Treatment of Severe Pincer-Type Femoroacetabular Impingement With Arthroscopic Significant Acetabular Rim Correction and Circumferential Labral Reconstruction Improves Patient-Reported Outcome Measures

Abstract

To validate an arthroscopic approach for performing significant acetabular rim correction and circumferential labral reconstruction required to treat severe pincer-type femoroacetabular impingement. Using a minimum of 2-year follow-up, data from 48 hips, including 47 patients (11 male, 36 female; mean age of 42 years) having undergone significant arthroscopic acetabuloplasty for severe pincer impingement (center edge angle >45°) with concomitant circumferential allograft labral reconstruction were analyzed to determine improvements in patient-reported outcomes and degree of radiographic correction. Findings demonstrated a 98% success rate, including substantial improvements on all radiographic measurements and patient-reported outcomes. Minimal clinically important differences were met with extremely strong measures of effect. The mean center edge angle improved from 49° to 36° (MΔ= 13.96, P ≤ .001, standard deviation [SD]= 55.97, confidence interval [CI] 12.17- 15.62, d= 2.33) and the mean Tönnis angle improved from -6° to 0° (MΔ= 6.2, P ≤ .001, SD= 2.76 CI -7.1 to -5.39, d= 2.29). Modified Hip Harris Scores improved by a mean of 34.45 points (P ≤ .001, SD= 20.64, 95% CI 28.45-40.44, d= 1.66). Lower extremity functional scale scores improved by a mean of 27.35 points (P ≤ .001, SD= 18.37, 95% CI 22.02-32.69, d=1.48). No complications were reported. One case converted to a total hip arthroplasty (2%). Findings validated that the significant acetabular rim correction required to treat severe pincer morphology is safe and feasible via an arthroscopic approach. This, in addition to concomitant circumferential allograft labral reconstruction, resulted in improvement in patient-reported outcomes and radiographic measurements. Level IV, therapeutic case-series.