Clinical Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement in Adolescents (SS-36)

Abstract

Introduction There are many etiologies of adolescent hip impingement that, once symptomatic, can progress to labral tears or chondral lesions. As the teenager grows and engages sooner in competitive sports, more sport-induced hip pain is seen in this young athletic population, including femoroacetabular impingement (FAI). There are very few large studies with greater than one year outcomes of adolescent hip arthroscopy for hip impingement. The goal of this study is to report clinical outcomes and revision rates in the adolescent population after hip arthroscopy for FAI with subsequent labral tear and chondral lesions with a minimum 2 years follow-up. Methods After IRB approval was obtained, prospectively collected data on 70 consecutive adolescents who were 16 years of age or younger and underwent hip arthroscopy for FAI were retrospectively reviewed. All patients had either isolated cam impingement, isolated pincer impingement, or mixed pathology. Surgical treatment for FAI in this adolescent population was with hip arthroscopic acetabular or femoral head-neck osteoplasty, labral debridement versus suture anchor repair, or a chondroplasty for articular cartilage defects. A limited osteoplasty was performed on cam lesion with an open physis. Data analyzed included patient demographics, radiographic parameters, intra-operative findings, and clinical outcomes at a minimum of 2 years. Clinical outcomes measurements included the modified Harris Hip Score (mHHS), and patient satisfaction with outcome (10=very satisfied, 1=very unsatisfied). Results Mean age at time of surgery was 15 years (range, 13 to 16 years) with 22 males and 48 females. CAM impingement was found in 10% of cases, pincer type in 15%, and mixed-type in 75%. Femoral head-neck osteoplasty was performed in 56 patients and rim trimming was performed in 55 patients. Labral tears were identified in all patients, and 83% of these were repaired. The remaining labral tears were debrided. 7 had grade 3-4 chondral defect on the femoral head and 3 on the acetabulum. All were treated with chondroplasty. The mean time of follow up was 3 years (range, 2 to 5 years). Mean preoperative mHHS was 60 (range, 31 to 85), and it improved to an average of 93 (range, 68 to 100). The median patient satisfaction was 10 (range, 5 to 10). After the index procedure, 8 patients needed revision arthroscopy for adhesions at the capsule/labral junction. All revision were females. Median satisfaction following revision was 9 (range 7 to 10). Conclusion Arthroscopic treatment of FAI, labral tears, and chondral lesions in the adolescent population is a safe procedure with excellent clinical outcomes. Females had a higher revision rate but with improved satisfaction after revision surgery.