Abstract
Introduction
The concept of femoroacetabular impingement (FAI) and the indication for surgical intervention have been established in the last decade. Despite promising short-term results and emerging arthroscopic techniques, it remains unclear whether patients benefit from surgical correction in the mid- to long-term and whether progressive joint degeneration can be prevented.
Materials and methods
A retrospective study of our first 50 consecutive patients who underwent arthroscopic correction for FAI was conducted. The modified Harris hip score (mHHS) was assessed preoperatively and at final follow-up. In addition, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and a subjective hip value (SHV) were added at final follow-up. Degenerative changes according to Kellgren and Lawrence scale and the α angle were analyzed preoperatively and on the most recent radiograph.
Results
Of a total of 50 patients, 44 (24 male, 20 female) with a mean age of 34.3 years (17–65) were available with complete follow-up. Of these 44 patients, 39 were treated with correction of the femoral offset for isolated cam deformity, 5 with additional focal pincer correction and partial labral resection. After a mean follow-up of 66.3 ± 14.5 months the mHHS had improved significantly from 67.2 ± 6.4 preoperatively to 86.4 ± 13.5 (p < 0.001). The WOMAC score (converted to 0 = best/100 = worst) resulted in mean indices for the subcategories pain, stiffness and function of 11.8 ± 16.5, 12.2 ± 17.8 and 9.1 ± 16.1. The SHV was reported with a mean of 77.7 ± 21.8 % at final follow-up. The α angle was reduced significantly from 57.2° ± 10.1° to 46.3° ± 7.4° (p < 0.001). The Kellgren and Lawrence score showed a non-significant trend from 2.0 ± 0.8 preoperatively to 2.2 ± 0.9 in the most recent radiograph (p = 0.46). 5 patients had been converted to a total hip arthroplasty a mean of 28 ± 7.1 months postoperatively. These patients were significantly (p < 0.01) older with a mean age of 49.8 ± 7.8 years and showed significantly higher present osteoarthritic changes with an average Kellgren and Lawrence score of 2.6 ± 2.5 before FAI correction (p < 0.01).
Conclusions
Arthroscopic correction of femoroacetabular impingement results in a persistent clinical improvement without significant progression of degenerative changes in the majority of patients. The indication for surgery should be established cautiously when degenerative changes are present.
Level of evidence
Level IV, Case series with no comparison group.
Similar content being viewed by others
References
Bardakos NV, Vasconcelos JC, Villar RN (2008) Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg Br 90:1570–1575
Beck M, Siebenrock KA, Affolter B, Notzli H, Parvizi J, Ganz R (2004) Increased intraarticular pressure reduces blood flow to the femoral head. Clin Orthop Relat Res 424:149–152
Botser IB, Jackson TJ, Smith TW, Leonard JP, Stake CE, Domb BG (2014) Open surgical dislocation versus arthroscopic treatment of femoroacetabular impingement. Am J Orthop 43:209–214
Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55:1629–1632
Byrd JW, Jones KS (2011) Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 27:1379–1388
Chahal J, Van Thiel GS, Mather RC, Lee S, Song SH, Davis AM, Salata M, Nho SJ (2015) The patient acceptable symptomatic state for the modified Harris Hip Score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med 43:1844–1849
Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL (2007) The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res 462:115–121
Dienst M, Gödde S, Seil R, Hammer D, Kohn D (2001) Hip arthroscopy without traction: in vivo anatomy of the peripheral hip joint cavity. Arthroscopy 17:924–931
Emara K, Samir W, el Motasem H, Ghafar KA (2011) Conservative treatment for mild femoroacetabular impingement. J Orthop Surg 19:41–45
Fink B, Sebena P (2010) Treatment of femoroacetabular impingement using a minimally invasive anterior approach. Oper Orthop Traumatol 22:17–27
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 83:1119–1124
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120
Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466:264–272
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16:717–721
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755
Horisberger M, Brunner A, Valderrabano V, Herzog RF (2010) Femoroacetabular impingement of the hip in sports—a review for sports physicians. Sportverletz Sportschaden Germany 24:133–139
Ipach I, Mittag F, Syha R, Kunze B, Wolf P, Kluba T (2012) Indications for total hip arthroplasty in young adults—idiopathic osteoarthritis seems to be overestimated. Rofo 184:239–247
Ito K, Minka MA, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Larson CM, Giveans MR (2008) Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy 24:540–546
Larson CM, Kelly BT, Stone RM (2011) Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 27:1732–1737
Leunig M, Beck M, Dora C, Ganz R (2005) Femoroacetabular impingement: etiology and surgical concept. Oper Tech Orthop 15:247–255
Leunig M, Beck M, Dora C, Ganz R (2006) Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade 35:77–84
Lung R, O’Brien J, Grebenyuk J, Forster BB, De Vera M, Kopec J, Ratzlaff C, Garbuz D, Prlic H, Esdaile JM (2012) The prevalence of radiographic femoroacetabular impingement in younger individuals undergoing total hip replacement for osteoarthritis. Clin Rheumatol 31:1239–1242
Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ (2011) Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy 27:252–269
Matsuda DK, Gupta N, Hanami D (2014) Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement. Arthrosc Tech 3:e197–e204
Naal FD, Miozzari HH, Schär M, Hesper T, Nötzli HP (2012) Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med 40:1501–1510
Nielsen TG, Miller LL, Lund B, Christiansen SE, Lind M (2014) Outcome of arthroscopic treatment for symptomatic femoroacetabular impingement. BMC Musculoskelet Disord 15:394
Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560
Nwachukwu BU, Rebolledo BJ, McCormick F, Rosas S, Harris JD, Kelly BT (2015) Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med [Epub ahead of print]
Palmer DH, Ganesh V, Comfort T, Tatman P (2012) Midterm outcomes in patients with cam femoroacetabular impingement treated arthroscopically. Arthroscopy 28:1671–1681
Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am 88:1735–1741
Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M (2007) Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med 35:1571–1580
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91:16–23
Philippon MJ, Schroder E, Souza BG, Briggs KK (2012) Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthroscopy 28:59–65
Redmond JM, El Bitar YF, Gupta A, Stake CE, Domb BG (2014) Arthroscopic acetabuloplasty and labral refixation without labral detachment. Am J Sports Med 43:105–112
Steppacher SD, Anwander H, Zurmühle CA, Tannast M, Siebenrock KA (2015) Eighty percent of patients with surgical hip dislocation for femoroacetabular impingement have a good clinical result without osteoarthritis progression at 10 years. Clin Orthop Relat Res 473:1333–1341
Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, Theiler R (1996) Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index. Z Rheumatol 55:40–49
Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D (2010) The Harris hip score: do ceiling effects limit its usefulness in orthopedics? Acta Orthop 81:703–707
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Hufeland, M., Krüger, D., Haas, N.P. et al. Arthroscopic treatment of femoroacetabular impingement shows persistent clinical improvement in the mid-term. Arch Orthop Trauma Surg 136, 687–691 (2016). https://doi.org/10.1007/s00402-016-2427-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-016-2427-7