Skip to main content

Advertisement

SpringerLink
Log in

Arthroscopic treatment of femoroacetabular pincer impingement

Arthroskopische Behandlung des femoroazetabulären Pincer-Impingements

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Abstract

Objective

Arthroscopic resection of the bony overhang of the acetabular rim with concurrent treatment of associated chondrolabral injury in order to improve femoroacetabular clearance, provide symptomatic relief and in theory, delay the onset or progression of osteoarthritis of the hip.

Indications

Clinical and radiographic evidence of femoroacetabular pincer or combined impingement, with minimal to moderate degenerative change in the hip joint.

Contraindications

Advanced osteoarthritis of the hip joint. Femoroacetabular pincer impingement arising from generalised overcoverage, e.g. coxa profunda. Acetabular retroversion in a dysplastic hip.

Surgical technique

Arthroscopy of the peripheral compartment, using a proximal anterolateral viewing portal and anterior and anterolateral working portals. Labral assessment, release from its capsular reflection, limited bony resection of the acetabular rim or labral ossification. Central compartment arthroscopy under traction, using the anterolateral and anterior portals alternately as viewing and working portals, and a distal anterolateral accessory portal. The labrum is detached to expose the bony overhang in the acetabular rim, which is resected with a burr. The labrum is refixed if it is of sufficient quality and debrided or resected otherwise.

Postoperative management

Labral resection: partial weight bearing, with pain-controlled progression to full weight bearing over 1–2 weeks. Labral refixation: Protected (20 kg) weight bearing for the first 4 weeks. Continuous passive motion therapy and the use of a stationary bicycle for 4 weeks, and early proprioceptive training are part of the rehabilitation regimen.

Results

Arthroscopic treatment of femoroacetabular impingement has been shown to provide symptomatic relief, improve hip outcome scores and is postulated to delay progression of osteoarthritis. Better clinical outcomes can be obtained with labral refixation if the labrum is of sufficient quality.

Zusammenfassung

Operationsziel

Arthroskopische Resektion des Pfannenrandüberhangs einschließlich der Behandlung des Folgeschadens am Knorpel-Labrum-Übergang, mit dem Ziel, die Gelenkmechanik zu normalisieren, Schmerzen zu reduzieren, und zumindest theoretisch eine sekundäre arthrotische Gelenkzerstörung aufzuhalten oder zu verzögern.

Indikation

Beschwerden und radiologischer Nachweis eines femoroazetabulären Pincer oder kombinierten Impingements, mit initialer oder moderater Gelenkschädigung.

Kontraindikationen

Fortgeschrittene Coxarthrose. Femoroazetabuläres Pincer-Impingement aufgrund einer global vermehrten Überdachung z. B. bei einer Coxa profunda. Azetabuläre Retroversion bei gleichzeitiger azetabulärer Restdysplasie.

Operationstechnik

Arthroskopie des peripheren Kompartiments über ein proximal ventrolaterales Portal zur Inspektion und ein ventrales und ventrolaterales Instrumentenportal. Beurteilung des Labrum acetabulare, Durchtrennung der kapsulolabralen Verbindung, Entfernung von möglichen Ossifikationen oder Kalzifikationen, partielle Pfannenrandtrimmung. Arthroskopie des zentralen Kompartiments unter Traktion über ein ventrolaterales und ventrales Portal als Inspektions- und Instrumentenportale sowie ein distal ventrolaterales Instrumentenportal. Vollständige Ablösung des Labrum, Darstellung und Resektion des überhängenden Pfannenrandanteils. Refixation eines qualitativ guten Labrum, anderenfalls Resektion.

Weiterbehandlung

Labrumresektion: Schmerzadaptierter Übergang zur Vollbelastung innerhalb von 1–2 Wochen. Labrumrefixation: Teilbelastung von 20 kg für die ersten 4 Wochen. Passive Motorschienenbehandlung für 4 Wochen, Standfahrrad und frühes Propriozeptionstraining.

