Abstract
Purpose
To review the literature on femoroacetabular impingement (FAI) treatment outcomes, specifically focusing on potential pre-operative radiographic parameters that may provide prognostic information regarding outcomes following surgical management.
Methods
A comprehensive review of computerized literature databases (Medline Ovid and PubMed) was performed, searching for articles reporting on FAI treatment outcomes. A single reviewer screened titles, abstracts and performed full-text reviews of eligible studies. The references of these studies were further screened for additional potentially relevant studies. A total of 243 studies were reviewed, with 18 meeting inclusion criteria.
Results
Thirteen arthroscopic studies reported on 1556 patients, with clinical improvement in 35–92 % of patients and associated failure rates of 12–71 %. Five open surgical studies reported on 238 patients with clinical improvement in 65–95 % of patients and associated failure rates of 0–35 %. Both arthroscopic and open studies identified inferior outcomes with pre-operative radiographic findings of an elevated Tönnis grade (grade 2 or higher), joint space <2 mm, lateral centre-edge angle (LCEA) <20° and incomplete femoral osteoplasty.
Conclusion
Pre-operative radiographic findings of osteoarthritis (Tönnis grade 2/3, <2 mm joint space) or dysplasia (LCEA < 20°) should be considered relative contraindications to joint preservation surgery as outcomes are worse among these patients and associated with a higher risk of conversion to total hip arthroplasty. Care should also be taken to perform a thorough femoral osteoplasty to reduce the risk of failure and need for revision surgery.
Level of evidence
III.
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References
Aprato A, Jayasekera N, Villar RN (2014) Revision hip arthroscopic surgery: outcome at three years. Knee Surg Sports Traumatol Arthrosc 22(4):932–937
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73
Bedi A, Chen N, Robertson W, Kelly BT (2008) The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 24(10):1135–1145
Bedi A, Dolan M, Hetsroni I, Magennis E, Lipman J, Buly R, Kelly BT (2011) Surgical treatment of femoroacetabular impingement improves hip kinematics: a computer-assisted model. Am J Sports Med 39(Suppl):43S–49S
Bedi A, Zaltz I, De La Torre K, Kelly BT (2011) Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med 39(Suppl):20S–28S
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840
Bizzini M, Notzli HP, Maffiuletti NA (2007) Femoroacetabular impingement in professional ice hockey players: a case series of 5 athletes after open surgical decompression of the hip. Am J Sports Med 35(11):1955–1959
Byrd JWT, Jones KS (2010) Prospective analysis of hip arthroscopy with 10-year followup. Clin Orthop Relat Res 468:741–746
Byrd JWT, Jones KS (2009) Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 467:739–746
Byrd JWT, Jones KS (2011) Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 27(10):1379–1388
Christensen CP, Althausen PL, Mittleman MA, Lee J, McCarthy JC (2003) The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res 406:75–83
Cohen SB, Huang R, Ciccotti MG, Dodson CC, Parvizi J (2012) Treatment of femoroacetabular impingement in athletes using a mini-direct anterior approach. Am J Sports Med 40(7):1620–1627
Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ (2014) Revision hip preservation surgery with hip arthroscopy: clinical outcomes. Arthroscopy 30(5):581–587
Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) 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 83(8):1119–1124
Gedouin J-E, May O, Bonin N, Nogier A, Boyer T, Sadri H, Villar R-N, Laude F (2010) Assessment of arthroscopic management of femoroacetabular impingement. A prospective multicenter study. Orthop Traumatol Surg Res 96(8 Suppl):S59–S67
Gupta A, Redmond JM, Stake CE, Dunne KF, Domb BG (2015) Does primary hip arthroscopy result in improved clinical outcomes? 2-Year clinical follow-up on a mixed group of 738 consecutive primary hip arthroscopies performed at a high-volume referral center. Am J Sports Med [Epub ahead of print]
