Combined Arthroscopic and Modified Open Approach for Cam Femoroacetabular Impingement: A Preliminary Experience

Lincoln, Max; Johnston, Kelly; Muldoon, Michael; Santore, Richard F.

doi:10.1016/j.arthro.2008.12.002

Cited by 75 publications

(48 citation statements)

References 36 publications

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“…However, Larson et al [21] reported superior results in pain reduction (using the visual analog scale) comparing labral reattachment and resection after hip arthroscopy. At followup, we found comparable results for the WOMAC [1,16,29], HHS [6,21,23,33,34], SF-12 [1,29], and UCLA [1] scores reported in the literature for studies with a variable percentage of labral reattachment (Table 6). decreased total femoral coverage or increased extrusion index.…”

Section: Discussionsupporting

confidence: 71%

“…This included a decrease in the incidence of a positive anterior impingement test or pain and an improvement of internal rotation, abduction, and the Merle d'Aubigné-Postel score (Table 4). Internal rotation in flexion is typically decreased in hips with FAI [41] and improvement after surgical correction has been reported [5,7,23,29]. Additionally, improvement in flexion has been reported in these studies [5,7,23,29] but could not be seen in the current study (Table 4).…”

Section: Discussionmentioning

confidence: 43%

“…In a study using computer-animated hip motion, decreased abduction was found for hips with FAI along with decreased internal rotation in flexion [41]. Improved clinical scores have been found for both labral reattachments and resection (Table 6) [1,5,11,16,21,23]. Espinosa et al [11] found a superior Merle d'Aubigné-Postel score for hips with labral reattachment compared with labral resection after surgical hip dislocation.…”

Section: Discussionmentioning

confidence: 97%

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Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Steppacher

Huemmer

Schwab

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Patients with femoroacetabular impingement (FAI) often develop pain, impaired function, and progression of osteoarthritis (OA); this is commonly treated using surgical hip dislocation, femoral neck and acetabular rim osteoplasty, and labral reattachment. However, results with these approaches, in particular risk factors for OA progression and conversion to THA, have varied. Questions/purposes We asked if patients undergoing surgical hip dislocation with labral reattachment to treat FAI experienced (1) improved hip pain and function; and (2) prevention of OA progression; we then determined (3) the survival of the hip at 5-year followup with the end points defined as the need for conversion to THA, progression of OA by at least one Tönnis grade, and/or a Merle d'Aubigné-Postel score less than 15; and calculated (4) factors predicting these end points. Methods Between July 2001 and March 2003, we performed 146 of these procedures in 121 patients. After excluding 35 patients (37 hips) who had prior open surgery and 11 patients (12 hips) who had a diagnosis of Perthes disease, this study evaluated the 75 patients (97 hips, 66% of the procedures we performed during that time) who had a mean followup of 6 years (range, 5-7 years). We used the anterior impingement test to assess pain, the Merle d'Aubigné-Postel score to assess function, and the Tönnis grade to assess OA. Survival and predictive factors were calculated using the method of Kaplan and Meier and Cox regression, respectively. Results The proportion of patients with anterior impingement decreased from 95% to 17% (p \ 0.001); the Merle d'Aubigné-Postel score improved from a mean of 15 to 17 (p \ 0.001). Seven hips (7%) showed progression of OA and another seven hips (7%) converted to THA Survival free from any end point (THA, progression of OA, or a Merle d'Aubigné-Postel \ 15) of well-functioning joints at 5 years was 91%; and excessive acetabular rim trimming, preoperative OA, increased age at operation, and weight were predictive factors for the end points. Conclusions At 5-year followup, 91% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment showed no THA, progression of OA, or an insufficient clinical result, but excessive acetabular trimming, OA, increased age, and weight were associated with early failure. To prevent early deterioration of the joint, excessive rim trimming or trimming of borderline dysplastic hips has to be avoided.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 97%

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Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Steppacher

Huemmer

Schwab

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Between the 5-and 10-year followup, some minor improvement in the WOMAC pain subscore and the physical component scale of the SF-12 were detected (Table 3). At latest followup, the results for the WOMAC [2,14,27], HHS [6,15,19,21,30,31], SF-12 [2,27,28], and UCLA [2] scores were comparable to those found in the literature. Fig The survival rate of clinically good-functioning, nonarthritic hips decreased from 91% at 5-year to 80% at 10-year followup (Fig.…”

supporting

confidence: 77%

“…We found an improvement of internal rotation, abduction, and extension at the 10-year followup ( Table 3). The internal rotation is typically decreased in patients with FAI and improvement after corrective surgery has been uniformly reported [5,7,21,27]. However, improvements in abduction and extension after surgical correction in hips with FAI have not previously been reported in the literature (Table 3).…”

mentioning

confidence: 94%

Eighty Percent of Patients With Surgical Hip Dislocation for Femoroacetabular Impingement Have a Good Clinical Result Without Osteoarthritis Progression at 10 Years

