Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement

Abstract

There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532–540.

Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

“…59 Labral preservation also retains proprioception, and decreases contact pressure on the cartilage. 81 Labral loss can cause increased translation of the femoral head relative to the acetabulum, especially during powerful movements as are experienced in athletes, predisposing to OA. 83 Labral repair also significantly decreases the mean cartilage strain compared with labral debridement.…”

Important matters that need attention

“…However, there are still very significant question marks over how and when periacetabular osteotomy should be performed, and what adjunctive treatments are needed. [21][22][23][24][25][26][27][28][29] A great deal more research is needed.…”