Skip to main content
SpringerLink
Log in

Eighty Percent of Patients With Surgical Hip Dislocation for Femoroacetabular Impingement Have a Good Clinical Result Without Osteoarthritis Progression at 10 Years

  • Symposium: 2014 Bernese Hip Symposium
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

We previously reported the 5-year followup of hips with femoroacetabular impingement (FAI) that underwent surgical hip dislocation with trimming of the head-neck junction and/or acetabulum including reattachment of the labrum. The goal of this study was to report a concise followup of these patients at a minimum 10 years.

Questions/purposes

We asked if these patients had (1) improved hip pain and function; we then determined (2) the 10-year survival rate and (3) calculated factors predicting failure.

Methods

Between July 2001 and March 2003, we performed surgical hip dislocation and femoral neck osteoplasty and/or acetabular rim trimming with labral reattachment in 75 patients (97 hips). Of those, 72 patients (93 hips [96%]) were available for followup at a minimum of 10 years (mean, 11 years; range, 10–13 years). We used the anterior impingement test to assess pain and the Merle d’Aubigné-Postel score to assess function. Survivorship calculation was performed using the method of Kaplan and Meier and any of the following factors as a definition of failure: conversion to total hip arthroplasty (THA), radiographic evidence of worsening osteoarthritis (OA), or a Merle d’Aubigné-Postel score less than 15. Predictive factors for any of these failures were calculated using the Cox regression analysis.

Results

At 10-year followup, the prevalence of a positive impingement test decreased from preoperative 95% to 38% (p < 0.001) and the Merle d’Aubigné-Postel score increased from preoperative 15.3 ± 1.4 (range, 9–17) to 16.9 ± 1.3 (12–18; p < 0.001). Survivorship of these procedures for any of the defined failures was 80% (95% confidence interval, 72%–88%). The strongest predictors of failure were age > 40 years (hazard ratio with 95% confidence interval, 5.9 [4.8–7.1], p = 0.002), body mass index > 30 kg/m2 (5.5 [3.9–7.2], p = 0.041), a lateral center-edge angle < 22° or > 32° (5.4 [4.2–6.6], p = 0.006), and a posterior acetabular coverage < 34% (4.8 [3.7–5.6], p = 0.006).

Conclusions

At 10-year followup, 80% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment had not progressed to THA, developed worsening OA, or had a Merle d’Aubigné-Postel score of less than 15. Radiographic predictors for failure were related to over- and undertreatment of acetabular rim trimming.

Level of Evidence

Level IV, therapeutic study.

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. 1A–B
Fig. 2A–B
Fig. 3
Fig. 4A–F

Similar content being viewed by others

References

  1. Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA. Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res. 2013;471:1602–1614.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.

    Article  PubMed  Google Scholar 

  3. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.

    Article  PubMed  Google Scholar 

  4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. 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. 1988;15:1833–1840.

    CAS  PubMed  Google Scholar 

  5. Brunner A, Horisberger M, Herzog RF. Sports and recreation activity of patients with femoroacetabular impingement before and after arthroscopic osteoplasty. Am J Sports Med. 2009;37:917–922.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Chiron P, Espie A, Reina N, Cavaignac E, Molinier F, Laffosse JM. Surgery for femoroacetabular impingement using a minimally invasive anterolateral approach: analysis of 118 cases at 2.2-year follow-up. Orthop Traumatol Surg Res. 2012;98:30–38.

  8. Cox DR. Regression models and life tables. J R Stat Soc B. 1972;34:187–220.

    Google Scholar 

  9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1171–1178.

    Article  CAS  PubMed  Google Scholar 

  11. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. 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. 2001;83:1119–1124.

    Article  CAS  PubMed  Google Scholar 

  12. Harris WH. 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. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  13. Holm I, Bolstad B, Lutken T, Ervik A, Rokkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Physiother Res Int. 2000;5:241–248.

    Article  CAS  PubMed  Google Scholar 

  14. Ilizaliturri VM Jr, Orozco-Rodriguez L, Acosta-Rodriguez E, Camacho-Galindo J. Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up. J Arthroplasty. 2008;23:226–234.

