Skip to main content


Log in

Quantitative evaluation of residual bony impingement lesions after arthroscopic treatment for isolated pincer-type femoroacetabular impingement using three-dimensional CT

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



The objective of this study is to determine the clinical characteristics of residual bony impingement lesions after arthroscopic treatment for pincer-type femoroacetabular impingement (FAI); and to determine the effects of residual bony impingement lesions on the clinical outcomes after 2 years of follow-up.


From December 2010 to January 2012, 42 patients underwent arthroscopic surgery for symptomatic pincer-type FAI. Clinical outcomes were evaluated using the modified Harris Hip Score (mHHS) and satisfaction scores. To quantitatively evaluate the acetabular bony impingement lesions, the acetabular bony impingement angles were measured on three-dimensional CT scans. The incidence and residual rates of residual bony impingement were calculated. According to residual rates, the patients were divided into three groups: group 1, residual rate <10 %; group 2, residual rate 10–20 %; and group 3, residual rate >20 %.


Thirty patients met the inclusion criteria and were enrolled in this study. The mean age was 34.5 years. The mean follow-up was 26.3 months. Nineteen cases had residual bony impingement lesions after surgery. The incidence was 63.3 % (19/30). Sixteen cases (84.2 %) had residual bony impingement lesions posterior to the actual acetabular resection zones. The preoperative and postoperative bony impingement angles were 77.47° ± 21.31° and 12.94° ± 18.04°, respectively. The residual rate was 14.48 %. The overall mHHS significantly improved (P < 0.001) from 55.18 ± 7.96 preoperatively to 94.71 ± 4.39 postoperatively. The overall satisfaction rate was 76.66 %. The postoperative mHHSs of groups 1–3 were 95.86 ± 1.71, 95.23 ± 1.99, and 85.52 ± 6.41, respectively. Group 3 exhibited significantly lower postoperative mHHS compared to the other two groups (P = 0.001). The satisfaction rates in groups 1–3 were 92.86, 80, and 33.33 %, respectively. The satisfaction rate in group 3 was significantly worse than those of the other two groups (P = 0.017). There was a significant inverse linear relationship between the residual rate of bony impingement lesions and the postoperative mHHS (R 2 = 0.516, P < 0.05).


The incidence of residual impingement lesions after arthroscopic pincer-type FAI correction was 63.3 %. The residual rate was 14.48 %. The residual impingement lesions were primarily in the posterior portion of the acetabulum. The clinical outcomes were associated with the residual rate of bony impingement lesions. The patients with residual rates >20 % exhibited significantly lower clinical scores and satisfaction rates.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Ganz R, Parvizi J, Notzli H (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    PubMed  Google Scholar 

  2. Hartmann A, Günther K-P (2009) Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results. Arch Orthop Trauma Surg 129:1001–1009. doi:10.1007/s00402-008-0806-4

    Article  PubMed  Google Scholar 

  3. Crawford JR, Villar RN (2005) Current concepts in the management of femoroacetabular impingement. J Bone Joint Surg Br 87:1459–1462

    Article  CAS  PubMed  Google Scholar 

  4. Siebenrock KA, Schoniger R, Ganz R (2003) Anterior femoroacetabular impingement due to acetabular retroversion and its treatment by periacetabular osteotomy. J Bone Joint Surg 85A:278–286

    Google Scholar 

  5. Ito K, Minka MA 2nd, Leunig M et al (2001) Femoroactabular impingement and the cam-effect: a MRI based quantitative study of the femoral head–neck offset. J Bone Joint Surg 83B:171–176

    Article  Google Scholar 

  6. Ganz R, Leunig M, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466:264–272

    Article  PubMed Central  PubMed  Google Scholar 

  7. 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 24:1135–1145

    Article  PubMed  Google Scholar 

  8. Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ (2007) Revision hip arthroscopy. Am J Sports Med 35(11):1918–1921

    Article  PubMed  Google Scholar 

  9. Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT (2007) Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy 23(12):1295–1302

    Article  PubMed  Google Scholar 

  10. Byrd JW, Jones KS (2011) Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 27(10):1379–1388

    Article  PubMed  Google Scholar 

  11. Robertson WJ, Kadrmas WR, Kelly BT (2007) Arthroscopic management of labral tears in the hip: a systematic review of the literature. Clin Orthop Relat Res 455:88–92

