Arthroscopic management of femoroacetabular impingement: evaluation of a two-year follow-up

Abstract

Objective Review outcomes of arthroscopic management of femoroacetabular impingement (FAI) at two years. Material and methods This is a retrospective, uncontrollable, unicenter level IV evidence study (case series) that included 29 patients (19 females and 10 males) with clinical and radiological signs of FAI treated arthroscopically. Exclusion criteria included Kellgren-Lawrence grade 3 osteoarthritis, avascular necrosis of the femoral head and Wiberg’s center edge angle 40°. All patients underwent a preoperative complete set of radiographic views including the plain, 45° and 90° Dunn's views to identify impingement mechanisms and quantify alpha and Wiberg's angles. The Kellgren-Lawrence scale was used to grade hip osteoarthritis. The Outerbridge classification system was intraoperatively applied for grading cartilage lesions. The Hip Disability and Osteoarthritis Outcome Score (HOOS) was used to evaluate physical function of the hip and the International Hip Outcome Tool (iHOT-12) and the Oxford Hip Score were employed to measure health-related quality of life. The mean follow-up period was 29.3 ± 3.1 months. Results Combined hip impingement was observed in 82.8 % of the cases, 10.3 % had Pincer and 6.9 % Cam types. The mean alpha and Wiberg's angles measured preoperatively 67.7 ± 12.1º and 31.8 ± 8.3º, respectively. Patients reported improved pain and function of the hip at a 3-month follow-up. Patient reported outcome measures rated 65.8 % results as excellent, 6.8 % good, 13.7 % fair and 13.7 % as poor at 12- and 24-month follow-ups. The mean alpha angle measured postoperatively 48.7 ± 3.9º. Patients with poor outcomes underwent consersion to total hip replacement within a year following arthroscopic procedure. No complications were recorded in the patients. Overall two-year survival was 86.3 %. Conclusion Hip arthroscopy now has an established place in the treatment of FAI. Poor outcomes seen in 13.7 % of the cases were associated with acetabular cartilage lesions undetected preoperatively and seen as intraoperative arthroscopic findings.

Keywords

• femoroacetabular impingement
• hip arthoscopy
• cartilage lesion