salata M, Nho S. The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris hip score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. Orthopaedic Journal of Sports Medicine. 2014;2:7.
Cohen SB, Huang R, Ciccotti MG, Dodson CC, Parvizi J. Treatment of femoroacetabular impingement in athletes using a mini-direct anterior approach. Am J Sports Med. 2012;40:1620–1627.
Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clin Sports Med. 2006;25:327–335.
Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2):36–53.
Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.
Farjo LA, Glick J, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15:132–137.
Ganz R, Gill TJ, Gautier E, Ganz K, Krugel 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;83:1119–1124.
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;466:264–272.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003:112–120.
Haviv B, O’Donnell J. The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:18.
Larson CM, Giveans MR, Stone RM. Arthroscopic débridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40:1015–1021.
Leunig M, Werlen S, Ungersbock A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br. 1997;79:230–234.
McCarthy JC. The diagnosis and treatment of labral and chondral injuries. Instr Course Lect. 2004;53:573–577.
Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Débridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.
Naal FD, Miozzari HH, Schar M, Hesper T, Notzli HP. Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med. 2012;40:1501–1510.
Outerbridge RE. The etiology of chondromalacia patellae. 1961. Clin Orthop Relat Res. 2001;389:5–8.
Parvizi J, Bican O, Bender B, Mortazavi SM, Purtill JJ, Erickson J, Peters C. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 2009;24:110–113.
Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;15:561–570.
Peters CL, Erickson J. The etiology and treatment of hip pain in the young adult. J Bone Joint Surg Am. 2006;88(Suppl 4):20–26.
Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.
Peters CL, Schabel K, Anderson LA, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010;468:504–510.
Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.
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;91:16–23.
Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–1047.
Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med. 2006;25:299–308, ix.
Philippon MJ, Schenker ML, Briggs KK, Maxwell RB. Can microfracture produce repair tissue in acetabular chondral defects? Arthroscopy. 2008;24:46–50.
Schilders E, Dimitrakopoulou A, Bismil Q, Marchant P, Cooke C. Arthroscopic treatment of labral tears in femoroacetabular impingement: a comparative study of refixation and resection with a minimum two-year follow-up. J Bone Joint Surg Br. 2011;93:1027–1032.
Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54–60.
Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenrock KA. Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat Res. 2014;472:337–348.
Acknowledgments
We thank Jill Erickson and Nadia Hamad for their contributions to this work.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at the University of Utah School of Medicine, Salt Lake City, UT, USA; and the Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
About this article
Cite this article
Peters, C.L., Anderson, L.A., Diaz-Ledezma, C. et al. Does the Nature of Chondrolabral Injury Affect the Results of Open Surgery for Femoroacetabular Impingement?. Clin Orthop Relat Res 473, 1342–1348 (2015). https://doi.org/10.1007/s11999-014-4039-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-014-4039-2