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Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Previous studies reporting the impact of osteoarthritis (OA) on pain and function after hip arthroscopy largely predate resection of femoroacetabular impingement (FAI).

Questions/purposes

We determined (1) functional improvement after resection of FAI impingement lesions in patients with preoperative radiographic joint space narrowing, and (2) identified preoperative predictors of pain, function, and failure rates in these patients.

Patients and Methods

Between September 2004 and April 2008, we treated 210 patients (227 hips) with FAI and a minimum 12-month followup (mean, 27 months). Group FAI consisted of 154 patients (169 hips) without radiographic joint space narrowing, whereas Group FAI-OA consisted of 56 patients (58 hips) with preoperative radiographic joint space narrowing. We collected Harris hip scores (HHS), Short Form-12 (SF-12), and pain scores on a visual analog scale (VAS) preoperatively and postoperatively.

Results

Score improvements were better for Group FAI compared with Group FAI-OA. The overall failure rate was greater for Group FAI-OA (52%) than for Group FAI (12%). Although patients with less than 50% joint space narrowing or greater than 2 mm joint space remaining on preoperative radiographs had improved scores throughout the study, we observed no score improvements at any time with advanced preoperative joint space narrowing. Greater joint space narrowing, advanced MRI chondral grade, and longer duration of preoperative symptoms predicted lower scores.

Conclusion

FAI correction with milder degrees of preoperative radiographic joint space narrowing resulted in improvements in pain and function at short-term followup. Patients with advanced radiographic joint space narrowing do not improve and we believe should not be considered for arthroscopic FAI correction.

Level of Evidence

Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

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

    Article  PubMed  Google Scholar 

  2. 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 

  3. Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739-746.

    Article  PubMed  Google Scholar 

  4. Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 10-year followup. Clin Orthop Relat Res. 2010;468:741–746.

    Article  PubMed  Google Scholar 

  5. Clohisy JC, Zebala LP, Nepple JJ, Pashos G. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am. 2010;92:1697–1706.

    Article  PubMed  Google Scholar 

  6. Dunn WR, Spindler KP, Amendola A, Andrish JT, Kaeding CC, Marx RG, McCarty EC, Parker RD, Harrell FE Jr, An AQ, Wright RW, Brophy RH, Matava MJ, Flanigan DC, Huston LJ, Jones MH, Wolcott ML, Vidal AF, Wolf BR; MOON ACL Investigation. Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. Am J Sports Med. 2010;38:1778–1787.

    Article  PubMed  Google Scholar 

  7. Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.

    Article  PubMed  Google Scholar 

  8. Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15:132–137.

    Article  PubMed  CAS  Google Scholar 

  9. 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 to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.

    Article  PubMed  CAS  Google Scholar 

  10. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  11. Goker B, Doughan AM, Schnitzer TJ, Block JA. Quantification of progressive joint space narrowing in osteoarthritis of the hip. Arthritis Rheum. 2000:43:988–994.

    Article  PubMed  CAS  Google Scholar 

  12. Harrell FE Jr. Regression Modeling Strategies. New York, NY: Springer; 2001.

    Google Scholar 

  13. Helenius I, Tanskanen P, Haapala J, Niskanen R, Remes V, Mokka R, Korkala O. Hip arthroscopy in osteoarthritis: a review of 68 patients. Ann Chir Gynaecol. 2001;90:28–31.

    PubMed  CAS  Google Scholar 

  14. Horisberger M, Brunner A, Herzog RF. Arthroscopic treatment of femoral acetabular impingement in patients with preoperative generalized degenerative changes. Arthroscopy. 2010;26:623–629.

    Article  PubMed  Google Scholar 

  15. 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 

  16. Jacobsen S, Sonne-Holm S, Søballe K, Gebuhr P, Lund B. The relationship of hip joint space to self reported hip pain: a survey of 4,151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy. Osteoarthritis Cartilage 2004;12:692–697.

    Article  PubMed  Google Scholar 

  17. Jerosch J, Schunck J, Khoja A. Arthroscopic treatment of the hip in early and midstage degenerative joint disease. Knee Surg Sports Traumatol Arthrosc. 2006;14:641–645.

    Article  PubMed  CAS  Google Scholar 

  18. Kim KC, Hwang DS, Lee CH, Kwon ST. Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis. Clin Orthop Relat Res. 2007;456:128–132.

    Article  PubMed  Google Scholar 

  19. Larson CM. Arthroscopic management of pincer-type impingement. Sports Med Arthrosc. 2010;18:100–107.

    Article  PubMed  Google Scholar 

  20. Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–546.

    Article  PubMed  Google Scholar 

  21. Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009:25;369–376.

    Article  PubMed  Google Scholar 

  22. Larson CM, Wulf CA. Intraoperative fluoroscopy for evaluation of bony resection during arthroscopic management of femoroacetabular impingement in the supine position. Arthroscopy. 2009;25:1183–1192.

    Article  PubMed  Google Scholar 

  23. Margheritini F, Villar RN. [The efficacy of arthroscopy in the treatment of hip osteoarthritis] [in English, Italian]. Chir Organi Mov. 1999;84:257–261.

    PubMed  CAS  Google Scholar 

  24. Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy 2005;21:385–393.

    Article  PubMed  Google Scholar 

  25. 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 

  26. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head–neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.

    Article  PubMed  CAS  Google Scholar 

  27. O’Leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy. 2001;17:181–188.

    Article  PubMed  Google Scholar 

  28. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.

    PubMed  Google Scholar 

  29. Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.

    Article  PubMed  Google Scholar 

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

    Article  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  PubMed  CAS  Google Scholar 

  32. Stahelin L, Stahelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy. 2008;24:51–57.e1.

    Article  PubMed  Google Scholar 

  33. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.

    PubMed  Google Scholar 

  34. Tonnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dysplasia (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1979;117:808–815.

    PubMed  CAS  Google Scholar 

  35. Walton NP, Jahromi I, Lewis PL. Chondral degeneration and therapeutic hip arthroscopy. Int Orthop. 2004;28:354–356.

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Hollis M. Fritz MD, Cooper R. Gundry MD, and Andrew E. Cooperman MD for assistance in grading MRI chondral changes.

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Authors and Affiliations

  1. Minnesota Orthopedic Sports Medicine Institute, 4010 West 65th Street, Edina, MN, 55435, USA

    Christopher M. Larson MD, M. Russell Giveans PhD & Mehul Taylor MD

Authors
  1. Christopher M. Larson MD
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  2. M. Russell Giveans PhD
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  3. Mehul Taylor MD
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Corresponding author

Correspondence to Christopher M. Larson MD.

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Each author certifies that he 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.

Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics in Edina, MN, USA.

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Larson, C.M., Giveans, M.R. & Taylor, M. Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?. Clin Orthop Relat Res 469, 1667–1676 (2011). https://doi.org/10.1007/s11999-010-1741-6

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  • DOI: https://doi.org/10.1007/s11999-010-1741-6

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