Surgical Treatment Of Femoroacetabular Impingement Research Articles

Surgical treatment of femoroacetabular impingement using controlled hip dislocation after occurrence of slipped capital femoral epiphysis

ObjectiveTo present our experience and preliminary results from using controlled hip dislocation to treat cam-like femoroacetabular impingement, in teenagers and young adults with sequelae of slipped capital femoral epiphysis. MethodsThis was a retrospective analysis on 15 patients who were treated in a tertiary-level hospital between 2011 and 2013. The following data were collected for analysis from these patients’ files: demographic data, surgical procedure reports, joint mobility evaluations, patients’ perceptions regarding clinical improvement and whether they would choose to undergo the operation again, previous hip surgery and complications. The exclusion criteria were: follow-up shorter than six months, the presence of any other hip disease, osteotomy of the proximal femur performed at the same time as the osteochondroplasty and incomplete medical files with regard to the information needed for the present study. ResultsFifteen patients (17 hips) who underwent osteochondroplasty to treat femoroacetabular impingement were evaluated. Nine of them were women, the mean age was 18 years old and the minimum follow-up was two years. Two patients underwent osteochondroplasty bilaterally; eight patients were operated on the left side and five on the right side. In 14 cases, the greater trochanter was lowered (relative lengthening of the neck) in association with the osteochondroplasty. For 13 patients, their previous surgery consisted of fixation of an occurrence of slipped capital femoral epiphysis; for six patients (eight hips), flexor osteotomy was performed previously; and for one patient, hip arthroscopy was performed previously. Fourteen patients presented improvement of mobility and hip pain relief, in comparison with before the operation, and they said that they would undergo the operation again. Two complications were observed: one of loosening of the fixation of the greater trochanter and one of heterotopic ossification. ConclusionThe preliminary results from this study suggest that osteochondroplasty through controlled surgical hip dislocation is a good option for treating femoroacetabular impingement. Through this method, the patients reported achieving improvement of joint mobility and hip pain, with few complications.

Arthroscopic assisted mini-open approach of the hip: Early multicentric experience.

Surgical treatment of femoroacetabular impingement is becoming accepted worldwide, owing to improvements in clinical results and quality of life. In addition to treatment by surgical dislocation or arthroscopy, arthroscopic assisted mini-open approach was postulated to treat this pathology. The aim of this study was to analyze early results of the first consecutive 72 cases of femoroacetabular impingement treated using the arthroscopic assisted mini-open approach in two different centers by two surgeons trained by a senior surgeon experienced in the technique. Seventy-two consecutive cases of femoroacetabular impingement were operated in arthroscopic assisted mini-open approach technique in two different centers. After a mean follow-up time of 15 months (range 6-24 months), the Western Ontario and McMaster Universities Arthritis Index, Hip disability and Osteoarthritis Outcome Score and University of California, Los Angeles activity score, alpha angle and Wiberg angle were obtained. In both centers, all three scores showed significantly better results at follow-up time than preoperatively. The Western Ontario and McMaster Universities Arthritis Index increased from 64.3 to 91.4 (A) and from 68.1 to 89 (B). The Hip disability and Osteoarthritis Outcome Score increased from 59.5 to 94.4 (A) and from 62.1 to 93.8 (B). The University of California, Los Angeles activity score increased from 5.2 to 8.1 (A) and from 5.3 to 8.4 (B). The alpha angle and the Wiberg angle were significantly reduced after osteoplasty. The overall complication rate was low. Early results of this study show a good clinical and radiological outcome; therefore, the arthroscopic assisted mini-open approach can be used as an alternative in treating femoroacetabular impingement.

Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results.

PurposeWe report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years.Materials and MethodsBetween May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared.ResultsAcetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area.ConclusionOpen surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.

Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework.

Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment.

Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement.

Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI.

Orthopaedic surgeons' use and knowledge of ionizing radiation during surgical treatment for femoroacetabular impingement.

