Arthroscopic management of large-size cam-type femoroacetabular impingement

Abstract

Background Ganz and colleagues have popularized that femoroacetabular impingement (FAI) is a cause of hip pain in adolescents and young adults, and it can eventually lead to osteoarthritis of the hip. FAI is the result of abnormal contact between the proximal femur and the acetabulum. A size and shape mismatch within the hip joint causes collision events that lead to labral and cartilage degeneration. The principle of treatment is based on providing an adequate clearance during terminal range of movement of the hip, thereby avoiding abutment of the proximal femur on the acetabular rim. Objective The aim of our study was to report the results of arthroscopic femoroplasty in cases with large-size cam-type FAI. Patients and methods Twenty patients (11 male and nine female) with a mean age of 33 years (range: 22–48 years), with a large cam-type FAI underwent arthroscopic femoroplasty. The duration of symptoms before surgical intervention averaged 14 months. The patients were assessed preoperatively and 3 months and 1 year postoperatively using the modified Harris hip score (MHHS). The patients were excluded if the disease state was too advanced to reasonably benefit from arthroscopic intervention, with bone-on-bone contact an absolute contraindication. Results The mean MHHS increased more than 20 points from 52 preoperatively to 72 postoperatively after 3 months and to 75 after 1 year. The mean abduction improved from 22° preoperatively to 28° at 12 months postoperatively. The mean internal rotation improved from 16° preoperatively to 23° at 12 months postoperatively. The mean pain score in MHHS increased from 25.8 preoperatively to 41 at 12 months postoperatively. The mean duration of arthroscopic femoroplasty was 120 min (range: 90–180 min). Conclusion With the advancement in hip arthroscopy techniques, it is now possible to address large cam-type FAI arthroscopically with results comparable to open surgical dislocation and femoroplasty with the advantage of low morbidity and early rehabilitation.