Clinical outcomes following arthroscopic treatment of femoro-acetabular impingement using a minimal traction approach and an initial capsulotomy. Minimum two year follow-up

Original Paper
  • 38 Downloads

Abstract

Purpose

Although the arthroscopic management of femoroacetabular impingement (FAI) is increasing, severe complications have been reported due to traction. We developed an arthroscopic technique based on an initial capsulotomy and a minimal traction approach. The main purpose of this study was to analyze the clinical outcomes of FAI treatment using this technique after at least two years of follow-up.

Methods

Forty-seven consecutive patients underwent surgery for FAI. There were two initial portals: a proximal anterolateral portal and a distal anterior instrumental portal. An anterior working space was created and a T-shaped incision was made in the anterior capsule to relieve joint distraction. Short traction (less than 20 mn) made it possible to approach the central compartment. Acetabuloplasty was performed in the presence of pincer impingement. Traction was then released. A head-neck femoral osteochondroplasty was performed in case of bump impingement. All patients underwent a mean 3.3 ± one years of follow-up based on two self-administered questionnaires: the Harris hip score and the QOL Oxford score. None of the patients were lost to follow-up.

Results

There were three complications: two ossifications and one case of injury to the femoral cutaneous nerve with good clinical outcomes at the final follow-up. Five patients (10%) underwent surgical revision after a mean 1.4 years of follow-up: three total hip arthroplasties, one peri-acetabular osteotomy, and one repeat arthroscopic hip debridement. The Harris score increased significantly from 60 ± 10 to 86 ± 15 (p < 0.0001) and the Oxford score improved from 34 ± 15 to 50 ± 11. Only 25% of patients had a “forgotten hip” at the final follow-up.

Conclusion

Our clinical results were comparable to previously reported outcomes with other surgical techniques for the management of FAI. However, it should also be noted that despite these good clinical outcomes, the percentage of patients with a “forgotten hip” is low, and patients should be informed of this.

Keywords

Hip arthroscopy Femoro-acetabular Impingement Traction Outcomes Forgotten hip 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethical committee.

Informed consent

All of the patients provided informed consent to participate in the study.

References

  1. 1.
    Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip an integrated mechanical concept. Clin Orthop Relat Res 466:264–272CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Simpson J, Sadri H, Villar R (2010) Hip arthroscopy technique and complications. Orthop Traumatol Surg Res 96:S68–S76CrossRefPubMedGoogle Scholar
  3. 3.
    Naoki N, Vikas K (2016) Complications in hip arthroscopy. Muscles Ligaments Tendons J 402:3Google Scholar
  4. 4.
    Horisberger M, Brunner A, Herzog R (2010) Arthroscopic treatment of femoroacetabular impingement of the hip: a new technique to access the joint. Clin Orthop Relat Res 468:182–190CrossRefPubMedGoogle Scholar
  5. 5.
    Scher DL, Belmont Jr PJ, Owens BD (2010) Osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res 468:3121–3125CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Khair M, Grzybowski J, Kuhns B, Wuerz T, Shewman E (2016) The effect of capsulotomy and capsular repair on hip distraction: a cadaveric investigation. Arthroscopy 22:30774–30775Google Scholar
  7. 7.
    Sariali E, Mouttet A, Pasquier G, Durante E, Catonne Y (2009) Accuracy of reconstruction of the hip using computerised three-dimensional pre-operative planning and a cementless modular neck stem. J Bone Joint Surg Br 91:333–340CrossRefPubMedGoogle Scholar
  8. 8.
    Outerbridge R (1961) Etiology of chondromalacia patella. J Bone Joint Surg Br 43:752–754CrossRefPubMedGoogle Scholar
  9. 9.
    Bedi A, Zbeda R, Bueno V, Downie B, Dolan M, Kelly B (2012) The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med 40:854–863CrossRefPubMedGoogle Scholar
  10. 10.
    Byrd J, Jones K (2011) Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. J Arthrosc Relat Surg (10):1379–1388Google Scholar
  11. 11.
    Clohisy J, Zebala L, Nepple J, Pashos G (2010) Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am 92:1697–1706CrossRefPubMedGoogle Scholar
  12. 12.
    Larson C, Giveans M (2008) Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy 24:540–546CrossRefPubMedGoogle Scholar
  13. 13.
    Nawabi D, Degen R, Fields K, McLawhorn A, Ranawat A, Sink E, Kelly B (2016) Outcomes after arthroscopic treatment of femoroacetabular impingement for patients with borderline hip dysplasia. Am J Sports Med 44:1017–1023CrossRefPubMedGoogle Scholar
  14. 14.
    Philippon M, Briggs K, Yen Y, Kuppersmith D (2009) Outcomes following hip arthroscopy for femoroacetabular impingementwith associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91:16–23CrossRefPubMedGoogle Scholar
  15. 15.
    Impellizzeri F, Mannion A, Naal F, Leunig M (2015) Validity, reproducibility, and responsiveness of the oxford hip score in patients undergoing surgery for femoroacetabular impingement. Arthroscopy 31:42–50CrossRefPubMedGoogle Scholar
  16. 16.
    Yeung M, Memon M, Simunovic N, Belzile E, Philippon M, Ayeni O (2016) Gross instability after hip arthroscopy: an analysis of case reports evaluating surgical and patient factors. Arthroscopy 32:1196–1204CrossRefPubMedGoogle Scholar
  17. 17.
    Rath E, Sherman H, Sampson T, BT T, Maman E, Amar E (2013) The incidence of heterotopic ossification in hip arthroscopy. Arthroscopy 29:427–433CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Orthopedic Surgery DepartmentHopital Pitié SalpétrièreParisFrance
  2. 2.Laboratoire d’imagerie BiomédicaleUniversité Pierre et Marie CurieParis VIFrance

Personalised recommendations