To better understand how radiograph imaging is currently used throughout perioperative care for femoroacetabular impingement (FAI) and to define surgeon knowledge and perspective on radiation safety when treating FAI. An online questionnaire was designed to be completed by hip arthroscopists on the imaging modalities and projections they use during evaluation and treatment of FAI and the associated radiation exposures and safety. A sample of practicing attending orthopaedic surgeons was surveyed via an anonymous survey link emailed to corresponding authors on publications related to FAI. The anonymous survey link was also provided to orthopaedic surgeons at the 2014 Vail Hip Symposium. Ninety-one surgeons completed the survey. Of these participants, 72 surgeons (79.1%) indicated they use pre-operative radiographs and intra-operative spot fluoroscopic images during FAI treatment. Thirty-three surgeons (36.3%) use pre-operative computed tomography (CT). Twenty-three surgeons (25.3%) use real-time moving fluoroscopy. A majority of surgeons incorrectly answered multiple-choice questions about which C-arm positions and settings result in the lowest doses of radiation to the surgeon or patient. Eighty-three surgeons (91.2%) indicated they believe most orthopaedic surgeons need to be more informed about radiation safety. This study gives a quantitative representation of the imaging modalities and projections utilized during perioperative treatment for FAI. This study also identified a lack of knowledge of radiation safety among orthopaedic surgeons treating patients with FAI and demonstrates the need for greater education. IV.

The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement

Background: There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). Purpose: To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” Results: There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values—at which patients considered their status to be satisfactory—at 1 year after surgery were 74 (mHHS), 87 (HOS–activities of daily living subscale), and 75 (HOS–sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS–activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. Conclusion: This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.

Preoperative predictors of outcome in the arthroscopic treatment of femoroacetabular impingement.

The aim of this study was to establish preoperative factors associated with a good outcome in the surgical treatment of femoroacetabular impingement. A prospective study including 253 consecutive patients (280 hips) was carried out. We defined a "good" score as one which had either a 20 point improvement from preoperative to 12 months postoperative follow-up, or a score of over 80 points at 12-month follow-up in either the Non Arthritic Hip Score (NAHS) or Modified Harris Hip Score (MHHS). We analysed 9 potential predictors of 12-month postoperative outcome: patient age, gender, BMI, surgery type (primary/revision), preoperative anxiety level, preoperative labro-chondral damage, operative side, patients belonging to the armed forces and patients being treated under the workers compensation scheme. We used logistic regression (multivariable, adjusted) and, Fisher's exact test and student t test (bivariate, unadjusted) to analyse the data. A strong association between workers' compensation status and not achieving a good outcome following arthroscopic surgery for femoroacetabular impingement (odds ratio 3.84, 95% CI, 0.13-0.51, P&lt;0.0001) was found. A negative effect on postoperative outcome was also observed with increased BMI, although this association was modest (odds ratio 1.06, 95% CI, 0.87-0.99 p = 0.03). Patients with a higher preoperative score did better at 12 months than the rest of the cohort. The data from this study may be useful for both patient and physician to consider when deciding on a suitable treatment in potential surgical candidates suffering from femoroacetabular impingement.

A review of management options of femoroacetabular impingement

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A333 534 A REVIEW OF MANAGEMENT OPTIONS OF FEMOROACETABULAR IMPINGEMENT J. Fairley, A. Teichtahl, Y. Wang, A. Wluka, S. Brady, F. Cicuttini. Monash Univ., Melbourne, Australia Purpose: Femoroacetabular impingement (FAI) is a common cause of hip pain treated surgically. However, the comparative efficacy of surgery versus non-surgical management is unclear. This review examines the evidence for surgical and non-surgical treatment for FAI using symptoms, hip shape and cartilage change as clinical endpoints. Methods: Electronic searches of MEDLINE and EMBASE were performed to identify relevant studies published from 2000 to July 2014.Studies that met a set of predefined criteria were included. Surgical management strategies (arthroscopy, surgical hip dislocation, combined and miniopen techniques) and non-surgical management (non-surgical, conservative) were searched with “Femoroacetabular Impingement.” Studies reporting outcomes (symptoms and anatomical change) were selected. Results: Sixteen studies comparingmanagement strategies for FAI were identified. Two studies examined non-surgical therapy prior to proceeding to surgical management. Thirteen studies examined symptom outcomes, while nine studies examined the effect on hip shape. Two studies examined impact on cartilage change. Symptom outcomes improved with both surgical and non-surgical treatment. Non-surgical management (anti-inflammatory medications, physiotherapy, activity modification) demonstrated good efficacy over 2 years with an average of 63% in the 2 studies avoiding escalation to surgery. There was no difference in symptom outcomes between surgical techniques (arthroscopy and surgical hip dislocation). Non-surgical therapy had no effect on hip shape while surgical procedures (both open and arthroscopic) resulted in improved, but not normalised, hip shape. Neither of the two studies examining cartilage effects showed any benefit of surgery. Conclusions: There are no studies that have directly compared nonsurgical and surgical treatment for FAI. When non-surgical management is used, approximately two thirds of patients do not proceed to surgery. Factors which predispose surgery have not been investigated. While with surgical intervention hip shape improves, impact on progression of joint degeneration is unclear. Further work addressing these will be needed in order to optimise patient outcome in FAI. 535 UNDERSTANDING FEAR OF MOVEMENT AND REINJURY WITH THE TAMPA SCALE OF KINESIOPHOBIA (TSK) IN INDIVIDUALS WITH MUSCULOSKELETAL KNEE PATHOLOGY: A SYSTEMATIC REVIEW L.M. Thoma y, K. Wolf y, L. Harris z, T. Best y, D. Flanigan y, L. Schmitt y. y The Ohio State Univ., Columbus, OH, USA; zOhio Univ., Columbus, OH,

