Paper 17: Open Surgical Dislocation Versus Arthroscopic Treatment of Femoro-Acetabular Impingement: A Prospective Comparison of A Single Surgeon Clinical Results

Abstract

Comparison of the results between 5 young patients who had open surgical dialocation vs 23 who had arthroscopic treatment for FAI. At average 9.9 months, improvements from baseline were comparable for mHSS and HOS-ADL. No statistically significant change from baseline scores between the two surgical groups was found. Arthroscopic approach showed earlier improvement in scores than open approach. Over the last decade two different methods have been developed to treat the FAI pathomechanism - the open surgical dislocation and the arthroscopic method. The purpose of the research was to prospectively compare the clinical results of those two surgical methods done by a single-surgeon. This study included 289 patients that had preservation hip surgery by the senior author. The inclusion criteria were patients under 30y old who had combined cam and pincer impingement. The exclusion criteria were workers' compensation, hip dysplasia, and previous hip surgery other than diagnostic arthroscopy. Two groups were utilized –open surgical dislocation (5 patients) and arthroscopic (23 patients). To confirm that the groups were adequately matched, we compared the demographic and preoperative characteristics. Patient outcomes were prospectively collected using four hip specific questionnaires. All patients in both groups had labral tears. Open group tended to have a larger tears (p=0.08). Larger number of anchors were used on average in the open group than in the arthroscopic group (p<0.001). All patients in the open group had labral refixation. Four patients of the arthroscopic group had partial debridement of the labrum. At 3 months f/u, the arthroscopic group tended to show greater improvement (not statistically significant). At average 9.9 months f/u, improvements from baseline hip scores were comparable between the two surgical groups for mHSS and HOS-ADL. Improvement in HOS-SSS at latest f/u tended to be greater in the arthroscopic group (mean = 40) than in open group (mean = 21) No statistically significant change from baseline scores between the two surgical groups. Arthroscopic approach showed earlier improvement in scores than open approach. Later outcomes were mostly comparable, except for sport-specific scores which were higher for arthroscopic group. Arthroscopic approach may allow faster recovery and return to sports.