Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

Abstract

Background The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress. Questions We assessed (1) how validated measures of patient-oriented assessment of hip function and quality of life change after surgical hip dislocation; (2) whether any patient-related or technique variables correlated with changes in the outcome scores; and (3) what the complications of treatment are and how many reoperations we performed on these patients. Methods We retrospectively reviewed a consecutive series of 71 hips in adolescents younger than 21 years who underwent surgical hip dislocation for FAI. The final cohort consisted of 44 patients (52 hips) with a mean age of 16 years. We analyzed changes in outcome variables after surgical hip dislocation and recorded reoperations during the study period. Results The minimum followup was 12 months (average, 27 months; range, 12-60 months). Modified Harris hip scores increased from a mean of 57.7 preoperatively to a mean of 85.8 postoperatively. Mean SF-12 scores increased from 42.3 to 50.6. Mean preoperative hip flexion increased from 97.5°to 106.2°. Mean internal rotation of the affected hip at 90°flexion increased from 18.19°to 34°. Conclusions Early results revealed improvements in hip function, patient quality of life, and ROM after surgical hip dislocation for the majority of this group of adolescents with FAI. However, 10% of the patients did not improve, and an additional 15% improved but still did not consider their hips good or excellent. This points toward the need for further studies in this population of patients.

Reporting of non-hip score outcomes following femoroacetabular impingement surgery: a systematic review

“…[ 45 ] Australia Case series IV 24(27) 100% 22 (16–29) 22 (6–60) months Arthroscopic 10 Sink et al. [ 46 ] USA Case series IV 44 (52) 15.9% 16.2 (13–19) 27 (12–60) months Arthroscopic 9 Tran et al. [ 47 ] Australia Case series IV 34 (41) 85.3% 15.7 (11–18) 14 months (1–2 years) Arthroscopic 12 Walker et al.…”

Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents

“…[6, 18, 19] However, SHD requires a relatively large skin incision, extensive soft tissue dissection, and a trochanteric osteotomy, which can lead to postoperative pain. In the original study by Ganz et al [2] and subsequent studies of SHD for treatment of FAI, [6–8, 15, 19–22] there were no references to any adjunct method of analgesia or postoperative pain protocol; except for the description that surgery is performed under general anesthesia. In this study, we describe a protocol for pain management using an intraoperative periarticular infiltration combined with an extra-articular continuous infusion of local anesthetics.…”

What Are the Demographic and Radiographic Characteristics of Patients With Symptomatic Extraarticular Femoroacetabular Impingement?

“…Patients with anterior extraarticular FAI displayed greater relative femoral retroversion versus posterior extraarticular FAI (median [first quartile, third quartile], 8° [2,18] versus 21° [20,30], respectively; location shift [95% CI], À16 [À26 to À4]; p = 0.005) and versus complex extraarticular impingement (20° [10,30]; location shift [95% CI], À10 [À18 to À2]; p = 0.007) ( Table 5). More advanced Tönnis grade changes were present in complex versus anterior extraarticular FAI (25% versus 2% of hips Tönnis Grade 2; OR [95% CI] 3 [1 to 10]; p = 0.039; 9], respectively, p = 0.199; two o'clock: 6°[0, 14], 18° [9,20], 11° [2,18], respectively, p = 0.122; three o'clock 15° [ 10,18], 20° [16,23], 16° [12,21] [29,37], respectively, p = 0.833) were not different between groups (Table 5). In anterior, posterior, and complex extraarticular FAI groups, presence of a cam lesion (51%, 29%, and 42%, respectively, p = 0.524) or labral tear (67%, 67%, 43%, respectively, p = 0.219) was not significantly associated with extraarticular FAI type ( Table 5).…”

“…These pathologic hip mechanics can injure the labral/chondral junction and potentially cause early osteoarthritic changes in the hip [32]. Both arthroscopic and open surgical hip dislocation approaches to address labral injury and contour the femoral head-neck junction and acetabular rim have resulted in improved clinical outcomes in patients with symptomatic FAI [5,6,17,19,21,23]. Despite the widespread adoption and success of these treatments for FAI, a subset of patients fails to improve after surgery, suggesting that unaddressed sources of impingement may exist.…”