Hetaimish BM, Khan M, Crouch S, Simunovic N, Bedi A, Mohtadi N, Bhandari M, Ayeni OR (2013) Consistency of reported outcomes after arthroscopic management of femoroacetabular impingement. Arthroscopy 29(4):780–787
Horisberger M, Brunner A, Herzog RF (2010) Arthroscopic treatment of femoral acetabular impingement in patients with preoperative generalized degenerative changes. Arthroscopy 26(5):623–629
Kappe T, Kocak T, Bieger R, Reichel H, Fraitzl CR (2011) Radiographic risk factors for labral lesions in femoroacetabular impingement. Clin Orthop Relat Res 469:3241–3247
Larson CM, Giveans MR, Samuelson KM, Stone RM, Bedi A (2014) Arthroscopic hip revision surgery for residual femoroacetabular impingement (FAI): surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction. Am J Sports Med 42(8):1785–1790
Larson CM, Giveans MR, Taylor M (2011) Does arthroscopic FAI correction improve function with radiographic arthritis? Clin Orthop Relat Res 469:1667–1676
Lattanzi R, Petchprapa C, Ascani D, Babb JS, Chu D, Davidovitch RI, Youm T, Meislin RJ, Recht MP (2014) Detection of cartilage damage in femoroacetabular impingement with standardized dGEMRIC at 3 T. Osteoarthritis Cartilage 22(3):447–456
McCarthy JC, Jarrett BT, Ojeifo O, Lee JA, Bragdon CR (2011) What factors influence long-term survivorship after hip arthroscopy? Clin Orthop Relat Res 469:362–371
McConnell S, Kolopack P, Davis AM (2001) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 45(5):453–461
Murphy S, Tannast M, Kim Y-J, Buly R, Millis MB (2004) Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res 429:178–181
Nepple JJ, Byrd JWT, Siebenrock KA, Prather H, Clohisy JC (2013) Overview of treatment options, clinical results, and controversies in the management of femoroacetabular impingement. J Am Acad Orthop Surg 21(Suppl 1):S53–S58
Parvizi J, Bican O, Bender B, Mortazavi SMJ, Purtill JJ, Erickson J, Peters C (2009) Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty 24(6 Suppl):110–113
Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am 88(8):1735–1741
Philippon MJ, Briggs KK, Carlisle JC, Patterson DC (2013) Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res 471(8):2492–2496
Philippon MJ, Briggs KK, Yen Y-M, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91(1):16–23
Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ (2007) Revision hip arthroscopy. Am J Sports Med 35(11):1918–1921
Philippon MJ, Schroder E, Souza BG, Briggs KK (2012) Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthroscopy 28(1):59–65
Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ (2010) Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. Am J Sports Med 38(1):99–104
Pollard TCB, McNally EG, Wilson DC, Wilson DR, Mädler B, Watson M, Gill HS, Carr AJ (2010) Localized cartilage assessment with three-dimensional dGEMRIC in asymptomatic hips with normal morphology and cam deformity. J Bone Joint Surg Am 92(15):2557–2569
Rakhra KS, Lattanzio P-J, Cárdenas-Blanco A, Cameron IG, Beaulé PE (2012) Can T1-rho MRI detect acetabular cartilage degeneration in femoroacetabular impingement? A pilot study. J Bone Joint Surg Br 94(9):1187–1192
Ross JR, Larson CM, Adeoyo O, Kelly BT, Bedi A (2015) Residual deformity is the most common reason for revision hip arthroscopy: a three-dimensional CT study. Clin Orthop Relat Res 473(4):1388–1395. doi:10.1007/s11999-014-4069-9
Sink EL, Fabricant PD, Pan Z, Dayton MR, Novais E (2013) Results of treatment of femoroacetabular impingement in adolescents with a surgical hip dislocation approach. Clin Orthop Relat Res 471(8):2563–2569
Stähelin L, Stähelin T, Jolles BM, Herzog RF (2008) Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy 24(1):51–57
Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenrock KA (2014) Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat Res 472(1):337–348
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Degen, R.M., Nawabi, D.H., Bedi, A. et al. Radiographic predictors of femoroacetabular impingement treatment outcomes. Knee Surg Sports Traumatol Arthrosc 25, 36–44 (2017). https://doi.org/10.1007/s00167-015-3794-2
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DOI: https://doi.org/10.1007/s00167-015-3794-2