Arthroscopic treatment of pincer-type femoroacetabular impingement performing acetabuloplasty without labral detachment

Abstract

Objectives:In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. However, when the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment.Methods:During the study period, we retrospectively analyzed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average followup of 32 months (range: 27-38). We excluded patients with CAM-type impingement and previous hip pathology. Radiographs were analyzed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of preoperative and postoperative modified Harris Hip Score (mHHS) and WOMAC as well as postoperative Visual Analogue Scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis..Results:Mean preoperative anterior and lateral center-edge angles were 35º and 29º, respectively. Mean preoperative alfa angle was 52º. Crossover sign was found in 82% of cases. mHHS changed from 51.06 (SD 4.81) preoperatively to 84.97 (SD 12.79) postoperatively. Preoperative WOMAC was 29.18 (SD 8) and postoperative, 13.10 (SD 11). Postoperative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding postoperative mHHS (89.9s vs 77.85, p=0.03), pain VAS (1.5 vs 6.3, p=0.03) and satisfaction VAS (8.2 vs 6.3, p=0.01). Postoperative WOMAC was slightly better for Tönnis 0 patients (8.31 vs 19.3, p=0.05). No differences were found in preoperative WOMAC and mHHS. Three of 44 patients required a second surgical procedure and were considered failures. Survival was 100% at 24 months and 76% at 40 months (95%CI: 35%-98%).Conclusion:Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes in all the evaluated scores. Slight degenerative changes on radiographs correlated with poorer clinical outcomes, exhibiting better results in patients without osteoarthritis.