Hip osteoplasty by an anterior minimally invasive approach for active patients with femoroacetabular impingement

Abstract

Femoroacetabular regularization in hip impingement is currently performed by means of trochanter osteotomy and hip dislocation or more recently by means of hip arthroscopy. We present a novel alternative through a unique mini-invasive anterior approach. Our first series consisted of 35 hips (32 patients) with a mean follow-up of 29.2 months. Range of motion (ROM) and clinical scores were evaluated preoperatively at six weeks, three months, six months and one-year follow-up (FU). Impingement test was negative in 33 out of 35 cases six weeks after surgery. Mean hospitalisation time was 2.6 days (2-5 days). Mean improvement in internal rotation was 23 degrees (p=0.006) and 21 degrees in flexion (p=0.011). There was a significant improvement in hip score according to the Merle d'Aubign evaluation (13.8 points preoperative vs. 16.9 at one-year visit) (p=0.017). No Trendelenburg, heterotopic calcifications or osteonecrosis were observed. Complications related to the femorocutaneous nerve appeared in six cases (17.1%) although all but one were neuroapraxia and disappeared before one year. Mean rehabilitation time was 4.4 weeks. We conclude that the anterior surgical approach for the treatment of femoroacetabular impingement enables early resumption of sport while accuracy in bone resection is maintained.