Open Therapy of Femoroacetabular Impingement

Abstract

ObjectiveElimination of an intraarticular femoroacetabular impingement conflict. Creation of a pain-free, normal range of motion of the hip.IndicationsFemoroacetabular impingement of any type (cam/pincer) and any localization (anterior/posterior).ContraindicationsAbsolute: advanced hip osteoarthritis, local infections around the hip.Relative: excessive acetabular retroversion with deficiency of the posterior wall.Surgical TechniqueLateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Detachment of the labrum. Trimming of the excessive acetabular rim. Refixation of the labrum. Creation of a sufficient femoral head-neck offset. Suture of the capsule. Refixation of the trochanter.Postoperative ManagementDuring hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90°. No active abduction and passive adduction over the body’s midline. Maximum weight bearing 10–15 kg for 6 weeks. Subsequently, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis until full weight bearing.ResultsShort- and mid-term results showed an improvement of the postoperative clinical score (Merle d’Aubigné Score) in 95% of all patients, depending on the individual degenerative joint alterations at the time of surgery. Good to excellent results were obtained in 91% of all cases. Cumulative 5-year survival was 91% (endpoint total hip arthroplasty or poor Merle d’Aubigné Score). Long-term results are not available yet.