    Article  PubMed  Google Scholar 

  12. Nawabi DH, Nam D, Park C, Ranawat AS (2013) Hip arthroscopy: the use of computer assistance. HSSJ 9:70–78

    Article  Google Scholar 

  13. Clohisy JC, Nepple JJ, Larson CM (2013) Persistent structural disease is the most common cause of repeat hip preservation surgery. Clin Orthop Relat Res 471:3788–3794

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bogunovic L, Pashos G, Baca G, Clohisy JC (2013) Why do hip arthroscopy procedures fail? Clin Orthop Relat Res 471:2523–2529

    Article  PubMed Central  PubMed  Google Scholar 

  15. Stähelin L, Stähelin T, Jolles BM (2008) Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy 24(1):51–57

    Article  PubMed  Google Scholar 

  16. Sussmann PS, Ranawat AS, Lipman J, Lorich DG, Padgett DE, Kelly BT (2007) Arthroscopic versus open osteoplasty of the head–neck junction: a cadaveric investigation. Arthroscopy 23:1257–1264

    Article  PubMed  Google Scholar 

  17. Oberlander W, Kurrat HJ, Breul R (1978) Examination of the extension of the osseous facies lunata. A functional study (author’s transl). Z Orthop Ihre Grenzgeb 116:675–682

    CAS  PubMed  Google Scholar 

  18. Wolf A, Digioia AM III, Mor AB, Jaramaz B (2005) Cup alignment error model for total hip arthroplasty. Clin Orthop Relat Res 437:132–137

    Article  PubMed  Google Scholar 

  19. Zumstein M, Hahn F, Sukthankar A, Dora C (2009) How accurately can the acetabular rim be trimmed in hip arthroscopy for pincer-type femoral acetabular impingement: a cadaveric investigation. Arthroscopy 25:164–168

    Article  PubMed  Google Scholar 

  20. Zingg PO, Ulbrich EJ, Tobias C (2013) Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results. Arch Orthop Trauma Surg 133:69–79. doi:10.1007/s00402-012-1616-2

    Article  PubMed  Google Scholar 

  21. Trompeter A, Colegate-Stone T, Khakha R, Hull J (2013) Hip arthroscopy for femoroacetabular impingement: results of 118 consecutive cases in a district general hospital. Hip Int 23:400–405

    Article  PubMed  Google Scholar 

  22. Nepple JJ, Zebala LP, Clohisy JC (2009) Labral disease associated with femoroacetabular impingement: do we need to correct the structural deformity? J Arthroplasty 24:114–119

    Article  PubMed  Google Scholar 

  23. Byrd JW (2003) Hip arthroscopy: the supine position. Instr Course Lect 52:721–730

    PubMed  Google Scholar 

  24. Sussmann PS, Zumstein M, Hahn F, Dora C (2007) The risk of vascular injury to the femoral head when using the posterolateral arthroscopy portal: cadaveric investigation. Arthroscopy 23:1112–1115

    Article  PubMed  Google Scholar 

  25. Lee CB, Clark J (2011) Fluoroscopic demonstration of femoroacetabular impingement during hip arthroscopy. Arthroscopy 27(7):994–1004

    Article  PubMed  Google Scholar 

  26. Mofidi A, Shields JS, Tan JS (2011) Use of intraoperative computed tomography scanning in determining the magnitude of arthroscopic osteochondroplasty. Arthroscopy 27(7):1005–1013

    Article  PubMed  Google Scholar 

  27. Clarke MT, Arora A, Villar RN (2003) Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res 406:84–88

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

One or more of the authors (XSW) have received funding from the Beijing Municipal Science and Technology Commission (Z131107002213125) and Beijing Municipal “Ten Hundred Thousand Health Worker Project”.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Hua Feng.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhuo, H., Wang, X., Liu, X. et al. Quantitative evaluation of residual bony impingement lesions after arthroscopic treatment for isolated pincer-type femoroacetabular impingement using three-dimensional CT. Arch Orthop Trauma Surg 135, 1123–1130 (2015).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: