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Femoroacetabular impingement syndrome management: arthroscopy or open surgery?

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Abstract

Purpose

This review explores the scientific evidence for clinical, functional and imaging outcomes after surgical management of Femoroacetabular Impingement (FAI) syndrome, and assesses the methodological quality of the published literature reporting this issue.

Methods

The medical literature databases of Pubmed, Medline, Ovid, Google Scholar and Embase were searched for articles published in English, Spanish, French and Italian, using a combination of the keywords ‘femoro-acetabular impingement syndrome’, ‘postoperative outcomes’, ‘open surgery’, and ‘arthroscopic management’. To address three main questions, we extracted data on demographic features, operative techniques, postoperative rehabilitation regimens, imaging features, pre and postoperative hip scores. Complications and conversion to arthroplasty were also investigated.

Results

Thirty-one studies published have reported clinical, functional and imaging outcomes after open and arthroscopic management of FAI syndrome. The modified Coleman methodology score (CMS) averaged 56.2 (range, 30–81). From extracted data, it was shown that arthroscopy, open surgery and arthroscopic surgery followed by mini open surgery are comparable for functional results, biomechanics, and return to sport. Progression of OA and conversion to hip arthroplasty are dependent on preoperative status of cartilage and osteoarthritis and type of management. Debridement and osteoplasty provide better results than debridement only. Significantly improved outcomes have been recorded in patients undergoing labral refixation than resection. The Coleman methodology score showed great heterogeneity in terms of study design and outcome assessment, and generally low methodological quality.

Conclusion

Although open and minimally invasive procedures allow athletes to return to professional sports activity, they are contraindicated in patients with severe osteoarthritis and cartilage degeneration.

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Conflicts of interest

All the authors disclose no conflicts of interest. No benefit in any form has been received or will be received from a commercial party related directly or indirectly to the subject of this paper.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy

    Rocco Papalia, Angelo Del Buono, Francesco Franceschi, Andrea Marinozzi & Vincenzo Denaro

  2. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK

    Nicola Maffulli

Authors
  1. Rocco Papalia
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  2. Angelo Del Buono
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  3. Francesco Franceschi
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  4. Andrea Marinozzi
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  5. Nicola Maffulli
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  6. Vincenzo Denaro
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Correspondence to Nicola Maffulli.

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Papalia, R., Del Buono, A., Franceschi, F. et al. Femoroacetabular impingement syndrome management: arthroscopy or open surgery?. International Orthopaedics (SICOT) 36, 903–914 (2012). https://doi.org/10.1007/s00264-011-1443-z

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  • DOI: https://doi.org/10.1007/s00264-011-1443-z

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