Return To Duty After Mini-Open Arthropscopic-Assisted Treatment Of Femoral Acetabular Impingement in an Active Duty Military Population (SS-37)

Abstract

Femoral acetabular impingement (FAI) is a common source of hip pain in young, active patients. Early surgical intervention has been advocated to minimize the degenerative process associated with FAI. Surgical options include surgical dislocation, mini-open arthroscopic assisted, and all arthroscopic approaches. To our knowledge, there are no known studies evaluating the surgical outcomes and return to duty of a mini-open arthroscopic assisted approach to FAI in a military population. We report the results of such here. A retrospective review of the S3 surgical database was performed for all patients at one institution undergoing a mini-open arthroscopic assisted approach for FAI between 2007 and 2011 under the direction of a single surgeon. All Army, Navy, and Marine active duty patients who underwent a primary mini-open arthroscopic assisted approach for FAI were included. Patients who underwent revision surgery for FAI, non-active duty patients, and patients with a history of previous hip surgery were excluded. Operative reports and clinic notes were reviewed for all patients. The US Army e-Profile system and the Physical Evaluation Board Liaison Offices of the Army and Navy/Marines were utilized to obtain return to duty information. Statistical analysis was performed using the Fisher’s exact test, t test, and Chi square analysis. A total of 179 consecutive surgeries were identified during the study period that met inclusion criteria. Of the 179 surgeries, 23 patients had bilateral procedures resulting in a total of 156 patients. There were 113 males, 43 females, and the average age at time of surgery was 29.5 years old. The study group included 125 patients with Cam FAI and 31 patients with combination Cam & Pincer FAI. With a minimum of 1-year follow-up, only 53% of patients returned to full active duty without any limitations. The remaining 47% of patients had been medically boarded for hip pain (22%), are on permanent profile (21%), or have been on temporary limited-duty profiles for greater than 6 months (4%). There was no statistically significant demographic risk factor identified with regards to branch of service, age, gender, type of lesion, or bilateral lesions. In the general population, good results have been reported for patients without advanced osteoarthritis or significant chondral injuries who have received surgical treatment for FAI. Results of operative intervention for FAI in high level athletes are also good at short- to mid-term follow-up with a return to activity rate of 78 – 95%. In our study of one surgeon’s experience of 179 consecutive surgeries on active duty military personnel using a mini-open arthroscopic assisted approach, the return to full military duty was only 53%. We believe that although the surgical treatment of FAI is effective in improving hip pain and function, the demands of the military may not be compatible for a subgroup of patients with this pre-osteoarthritic condition.