Poor Prognosis Factors for Treatment of Femoroacetabular Impingement

Background: Femoroacetabular impingement is a common source of hip pain and dysfunction, especially in young and active patients. It is considered to be the main cause of early hip osteoarthritis. We set the purpose to identify poor prognosis factors in the surgical treatment of femoroacetabular impingement. Methods: We realized a prospective observational study in a case series of 50 hips in 44 patients with femoroacetabular impingement operated with surgical hip dislocation between 2001-2006. Clinical, radiologic, surgical and functional factors of whole patients were assessed. Clinical outcomes were determined with a subjective scale. Also, functional assessment was performed with a modified Harris Hip Score (HHS). Both evaluations were applied at 6, 9, and 12 months, and so every year once. Finally, the statistical analysis was done with SPSS 15.0 software. Results: With an average of 6.2 post-operative years (5-10.1) of follow-up, 35 patients (70%) were “asymptomatic” (HHS=100), 11 patients (22%) “better” (HHS=94.09), and 4 patients (8%) “the same or worse” (HHS=68.25). 40% of patients older than 45 years old were “asymptomatic”, versus 77% younger than 45 years old (p=0.03). 37% of patients with mixed femoroacetabular impingement were “asymptomatic”, 87% of patients with camtype and 82% with picer-type (p=0.003). The factors related to a poor prognosis were as follows: age >45 and mixed-type impingement; and other factors such as radiological osteoarthritis, labral injury and prolonged symptomatology were also associated to poor prognosis results in our study, without being statistically significant. Conclusions: Age >45 years old and mixed type of impingement are significant statistic factors related to a poor prognosis in patients treated with surgical hip dislocation. This data are useful to predict the treatment outcome for each patient

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement Which are the Red Lights for Poor Results

Background: Femoroacetabular impingement is a common source of hip pain and dysfunction, especially in young and active patients. It is considered to be the main cause of early hip osteoarthritis. We set the purpose to identify poor prognosis factors in the surgical treatment of femoroacetabular impingement. Methods: We realized a prospective observational study in a case series of 50 hips in 44 patients with femoroacetabular impingement operated with surgical hip dislocation between 2001 and 2006. Clinical, radiologic, surgical and functional factors of whole patients were assessed. Clinical outcomes were determined with a subjective scale. Also, functional assessment was performed with a modified Harris Hip Score (HHS). Both evaluations were applied at 6, 9, and 12 months, and so every year once. Finally, the statistical analysis was done with SPSS 15.0 software. Results: With an average of 6.2 post-operative years (5-10.1) of follow-up, 35 patients (70%) were “asymptomatic” (HHS=100), 11 patients (22%) “better” (HHS=94.09), and 4 patients (8%) “the same or worse” (HHS=68.25). 40% of patients older than 45 years old were “asymptomatic”, versus 77% younger than 45 years old (p=0.03). 37% of patients with mixed femoroacetabular impingement were “asymptomatic”, 87% of patients with cam-type and 82% with picer-type (p=0.003). The factors related to a poor prognosis were as follows: age >45 and mixed-type impingement; and other factors such as radiological osteoarthritis, labral injury and prolonged symptomatology were also associated to poor prognosis results in our study, without being statistically significant. Conclusion: Age > 45 years old and mixed type of impingement are significant statistic factors related to a poor prognosis in patients treated with surgical hip dislocation. This data are useful to predict the treatment outcome for each patient.

