Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage

Abstract

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

Factors Associated With the Failure of Surgical Treatment for Femoroacetabular Impingement

“…Pain and functional outcomes were measured using various standardized scoring methods. Of the seven studies measuring pain and functional scores, four used the Harris Hip Score 21 (HHS) two used the Western Ontario and McMaster Universities (WOMAC) arthritis index 3 and one used the Merle d'Aubigné-Postel 8 and the Dexus combined score 29 . All included studies noted whether a repeat arthroscopy or hip arthroplasty was offered or performed for any patient.…”

“…The same study noted that patients with Tonnis grade 0 and 1 had significant improvement in clinical outcome scores (P < 0.001) at 1 year and remained unchanged at subsequent yearly follow-ups. 29 …”

“…Further, in a middle-aged patient with FAI and early OA who complains of pain, it is difficult to ascribe the pain to either the impingement or the existing arthritis alone. While many studies demonstrated poor outcomes for FAI surgery in an already arthritic hip 4, 13, 14, 17, 19, 26, 28, 29 , several of the included studies found that many patients with good outcomes had severe cartilage damage as well. 1, 14, 22 Investigators in several of the studies included in this review excluded patients without mechanical symptoms, older patients and those with “aching” pain only 17 , and offered them a total hip arthroplasty instead.…”

“…While most studies report good short-term outcomes of both arthroscopic and open approaches for FAI surgery, these studies invariably contain a subset of patients who do not benefit from these operations and go on to require additional operations or joint replacement for pain relief. 1, 4, 6, 13, 14, 16, 17, 19, 22, 25, 26, 28, 29 To date, no study has been conducted to specifically review pertinent literature in order to identify patient-related factors that determine post-surgical outcomes.…”

The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement

“…43,44 However, it has been demonstrated that the vast majority of chondral and labral lesions are located in the accessible area of this surgical approach. 45 One of the strategies that can be used to improve the view of the central compartment during a mini-open approach is to use of a 70° arthroscope, which allows a thorough evaluation of the central compartment of the hip 46,47 ; however, we did not use this technique. We also accept that the use of other methods to classify articular cartilage and labral pathology [48][49][50][51] could have led to a different result with regard to the predictive value of the studied variables.…”