Steppacher

Anwander

Zurmühle

et al. 2015

Clinical Orthopaedics &Amp; Related Research

106

100

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Background We previously reported the 5-year followup of hips with femoroacetabular impingement (FAI) that underwent surgical hip dislocation with trimming of the head-neck junction and/or acetabulum including reattachment of the labrum. The goal of this study was to report a concise followup of these patients at a minimum 10 years. Questions/purposes We asked if these patients had (1) improved hip pain and function; we then determined (2) the 10-year survival rate and (3) calculated factors predicting failure. Methods Between July 2001 and March 2003, we performed surgical hip dislocation and femoral neck osteoplasty and/or acetabular rim trimming with labral reattachment in 75 patients (97 hips). Of those, 72 patients (93 hips [96%]) were available for followup at a minimum of 10 years (mean, 11 years; range, 10-13 years). We used the anterior impingement test to assess pain and the Merle d'Aubigné-Postel score to assess function. Survivorship calculation was performed using the method of Kaplan and Meier and any of the following factors as a definition of failure: conversion to total hip arthroplasty (THA), radiographic evidence of worsening osteoarthritis (OA), or a Merle d'Aubigné-Postel score less than 15. Predictive factors for any of these failures were calculated using the Cox regression analysis. Results At 10-year followup, the prevalence of a positive impingement test decreased from preoperative 95% to 38% (p \ 0.001) and the Merle d'Aubigné-Postel score increased from preoperative 15.3 ± 1.4 (range, 9-17) to 16.9 ± 1.3 (12-18; p \ 0.001). Survivorship of these procedures for any of the defined failures was 80% (95% confidence interval, 72%-88%). The strongest predictors of failure were age [ 40 years (hazard ratio with 95% confidence interval, 5.9 [4.8-7.1], p = 0.002), body mass index [ 30 kg/m 2 (5.5 [3.9-7.2], p = 0.041), a lateral center-edge angle \ 22°o r [ 32°(5.4 [4.2-6.6], p = 0.006), and a posterior acetabular coverage \ 34% (4.8 [3.7-5.6], p = 0.006). Conclusions At 10-year followup, 80% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment had not progressed to THA, developed worsening OA, or had a Merle d'Aubigné-Postel score of less than 15. Radiographic predictors for failure were related to over-and undertreatment of acetabular rim trimming. Level of Evidence Level IV, therapeutic study.

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Effect of posture and femoral neck osteochondroplasty on femur‐acetabulum clearance in patients with cam‐type femoroacetabular impingement

Wilson

Zhang

Jones

et al. 2021

Journal Orthopaedic Research

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It is not clear whether femoral neck osteochondroplasty achieves its objective of increasing femoroacetabular clearance. We used an upright open magnetic resonance imaging scanner to image the hip joint in multiple postures to explore the effect of posture and femoral neck osteochondroplasty on femur‐acetabulum clearance in patients with cam‐type femoroacetabular impingement. We recruited 13 consecutive patients scheduled to undergo arthroscopic femoral neck osteochondroplasty and completed assessments on 10 patients. We scanned each subject before surgery and at 6 months post‐op in supine and 3 other physiological postures: supine 90° flexion with adduction and internal rotation (FADIR), sitting deep (maximal flexion with internal rotation and adduction), and sitting crossed leg (maximal adduction with flexion and internal rotation). We measured the alpha angle, which describes the severity of cam deformity, and the beta angle, which defines joint clearance. We also evaluated hip flexion, internal rotation, and adduction before and after surgery. Femoral neck osteochondroplasty significantly decreased alpha angle by 23.9° ± 4.6° (p = 0.001) and increased beta angle across all postures by 28.1° ± 6.3° (p = 0.002). An increase in beta angle represented a decreased chance of impingement. Femoral neck osteochondroplasty significantly increased flexion by an average of 8.6° in the sitting deep posture after surgery (p = 0.007) which might indicate an improvement of joint function. These findings lend support to the hypothesis that arthroscopic osteochondroplasty accomplishes its stated goals of increasing bone‐bone clearance in the hip joint and improving joint mechanics for the static postures assessed.

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Combined Arthroscopic and Modified Open Approach for Cam Femoroacetabular Impingement: A Preliminary Experience

Cited by 75 publications

References 36 publications

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Eighty Percent of Patients With Surgical Hip Dislocation for Femoroacetabular Impingement Have a Good Clinical Result Without Osteoarthritis Progression at 10 Years

Effect of posture and femoral neck osteochondroplasty on femur‐acetabulum clearance in patients with cam‐type femoroacetabular impingement

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