The Minimal Clinical Important Difference (MCID) And Patient Acceptable Symptomatic State (PASS) For The Modified Harris Hip Score And Hip Outcome Score Among Patients Undergoing Surgical Treatment For Femoroacetabular Impingement

Objectives:The objective of this study was to determine the minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) in a population of patients with femoroacetabular impingement treated with arthroscopic surgery of the hip.Methods:We conducted a prospective cohort study at a single centre in a consecutive series of patients with femoroacetabular impingement who were treated with arthroscopic labral repair/re-fixation and femoral osteoplasty. The mHHS and HOS were administered at baseline and at 3, 6, and 12 months post-operatively. Using external anchor questions at the aforementioned post-operative time points, the approach outlined by Juniper et al. was used to determine the MCID, whereas the specific anchor question designed by Tubach was used to determine the PASS. A receiver-operator curve was constructed and used to determine the cuff off point which optimally defined the MCID based on sensitivity and specificity values for each observed change score. The PASS was defined as the 75th percentile of the final mHHS score or HOS subscale scores for patients who considered their state satisfactory. We also stratified the analysis according whether baseline scores influenced the likelihood of achieving the MCID and PASS and odds ratios (OR) were also calculated.Results:There were 130 patients with a mean age of 35.6 (sd 11.7) years and 42.3% were male. The MCID for the mHHS at 3, 6, and 12 months was 13.0, 9.0, and 20.0, respectively. For the HOS (ADL), the MCID was 14.7, 15.0, and 23.0 at 3, 6, and 12 months. For the HOS (Sports), MCID values at 3, 6, and 12 months were 25, 28, and 47. In regards to the PASS, the observed values at 1 year following surgery were as follows: mHHS 84, HOS (ADL) 98, HOS (Sport) 94. The high values observed for the PASS across the different subscales suggests a high proportion of ceiling effects with the mHHS and HOS in this population. The MCID was significantly greater at 1 year for patients with an initial ‘low’ baseline score compared to patients with a ‘high’ baseline score. The PASS was not affected by baseline scores across different instruments. Patients with lower baseline scores were less likely to achieve the MCID one year following surgical intervention [mHHS - OR 0.28; HOS (ADL) - OR 0.23; HOS (Sports) - OR 0.06] yet more likely to achieve the PASS [mHHS - OR 3.36; HOS (ADL) - OR 3.83; HOS (Sports) - OR 3.38). There was a significant negative correlation between increasing age and the ability to obtain a mHHS or HOS above the PASS threshold (p<0.05). Age and sex were not significantly related to the odds of achieving the MCID for the mHHS or HOS.Conclusion:This is the first study in the literature to determine the MCID and PASS for two commonly used hip-joint specific patient-reported outcome measures in patients undergoing arthroscopic hip surgery for FAI. Our findings will allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for power calculations in future randomized trials related to hip arthroscopy and the treatment of FAI.

Sports and Activity Levels After Open Surgical Treatment of Femoroacetabular Impingement

