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International Orthopaedics

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01-04-2018 | Original Paper

Arthroscopic versus open treatment of cam-type femoro-acetabular impingement: retrospective cohort clinical study

Authors: Paulo A. Rego, Vasco Mascarenhas, Filipe S. Oliveira, Pedro C. Pinto, Eduardo Sampaio, Jacinto Monteiro

Published in: International Orthopaedics | Issue 4/2018

Abstract

Purpose

The purpose of this study was to determine if there were significant differences between patients submitted to hip arthroscopy (HA) and surgical hip dislocation (SHD) to treat femoro-acetabular impingement (FAI), which variables were significantly associated with hip function before surgery and those predictive of the applied functional outcome scale and its variation rate after surgery.

Methods

We selected 198 patients treated with HA or SHD with a mean follow-up of 59 months. Inclusion criteria were ages 18–50 years, isolated FAI cam morphology and complete clinical and radiologic documentation. The subjective outcome measure used was the nonarthritic hip score (NAHS). We compared pre-operative and post-operative NAHS, alpha angles and complication rates. Multiple linear regression analyses were performed to find which variables could influence NAHS values.

Results

The mean alpha-angle value improved from 71.5° to 40.8°, and mean NAHS improved from 50 to 83 points, with no difference between groups (HA/SHD). We found only a 16.9% influence rate on the pre-operative score, explained by variables of gender/pre-operative alpha angle and presence of degenerative changes/age. The influence rate on the NAHS variation ratio after surgery was 62.8%, explained by the variables of pre-operative score, type of surgery and type of surgery/alpha angle. The complication rate was 7%.

Conclusions

FAI surgery can be considered effective in improving patient symptoms. There were no differences in clinical or radiographic results between techniques. We could more accurately predict the variation ratio of NAHS after surgery than its pre-operative value.

Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83(8):1119–1124CrossRefPubMed

Leunig M, Puloski S, Beck M, Siebenrock K-A, Ganz R (2005) Proximal femoral osteotomy: current indications and techniques. Semin Arthroplast 16(1):53–62. https://doi.org/10.1053/j.sart.2004.12.006 CrossRef

Ganz R, Huff TW, Leunig M (2009) Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect 58:241–255PubMed

Schoenecker PL, Clohisy JC, Millis MB, Wenger DR (2011) Surgical management of the problematic hip in adolescent and young adult patients. J Am Acad Orthop Surg 19(5):275–286CrossRefPubMed

Sussmann PS, Ranawat AS, Shehaan M, Lorich D, Padgett DE, Kelly BT (2007) Vascular preservation during arthroscopic osteoplasty of the femoral head-neck junction: a cadaveric investigation. Arthroscopy 23(7):738–743. https://doi.org/10.1016/j.arthro.2007.01.025 CrossRefPubMed

Grose AW, Gardner MJ, Sussmann PS, Helfet DL, Lorich DG (2008) The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip. J Bone Joint Surg Br 90(10):1298–1303. https://doi.org/10.1302/0301-620X.90B10.20983 CrossRefPubMed

Kalhor M, Horowitz K, Gharehdaghi J, Beck M, Ganz R (2012) Anatomic variations in femoral head circulation. Hip Int 22(3):307–312. https://doi.org/10.5301/HIP.2012.9242 CrossRefPubMed

Rego P, Mascarenhas V, Collado D, Coelho A, Barbosa L, Ganz R (2017) Arterial topographic anatomy near the femoral head-neck perforation with surgical relevance. J Bone Joint Surg Am 99(14):1213–1221. https://doi.org/10.2106/jbjs.16.01386 CrossRefPubMed

Rego PRA, Mascarenhas V, Oliveira FS, Pinto PC, Gaspar A, Ovídio J, Collado DG (2015) Morphologic and angular planning for cam resection in femoro-acetabular impingement: value of the omega angle. Int Orthop. https://doi.org/10.1007/s00264-015-3053-7

10.

Busse J, Gasteiger W, Tönnis D (1972) Significance of the “summarized hip factor” in the diagnosis and prognosis deformed hip joints. Arch Orthop Unfallchir 72(3):245–252CrossRefPubMed

11.

Christensen CP, Althausen PL, Mittleman MA, Lee J-A, McCarthy JC (2003) The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res 406:75–83. https://doi.org/10.1097/01.blo.0000043047.84315.4b CrossRef

12.

Del Castillo LNC, Leporace G, Cardinot TM, Levy RA, de Oliveira LP (2013) Translation, cross-cultural adaptation and validation of the brazilian version of the nonarthritic hip score. Sao Paulo Med J 131(4):244–251. https://doi.org/10.1590/1516-3180.2013.1314487 CrossRefPubMed

13.

Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J (2012) Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 470(8):2220–2226. https://doi.org/10.1007/s11999-012-2343-2 CrossRefPubMedPubMedCentral

14.

Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272. https://doi.org/10.1007/s11999-007-0060-z CrossRefPubMedPubMedCentral

15.

Mascarenhas VV, Rego P, Dantas P, Gaspar A, Soldado F, Consciência JG (2016) Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjects. Eur Radiol. https://doi.org/10.1007/s00330-016-4530-0

16.

Jamali AA, Mak W, Wang P, Tai L, Meehan JP, Lamba R (2013) What is normal femoral head/neck anatomy? An analysis of radial CT reconstructions in adolescents. Clin Orthop Relat Res 471(11):3581–3587. https://doi.org/10.1007/s11999-013-3166-5 CrossRefPubMedPubMedCentral

17.

Yanke AB, Khair MM, Stanley R, Walton D, Lee S, Bush-Joseph CA et al (2015) Sex differences in patients with CAM deformities with femoroacetabular impingement: 3-dimensional computed tomographic quantification. Arthroscopy 31(12):2301–2306. https://doi.org/10.1016/j.arthro.2015.06.007 CrossRefPubMed

18.

Hetsroni I, Dela Torre K, Duke G, Lyman S, Kelly BT (2013) Sex differences of hip morphology in young adults with hip pain and labral tears. Arthroscopy 29(1):54–63. https://doi.org/10.1016/j.arthro.2012.07.008 CrossRefPubMed

19.

Halim A, Badrinath R, Carter CW (2015) The importance of sex of patient in the management of femoroacetabular impingement. Am J Orthop (Belle Mead NJ) 44(4):172–175

20.

Joseph R, Pan X, Cenkus K, Brown L, Ellis T, Di Stasi S (2016) Sex differences in self-reported hip function up to 2 years after arthroscopic surgery for femoroacetabular impingement. Am J Sports Med 44(1):54–59. https://doi.org/10.1177/0363546515610535 CrossRefPubMed

21.

Mast NH, Impellizzeri F, Keller S, Leunig M (2010) Reliability and agreement of measures used in radiographic evaluation of the adult hip. Clin Orthop Relat Res 469(1):188–199. https://doi.org/10.1007/s11999-010-1447-9 CrossRefPubMedPubMedCentral

22.

McCarthy JC, Lee J-A (2006) Hip arthroscopy: indications, outcomes, and complications. Instr Course Lect 55:301–308PubMed

23.

Sink EL, Beaulé PE, Sucato D, Kim Y-J, Millis MB, Dayton M et al (2011) Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am 93(12):1132–1136. https://doi.org/10.2106/JBJS.J.00794 CrossRefPubMed

24.

Papavasiliou AV, Bardakos NV (2012) Complications of arthroscopic surgery of the hip. Bone Joint Res 1(7):131–144. https://doi.org/10.1302/2046-3758.17.2000108 CrossRefPubMedPubMedCentral

25.

Harris JD, McCormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR et al (2013) Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy 29(3):589–595. https://doi.org/10.1016/j.arthro.2012.11.003 CrossRefPubMed

26.

Walker JA, Pagnotto M, Trousdale RT, Sierra RJ (2012) Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery. Clin Orthop Relat Res 470(12):3414–3420. https://doi.org/10.1007/s11999-012-2506-1 CrossRefPubMedPubMedCentral

27.

Anwander H, Siebenrock KA, Tannast M, Steppacher SD (2016) Labral reattachment in femoroacetabular impingement surgery results in increased 10-year survivorship compared with resection. Clin Orthop Relat Res 475(4):1178–1188. https://doi.org/10.1007/s11999-016-5114-7 CrossRef

28.

Hetaimish BM, Khan M, Crouch S, Simunovic N, Bedi A, Mohtadi N et al (2013) Consistency of reported outcomes after arthroscopic management of femoroacetabular impingement. Arthroscopy 29(4):780–787. https://doi.org/10.1016/j.arthro.2012.11.011 CrossRefPubMed

Title: Arthroscopic versus open treatment of cam-type femoro-acetabular impingement: retrospective cohort clinical study
Authors: Paulo A. Rego
Vasco Mascarenhas
Filipe S. Oliveira
Pedro C. Pinto
Eduardo Sampaio
Jacinto Monteiro
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3735-4

At a glance: The STEP trials

Springer Medicine

Arthroscopic versus open treatment of cam-type femoro-acetabular impingement: retrospective cohort clinical study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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