Treatment of femoroacetabular impingement: a systematic review

Abstract

The purpose of this review is to determine if there is a difference in outcomes after: (1) nonsurgical vs surgical treatment of FAI; (2a) surgical dislocation with greater trochanteric osteotomy, (2b) anterior mini-open, (2c) arthroscopic plus mini-open, and (2d) arthroscopic surgery for FAI; (3) difference in complication and re-operation rates; and (4a) labral refixation and (4b) labral debridement for labral injuries. A systematic review of multiple databases was performed after PROSPERO registration and using PRISMA guidelines. Level I-IV evidence clinical studies with minimum 2-year follow-up were included. Data were compared using 2-sample and 2-proportion Z-test calculators. Study methodological quality was analyzed using Modified Coleman Methodology Score (MCMS). Recommendations were made using SORT (Strength Of Recommendation Taxonomy). Twenty-nine studies were included (2369 subjects; 2507 hips). MCMS was poor. Mean subject age was 34.4+/−8.4 years and mean follow-up was 3.1+/−0.9 years. Statistically significant differences were observed following both nonsurgical and surgical treatment, with greater (P< 0.05) improvements following surgery (SORT B), without consistent significant differences observed between different surgical techniques (SORT C). There was a greater (P<0.05) reoperation and complication rate following surgical dislocation vs mini-open and arthroscopic techniques (SORT A). Clinical outcomes were significantly better (P<0.05) following labral refixation vs debridement (SORT B). Outcomes of operative treatment of femoroacetabular impingement are significantly better than nonsurgical management. Surgical treatment significantly improves outcomes, with no consistent significant differences exhibited between open and arthroscopic techniques. Open surgical dislocation has significantly greater reoperation and complication rates vs miniopen and arthroscopic techniques. Outcomes of labral refixation are significantly better than debridement in patients with labral injuries.

Accuracy and Feasibility of Dual Fluoroscopy and Model-Based Tracking to Quantify In Vivo Hip Kinematics During Clinical Exams

“…21 However, Harris et al reported a BMI of 24.5±2.6 kg/m 2 in a review of more than 2,000 FAI patients, making the results of this study relevant to the future study of FAI with dualfluoroscopy and model-based tracking. 22 Still, the radiation and imaging settings used in our study may not be applicable to overweight or obese individuals. Nonetheless, use of ionizing radiation, especially with regards to CT, needs to be carefully evaluated.…”

Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis

“…Mostly low level of evidence case series with broad patient inclusion criteria indicate that the arthroscopic treatment of intra-articular pathologies and correction of bony deformities related to FAI seem to reduce hip pain and improve hip function, with the majority of patients being satisfied with the surgical outcome 5. However, to the best of our knowledge, no published study has compared hip arthroscopy with other non-surgical interventions to establish the true effectiveness of hip arthroscopy for the management of FAI 6 7.…”

“…Some systematic reviews have already summarised the current knowledge on patient-reported outcomes after hip arthroscopy in patients with FAI 5 8–12. The large majority of studies included in previous systematic reviews reported hip arthroscopy outcomes with composite scores (eg, Harris Hip Score and Non-Arthritic Hip Scale) 5 8–12.…”

Diagnosis and management of femoroacetabular impingement: A review of the literature

“…Harris et al [43] in a comprehensive systematic review reported that statistically significant differences were observed among patients following surgical and non-surgical treatments for FAI, with greater improvement found among patients that underwent surgery. No significant differences were observed between the different surgical techniques used.…”