Retrospective Evaluation of Femoral Osteoplasty And Labral Debridement in Cam-Type Femoroacetabular Impingement Patients—An Average Followup of 5 Years (SS-38)

Abstract

Femoroacetabular impingement (FAI) has been increasingly recognized as a source of primary hip pathology and has been associated with early onset degenerative hip disease. Cam-type impingement can create shear stress at the acetabular rim, causing chondral delamination and articular-sided labral degeneration. The purpose of this study is to evaluate the clinical outcomes of arthroscopic treatment of cam-type femoroacetabular impingement. Ninety-four consecutive patients (100 hips) with cam impingement underwent arthroscopic femoral neck osteoplasty and labral debridement. Eighty-two hips (82%) were contacted and available for followup at a mean of 60 months (range, 40-74). Patients were assessed with preoperative and postoperative physical examination, nonarthritic hip score (NAHS), Western Ontario and McMasters Universities (WOMAC) score, and radiographs to assess the Tonnis Grade for osteoarthritis and alpha-angle. Postoperative evaluation included pain score assessment with a visual analog scale and satisfaction assessment. Eighty-two hips were contacted for followup evaluation. There were 54 patients who had not undergone additional surgeries. Six patients required revision hip arthroscopies. Twenty-two patients underwent hip arthroplasty, summing up to an overall revision rate of 28%. Of the patients who had not undergone revision surgeries, the mean NAHS rose from 48.9 to 78 and the WOMAC increased from 66.8 to 77. Patient satisfaction was 70 percent. Twenty-five of the 54 hips were available for clinical evaluation. Presence of internal rotation impingement sign decreased from 92.6 to 37.5 percent. Repeat radiograph showed improved alpha angles from 76.8 to 61.6 degrees. Of the patients with pre-existing osteoarthritis (Tonnis Grade 2-3), 84.6% went on to require hip arthroplasty. Of the patients with minimal to no pre-existing osteoarthritis (Tonnis Grade 0-1), 16.4% went on to require hip arthroplasty. Arthroscopic femoral neck resection in patients with cam-type FAI results in improved clinical outcomes, decreased physical symptoms, and a high patient satisfaction at a mean followup of 5 years. In the subset of patients with pre-existing osteoarthritis, there is high risk of needing an arthroplasty procedure within 5 years.