Background: Several studies indicate that professional athletes can successfully return to competition after surgical treatment of femoroacetabular impingement (FAI). However, little is known about sports and activity levels after FAI surgery in the general patient population. Hypothesis/Purpose: The purpose was to determine the sports behavior, satisfaction with sports ability, and activity levels in a consecutive cohort of patients with FAI who were treated by surgical hip dislocation. The hypothesis was that the majority of patients (>75%) would be active in sports at follow-up. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study included 153 patients (mean age, 30.0 years; 40.5% female) with 192 hips treated. Sports behavior and satisfaction were determined at a mean follow-up of 59.4 months with the use of a questionnaire. Activity levels at follow-up were assessed by the Hip Sports Activity Scale (HSAS) and the University of California, Los Angeles (UCLA) activity scale. Results: Of 126 patients who were regularly active in sports before surgery, 107 (85%) were so at follow-up. Nineteen patients (12.4%) stopped participating in regular sports, and 8 (5.2%) commenced with sports after the operation. The most popular activities before surgery were skiing (22%), cycling (22%), jogging (20%), and soccer (13%). At follow-up, most patients were engaged in cycling (23%), fitness/weight training (20%), skiing (18%), and jogging (11%). Of all patients, 75% were satisfied with their sports ability, and 25% were not. Moreover, 60.3% stated that their sports ability had improved after surgery, 20.5% declared no change, and 19.2% were subjectively deteriorated. The mean pain level during sports was rated to be 2.1 according to the visual analog scale. The mean HSAS score was 3.5 (range, 0-8), and the mean UCLA score was 7.7 (range, 3-10); male patients reported significantly higher scores than did female patients on the HSAS (4.1 vs 2.7, respectively) and UCLA scale (8.2 vs 7.0, respectively). Conclusion: The vast majority of patients with FAI who are treated by surgical hip dislocation return to sports activities, and most patients are satisfied with their sports ability at midterm follow-up. Activity levels are significantly higher in male patients, but this does not yield higher satisfaction rates.

Open Surgical Treatment of Femoroacetabular Impingement in Adolescent Athletes

The surgical dislocation of the hip (SDH) approach has gained popularity in the treatment of femoroacetabular impingement (FAI) secondary to pediatric hip disorders. However, it has been suggested that SDH may preclude a return to previous levels of function in athletes. The purpose of this study was (1) to determine the level of activity and pain in young athletes before and after open hip surgery through an SDH approach for the treatment of FAI; (2) to investigate how clinical improvement correlates with physical activity; (3) to determine whether articular cartilage injury and the complexity of surgical procedures are associated with improvement in activity level and pain. SDH was utilized in 29 young athletes treated for symptomatic FAI (20 males 9 females, age range 12.7 to 20.7 years (mean age, 17 y)). Evaluation included sport(s) played, University of California Los Angeles (UCLA) physical activity level, and clinical outcome in terms of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Pain scores. Intraoperative articular cartilage status and anteroposterior pelvic and lateral hip radiographs were assessed. All patients had regularly participated in one or more of 13 distinct sports. The median UCLA score increased with marginal significance (P=0.057) after surgery. Change in the level of pain from preoperatively to postoperatively, as measured by the WOMAC-Pain subscale, was found to be statistically significant (P=0.0024). A statistically significant correlation between changes in UCLA and WOMAC was estimated (ρ=-0.61, P≤0.001). No statistically significant correlation was found between change in UCLA and the addition of a second procedure other than femoral head-neck osteochondroplasty. Finally, no statistically significant correlation was found between severity of cartilage injury and change in UCLA or WOMAC scores. The femoral α-angle improved an average of 22.7 degrees (P<0.001) after surgery. Pain relief and maintenance or improvement in activity level may be achieved with open FAI surgery through an SDH approach in young athletes. Although this approach is more invasive than hip arthroscopy, it should be considered in the management of adolescents with FAI and complex hip deformities associated with pediatric disorders such as slipped capital femoral epiphysis and Perthes disease. Level IV-case series; retrospective.

Surgical Treatment of Femoroacetabular Impingement: What Are the Limits of Hip Arthroscopy?

The variety of hip pathology that can be addressed in a minimally invasive fashion in the young, pre-arthritic patient has rapidly grown in parallel with technical advances in hip arthroscopy. However, the indications and limits of arthroscopy must be carefully defined and indications must evolve correspondingly to avoid an increase in failure rates and unsatisfactory clinical outcomes. Some diagnoses may be better and more comprehensively addressed with open procedures or combined surgical approaches. The purpose of this article is to provide an unbiased and evidence-based review of conditions of the pre-arthritic hip to define our current understanding of the advantages, disadvantages, and limitations of an arthroscopic approach.

Arthroscopic Acetabular Rim Resection in the Treatment of Femoroacetabular Impingement

Appropriate identification and precise resection of the pincer lesion are integral parts of the arthroscopic surgical treatment of femoroacetabular impingement. Preoperative radiographic planning of the bone resection, as well as executing the plan intraoperatively using both fluoroscopic and arthroscopic cues, is critical to adequately removing the pincer lesion. We present our surgical technique of removing the impinging bone by defining the focal acetabular rim overcoverage, accessing the pincer lesion with labral detachment, and then performing acetabular rim resection.