    Article  PubMed  Google Scholar 

  15. Jackson TJ, Hanypsiak B, Stake CE, Lindner D, El Bitar YF, Domb BG. Arthroscopic labral base repair in the hip: clinical results of a described technique. Arthroscopy. 2014;30:208–213.

    Article  PubMed  Google Scholar 

  16. Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  18. Kirmit L, Karatosun V, Unver B, Bakirhan S, Sen A, Gocen Z. The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil. 2005;19:659–661.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Relat Res. 2009;467:747–752.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Lincoln M, Johnston K, Muldoon M, Santore R. Combined arthroscopic and modified open approach for cam femoroacetabular impingement: a preliminary experience. Arthroscopy. 2009;25:392–399.

    Article  PubMed  Google Scholar 

  22. Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38:71–77.

    Article  PubMed  Google Scholar 

  23. McCarthy J, Mc Millan S. Arthrocopy of the hip: factors affecting outcome. Orthop Clin North Am. 2013;44:489–498.

    Article  PubMed  Google Scholar 

  24. McWhirk LB, Glanzman AM. Within-session inter-rater realiability of goniometric measures in patients with spastic cerebral palsy. Pediatr Phys Ther. 2006;18:262–265.

    Article  PubMed  Google Scholar 

  25. Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prostesis. J Bone Joint Surg Am. 1954;36:451–475.

  26. Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.

    Article  PubMed  Google Scholar 

  27. Naal FD, Miozzari HH, Schar M, Hesper T, Nötzli HP. Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med. 2012;40:1501–1510.

    Article  PubMed  Google Scholar 

  28. Naal FD, Miozzari HH, Wyss TF, Notzli HP. Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med. 2011;39:544–550.

    Article  PubMed  Google Scholar 

  29. Palmer DH, Ganesh V, Comfort T, Tatman P. Midterm outcomes in patients with cam femoroacetabular impingement treated arthroscopically. Arthroscopy. 2012;28:1671–1681.

    Article  PubMed  Google Scholar 

  30. Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010;468:504–510.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91:16–23.

    Article  CAS  PubMed  Google Scholar 

  32. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  CAS  PubMed  Google Scholar 

  33. Siebenrock KA, Schaller C, Tannast M, Keel M, Büchler L. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg. Epub ahead of print. DOI: 10.2106/JBJS.M.00842.

  34. Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res. 2012;470:2220–2226.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenroc KA. Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat Res. 2014;472:337–348.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Tannast M, Kakaty DK, Zheng G, Siebenrock K. What is a normal acetabulum? A computer-assisted radiographic study. In: Davies BL, Joskowicz L, Murphy SB, eds. Computer Assisted Orthopaedic Surgery. Berlin, Germany: Pro Business; 2009:254–257.

    Google Scholar 

  38. Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm-reliable and validated. J Orthop Res. 2008;26:1199–1205.

    Article  PubMed  Google Scholar 

  39. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.

    Article  PubMed  Google Scholar 

  40. Tönnis D. General radiography of the hip joint. In: Tönnis D, ed. Congenital Dysplasia and Dislocation of the Hip. Heidelberg, Germany: Springer-Verlag; 1987:100–142.

    Chapter  Google Scholar 

  41. Ware JJ, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  42. Wyss TF, Clark JM, Weishaupt D, Notzli HP. Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res. 2007;460:152–158.

    PubMed  Google Scholar 

  43. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Simon D. Steppacher MD, Helen Anwander MD, Corinne A. Zurmühle MD, Moritz Tannast MD & Klaus A. Siebenrock MD

Authors
  1. Simon D. Steppacher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen Anwander MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corinne A. Zurmühle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moritz Tannast MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus A. Siebenrock MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon D. Steppacher MD.

Additional information

One of the authors (MT) has received funding from the Swiss National Science Foundation (SNSF).

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steppacher, S.D., Anwander, H., Zurmühle, C.A. et al. 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 (2015). https://doi.org/10.1007/s11999-014-4025-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-4025-8

Keywords

Search

Navigation