Ergebnisse

Die arthroskopische Behandlung des femoroazetabulären Impingements führt zu einer signifikanten Schmerzreduktion, zur Steigerung von Ergebnisscores und möglicherweise zu einer Verzögerung einer arthrotischen Gelenkschädigung. Bessere klinische Resultate ergeben sich nach Refixationen eines qualitativ guten Labrum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. Beck M, Kalhor M, Leunig M et al (2005) 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 Am 87:1012–1018

    Article  CAS  Google Scholar 

  2. Botser IB, Smith TW, Jr., Nasser R et al. (2011) Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 27:270–278

  3. Brand RA (2009) Femoroacetabular impingement: current status of diagnosis and treatment: Marius Nygaard Smith-Petersen, 1886–1953. Clin Orthop Rel Res 467:605–607

    Article  Google Scholar 

  4. Byrd JW, Jones KS (2011) Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 27:1379–1388

    Article  PubMed  Google Scholar 

  5. Cadet ER, Chan AK, Vorys GC et al (2012) Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med 40:2218–2223

    Article  PubMed  Google Scholar 

  6. Dienst M, Kusma M, Steimer O et al (2010) Arthroscopic resection of the cam deformity of femoroacetabular impingement. Oper Orthop Traumatol 22:29–43

    Article  PubMed  Google Scholar 

  7. Eijer H, Myers SR, Ganz R (2001) Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 15:475–481

    Article  CAS  PubMed  Google Scholar 

  8. Espinosa N, Rothenfluh DA, Beck M et al (2006) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 88:925–935

    Article  PubMed  Google Scholar 

  9. Ferguson SJ, Bryant JT, Ganz R et al (2003) An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 36:171–178

    Article  CAS  PubMed  Google Scholar 

  10. Ganz R, Parvizi J, Beck M et al (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Rel Res 417:112–120

    Google Scholar 

  11. Ganz R, Leunig M, Leunig-Ganz K et al (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Rel Res 466:264–272

    Article  Google Scholar 

  12. Hossain M, Andrew JG (2008) Current management of femoro-acetabular impingement. Current Orthopaedics 22:300–310

    Article  Google Scholar 

  13. Ilizaliturri VM, Jr. (2009) Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Rel Res 467:760–768

  14. Jackson TJ, Hanypsiak B, Stake C et al (2014) Arthroscopic labral base repair in the hip: Clinical results of a described technique. Arthroscopy 30:208–213

    Article  PubMed  Google Scholar 

  15. Kim YT, Azuma H (1995) The nerve endings of the acetabular labrum. Clin Orthop Rel Res 320:176–181

    Google Scholar 

  16. Krych AA, Thompson M, Knutson Z et al (2013) Arthroscopic labral repair vs. selective labral debridement in female patients with femoroacetabulr impingement: A prospective randomized study. Arthroscopy 29:46–53

    Article  PubMed  Google Scholar 

  17. Larson CM, Giveans MR, Stone RM (2012) Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med 40:1015–1021

    Article  PubMed  Google Scholar 

  18. Leunig M, Beaule PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Rel Res 467:616–622

    Article  Google Scholar 

  19. Matsuda DK, Carlisle JC, Arthurs SC et al (2011) Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy 27:252–269

    Article  PubMed  Google Scholar 

  20. Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Rel Res 363:93–99

    Google Scholar 

  21. Ng VY, Arora N, Best TM et al (2010) Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med 38:2337–2345

    Article  PubMed  Google Scholar 

  22. Philippon MJ, Arnoczky SP, Torrie A (2007) Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy 23:376–380

    Article  PubMed  Google Scholar 

  23. Philippon MJ, Briggs KK, Yen YM et al (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

    Article  CAS  PubMed  Google Scholar 

  24. Schilders E, Dimitrakopoulou A, Bismil Q et al (2011) 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 93:1027–1032

    Article  CAS  PubMed  Google Scholar 

  25. Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85-A:278–286

    CAS  PubMed  Google Scholar 

  26. Smith MV, Panchal HB, Ruberte Thiele RA et al (2011) Am J Sports Med 39:103S–110S

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopädische Chirurgie München (OCM), Steinerstraße 6, 81369, Munich, Germany

    S.-Y. Poh, R. Hube & M. Dienst M.D.

Authors
  1. S.-Y. Poh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Hube
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dienst M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Dienst M.D..

Ethics declarations

Conflict of interest

S.-Y. Poh and R. Hube state that they have no conflict of interest. M. Dienst is consultant for Karl Storz.

This manuscript does not include studies on humans or animals.

Additional information

Redaktion

U. Bosch, Hannover

Zeichner

R. Himmelhan, Mannheim

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poh, SY., Hube, R. & Dienst, M. Arthroscopic treatment of femoroacetabular pincer impingement. Oper Orthop Traumatol 27, 536–552 (2015). https://doi.org/10.1007/s00064-015-0400-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-015-0400-1

Keywords

Schlüsselwörter

Search

Navigation