Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage

Abstract

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.

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

“…18 Surgery has been shown to improve pain and function scores in 65%-96% of patients at short-term follow up. 19,20 Risk factors for poor outcome have been found to include patients with advanced arthrosis (Tonnis grade 2 or 3) on preoperative imaging 21,22 and either chondral or labral disease identified intraoperatively. 23 Cam-type impingement is associated with cartilage delamination.…”

Treatment of cam-type femoroacetabular impingement using anterolateral mini-open and arthroscopic osteochondroplasty

“…Several studies have reported the results of using mini-open technique in the treatment of FAI [8, 9, 19]. Most of the authors used anterior Hueter approach on an extension table or fracture table, taking the advantage of intermuscular and internervous dissection [18].…”

“…The use of mini-open technique with arthroscopic assistance is less often reported in the literature [18]. The advantages of this approach include both minimal soft tissue invasion and improved quality of the osteochondroplasty by direct visualization on femoral head and neck that would otherwise only be obtained with surgical dislocation [19]. The assistance of arthroscopy provided detailed visualization and management of chondral and labral injuries in a small wound [20].…”

Femoroacetabular Impingement: Saving the Joint

“…A recent case series demonstrated that patients with Tönnis 2 arthritis had significantly less chance of improvement (58%) than patients with Tönnis 0 or 1 arthritis (94% and 95%, respectively). 8 Even slight joint space narrowing, however, may indicate severe cartilage damage, which will affect axial loading and limit the possibility of improvement. 9 Therefore, patients with FAI and significant degenerative joint disease should be treated nonoperatively until they are ready for a total hip replacement.…”

“…Postoperatively, patients are able to quickly return to full weight bearing activity at 6 weeks. Ribas et al 8 published a series of 117 hips that underwent mini-open FAO that shows significant clinical and functional improvement, especially those with Tönnis 1 and Tönnis 2 arthritis. From our institutional experience, of 82 patients that underwent mini-open direct anterior FAO by the senior author (J.P.) that have reached at least 1 year of follow-up, 78 experienced significant improvements in their function, measured by modified Harris hip score, SUSHI (ie, SUper Simple HIp) score, and UCLA score.…”