Traitement actuel arthroscopique du conflit fémoro-acétabulaire

Abstract

Summary Introduction Arthroscopic treatement of femoroacetabular impingement (FAI) is recommended since it is a minimally invasive procedure allowing full access to the hip joint. Hypothesis Arthroscopic treatment can alleviate FAI without use of a perineal support. Goals of the study To describe an early experience of hip arthroscopy in the treatment of FAI using 2 types of hip distraction without perineal support; to assess morbidity of FAI release under arthroscopic control and its early clinical and radiological outcome. Materials and methods In the first 32 cases, the procedure used an invasive distractor and started with the central compartment. In the last six cases, it started with the peripheral compartment using a dedicated traction table with a contralateral buttock support. Inclusion criteria were: positive impingement test and radiological evidence of FAI. Thirty-eight consecutive patients with mean age 36 years (range 24–64) underwent arthroscopic treatment for FAI. Clinical outcome used WOMAC and Postel Merle d’Aubigne (PMA) scores. Radiological development of osteoarthritis (OA) was graded according to Tonnis score. Results At mean final follow-up of 1.3 years (range 0.5–3) there were no complications of either type of traction technique used. Mean WOMAC score increased from 55 to 75 points and PMA from 14.6 to 16.7 points. The subjective overall satisfaction rate was 79%. Radiological OA changes appeared in two hips, were unchanged in 33, and deteriorated in three. Discussion Invasive distraction has been effective but appeared complex and costly. The procedure is now performed without it and begins at the peripheral compartment by the capsulotomy, which allows secondary distraction using a contralateral buttock. Preoperative OA seems to be a negative prognostic factor for clinical outcome. Conclusions Arthroscopic treatment of FAI is a safe technique, which can be achieved without perineal complications. Limited anterior-superior capsulectomy and cephalic bone resection represent the first operative step, allowing acetabular trimming, labral reattachment and FAI relief. It is effective in term of early clinical results. Level of evidence Level IV: retrospective study.