Factors Associated With the Failure of Surgical Treatment for Femoroacetabular Impingement

Background: With the recent increased recognition of femoroacetabular impingement (FAI) as a cause of hip pain and early osteoarthritis, surgical treatment has proliferated. There is a growing body of literature on outcomes of surgical intervention for FAI, but factors associated with inferior surgical outcomes have not been reviewed systematically. Purpose: To review the available literature and identify factors associated with the failure of open or arthroscopic surgery for FAI. Study Design: Systematic review. Methods: Using the PubMed database, we searched for relevant English-language articles published from January 1966 through August 2012. Inclusion criteria were a primary focus on the surgical treatment of FAI, measurement of functional or pain outcomes, identification of treatment failures, and statistical analysis of factors leading to failure. Exclusion criteria were review articles, technique-only articles, and studies of nonoperative management. Two definitions of failure were considered: (1) a lack of statistically significant improvement in validated measures of pain, function, or satisfaction postoperatively; and (2) revision surgery or conversion to hip arthroplasty because of persistent symptoms. The consistency of association between preoperative variables and clinical outcomes was reported across all studies. Results: Thirteen studies were included. Three were retrospective; there were no randomized controlled trials. Many studies had important methodological limitations. Preoperative cartilage damage or osteoarthritis had the strongest and most consistent relationship with conversion to hip arthroplasty and with a lack of improvement in pain or function. Greater age at the index operation, worse preoperative modified Harris Hip Score, and longer duration of symptoms preoperatively (>1.5 years) were associated with conversion to hip arthroplasty. Conclusion: Older age, presence of arthritic changes, longer duration of symptoms, and worse preoperative pain and functional scores are associated with poor outcomes of surgery for FAI. Incorporation of these data into discussions with patients may facilitate informed, shared decision making about the surgical treatment of FAI.

Assessment of Range of Motion and Contact Zones with Commonly Performed Physical Exam Manoeuvers for Femoroacetabular Impingement (FAI): What do These Tests Mean?

Recognition of the magnitude and location of mechanical conflicts is critical to reliably and reproducibly improve functional range of motion and outcomes after surgical treatment of femoroacetabular impingement (FAI). The purpose of this study was to assess the ROM and location of intra-articular and extra-articular mechanical conflict with seven commonly performed physical exam manoeuvers in a cohort of hips with symptomatic FAI. Internal rotation in flexion results in mechanical contact between the anterolateral and anterior femoral head-neck junction with the acetabulum, most commonly at a 1:15 o'clock position. Associated adduction, however, significantly reduces the available internal rotation secondary to contact in the same locations. Straight abduction results in mechanical conflict between the superior femoral head-neck junction and the 12:00 o'clock position of the acetabulum. With external rotation of the hip in various degrees of hip flexion, the potential mechanical impingement is extra-articular between the greater trochanter and ischium or pubic ramus. The zones of proximal femoral and acetabular contact are not intuitive, and may extend significantly more laterally and distally on the femoral head-neck junction than previously appreciated.

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage. These procedures should be considered for patients with symptoms due to a deformity of the hip secondary to SCFE.Cite this article: Bone Joint J 2013;95-B:445–51.

Current concepts in the treatment of adolescent femoroacetabular impingement.

There is growing evidence that symptomatic femoroacetabular impingement leads to intra-articular damage and the development of early-onset osteoarthritis. Symptoms of femoroacetabular impingement often do not manifest until adulthood, but have been increasingly recognised in the paediatric and adolescent population. The surgical treatment of femoroacetabular impingement is aimed at restoring a more normal femoral head-neck offset in order to increase the clearance and prevent femoral abutment against the acetabular edge. Current methods include open and arthroscopic techniques. The latter has been combined with an open approach to gain access to the head-neck junction for osteochondroplasty. Proximal femoral and/or periacetabular osteotomies are used to treat femoroacetabular impingement associated with deformity secondary to childhood hip conditions, such as slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Some adolescents have severe degenerative joint disease at the time of presentation and may require arthroplasty or arthrodesis. The aim of this review is to identify the major trends and advancements in the management of femoroacetabular impingement in adolescents, including the outcome of studies of the surgical treatment modalities used.