Abstract
PurposeDynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI).The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery.MethodsThirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM.ResultsMean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm3 and did not correlate to post-operative ROM.ConclusionsACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM.Level of evidenceTherapeutic prospective cohort study, level II.
Highlights
Femoroacetabular impingement (FAI) is caused by excess bone on the acetabular rim, by excess bone on the proximal femur or by a combinationHansen et al Journal of Experimental Orthopaedics (2022) 9:4 symptomatic FAI primarily consist of motions bringing the hip towards impingement [7,8,9, 13].The surgical treatment of FAI is arthroscopic osteochondroplasty on the femoral and/or acetabular side (ACH) [29]
arthroscopic osteochondro‐ plasty of the hip (ACH) surgery in FAI patients had no impact of range of motion (ROM) at 1-year follow-up
This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM
Summary
Femoroacetabular impingement (FAI) is caused by excess bone on the acetabular rim (pincer- type), by excess bone on the proximal femur (cam-type) or by a combinationHansen et al Journal of Experimental Orthopaedics (2022) 9:4 symptomatic FAI primarily consist of motions bringing the hip towards impingement [7,8,9, 13].The surgical treatment of FAI is arthroscopic osteochondroplasty on the femoral and/or acetabular side (ACH) [29]. Clinical studies of hip joint kinematics in FAI patients are limited. Some studies using CT-bone models for simulation of impingement positions exist, but the clinical value is limited as they do not describe the in vivo joint motion or correlations with clinical symptoms [3, 25, 35]. Kapron et al [20, 21] showed that FAI-patients have decreased adduction and internal rotation during passive tests. They showed that ROM is governed by soft tissue restraints and not by bone-bone contact, but postoperative kinematics were not investigated
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