We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

According to our experience there are several presentations of FAI and associated hip conditions, where other authors advocate surgical dislocation, which can be conducted through a mini-open approach when increased surgical skills are reached. Moreover, this technique was found to be useful as an additional tool to consider, even for surgeons involved in the arthroscopic learning curve.

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Many of the described labral-reconstruction procedures are purely arthroscopic. This approach only allows segmentary reconstructions. For more extensive reconstructions, surgical dislocation of the hip still represents the more suitable approach. We present an arthroscopy-assisted procedure combined with an anterior mini-open approach, which could be considered for reconstruction of nonrepairable labral lesions located in the posterior aspect of the acetabulum and massive reconstructions in cases of global-pincer femoroacetabular impingement and protrusio acetabuli. Our technique saves the morbidity that might be related to the surgical dislocation of the hip and incorporates a peroneus brevis tendon allograft. This option may restore the anatomy and labral function without morbidity at the donor site, as well as remove graft length restrictions during massive reconstructions.

In the previous decade, metal-on-metal hip resurfacing has been considered an attractive option and theoretically advantageous over conventional total hip arthroplasty, especially in young active patients. Different authors have reported favourable mid-term clinical and functional results with acceptable survival rates. Proper indication and planning, as accurate technical execution have been advocated to be crucial elements for success.Concerns regarding serum metal ion levels and possible clinical implications have led in the last years to a decline in the use of metal-on-metal hip resurfacing and metal-on-metal bearings in general.The aim of this study is to present the results of our first 486 cases of hybrid hip resurfacing arthroplasties with a second generation cementing technique, and to describe our current restricted indication of this type of prosthesis, in the light of recent findings in the literature about the possible complications related to metallosis or improper patient selection. Global survivorship of our series was 97.9% at a mean follow-up of 7.2 years.In the second season of our experience the indication is restrictive. The candidate for a resurfacing hip replacement is a young and active male patient, with good bone quality, that has been made aware of the risks and benefits of this type of prosthesis.

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