J Korean Orthop Assoc.  2010 Jun;45(3):188-197. 10.4055/jkoa.2010.45.3.188.

Arthroscopic Management of Femoroacetabular Impingement in Early Osteoarthritis of the Hip: 2 to 5 Year Results

• Lee JB
• Hwang DS
• Kang C
• Yeon KW

• KMID: 2185517
• DOI: http://doi.org/10.4055/jkoa.2010.45.3.188

Abstract

PURPOSE
To report the clinical and radiological outcomes of a mid-term follow-up of patients with femoroacetabular impingement treated using an arthroscopic method. MATERIALS AND
METHODS
Of the patients who underwent an arthroscopic labrectomy (91 cases), femoroplasty (82 cases) or acetabuloplasty (9 cases) after a diagnosis of femoroacetabular impingement, 82 patients (91 cases) who had been followed up were examined. The preoperative and postoperative clinical outcomes were evaluated using the Modified Harris hip score, Hip Outcome Score, pain score and patient's satisfaction. The radiological assessment was performed by measuring the alpha angle, femoral offset, and center edge angle using simple radiographs and computed tomography.
RESULTS
The patients consisted of 63 men and 19 women, whose mean age was 33.5 years (range, 15-70 years). The mean follow-up period was 42.2 months (range, 25-60 months). On the clinical results, the mean pain score improved from 0.72 points preoperatively to 2.02 points at the final follow-up. The Modified Harris hip score improved from 61.4 preoperatively to 83.4 at the final follow-up. The median patient satisfaction was 8.2 (range,0-10 points). On the radiological assessment, the alpha angle decreased from 60.9degrees to 40.4degrees, and the femoral offset recovered from 4.9 mm to 10.0 mm.
CONCLUSION
The arthroscopic treatment of femoroacetabular impingement could be an excellent modality to prevent osteoarthritis of the hip. However, recovery of clinical results by arthroscopic treatment is not expected in elderly patients or those with developed osteoarthritis, a low preoperative Modified Harris hip score and concurrent degenerative disease.

Keyword

hip; femoroacetabular impingement; arthroscopy; femoroplasty; acetabuloplasty

MeSH Terms

Aged
Arthroscopy
Female
Femoracetabular Impingement
Follow-Up Studies
Hip
Humans
Male
Osteoarthritis
Patient Satisfaction

Figure

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  Figure 1 Plain radiographs representing a mixed type (mainly cam type) FAI with asphericity. Main complaints of this patient was limitation of abduction and internal rotation. (A, B, C) The oblique thin arrow in A shows right femoral head asphericity with formation of pistol grip deformity. (D) The small black arrow indicates the bump located at femoral head neck junction.

• 

  Figure 2 Arthroscopic surgery was performed. The arethroscopic view (A) shows labral tear with partial detachment. (B) Partial labrectomy and acetabular trimming was performed. (C) Femoral head neck junction bump was found. (D) Bumpectomy using arthroscopic burr was performed.

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  Figure 3 A 22-year-old male with mixed type FAI. (A, B) Simple radiographs showed marked femoral head neck bump and acetabular retroversion.

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  Figure 4 Comparison of preoperative and postoperative hip CT images. (A) preoperative CT, (B) postoperative CT.

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  Figure 5 Postoperative radiographs. (A, B) Frog leg and groin lateral view demonstrate the right femoral bumpectomy site (arrows).

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  Figure 6 4 year follow-up radiographs of the same patient. (A, B) Both anteroposterior view & groin lateral view demonstrate no evidence of progression of osteoarthritic changes or joint space narrowing, and well remodeling of the bumpectomy site was formed.

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  Figure 7 A 19-year-old man with mixed type FAI (mainly cam). (A, B) Simple radiographs show herniation pit on frog-leg view, and bump at femoral head-neck junction. (C, D) Arthroscopic partial labrectomy and femoroplasty was performed.

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  Figure 8 Patient's symptom was aggravated after a minor traffic accident occurred after 6 months, and despite of appropriate conservative treatment, symptom didn't relieve. (A) Simple radiographs with nonspecific findings. (B) MDCT shows remaining herniation pit, but femoral head remodeling was occurring. (C, D) Arthroscopic findings show capsulolabral adhesion and remnant labral tear, suggesting it to be a main factor of the patient's persisting pain.

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