Femoroacetabular impingement syndrome management: arthroscopy or open surgery?

Papalia, Rocco; Buono, Angelo Del; Franceschi, Francesco; Marinozzi, Andrea; Maffulli, Nicola; Denaro, Vincenzo

doi:10.1007/s00264-011-1443-z

Cited by 65 publications

(46 citation statements)

References 62 publications

(147 reference statements)

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“…Femoroacetabular impingement (FAI) is a common cause of hip pain most frequently affecting athletes and active young individuals [1][2][3][4]. Although FAI is often compounded by acetabular cartilage damage and labral lesions, rapid return to health is of personal and economic importance, particularly in such patient groups [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

Mancini

Fontana²

2014

International Orthopaedics (SICOT)

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Purpose This study assesses and compares the clinical outcomes of the arthroscopic matrix-induced autologous chondrocyte implant (MACI) and autologous matrix-induced chondrogenesis (AMIC) techniques for the treatment of acetabular chondral defects between 2 and 4 cm 2 consequent to femoral acetabular impingement. Methods Fifty-seven consecutive patients were treated with the MACI (n=26) or AMIC (n=31) technique. Patients were assessed pre-operatively and up to five years using the modified Harris Hip Score (mHHS) to compare outcomes. Results In both the MACI and AMIC groups, significant hip score improvements were measured over baseline levels at six months post-op (81.2±8.4 for MACI, 80.3±8.3 for AMIC, both p<0.001). The mHHS continued to improve up to three years post-op and remained stable over time until the final five year follow-up. Statistically significant differences between the groups were not observed. The mean mHHS improvement at the five year follow-up with respect to preoperative level was 37.8±5.9 and 39.1±5.9 in patients who underwent MACI and AMIC, respectively (NS). Subgroup analysis of both MACI and AMIC treatment outcomes for patients with an initial chondral defect larger than 3 cm 2 yielded comparable results at each time point. Conclusions This study suggests that both arthroscopic MACI and AMIC are valid procedures to repair mediumsized chondral defects on the acetabular side of the hip found during treatment of femoroacetabular impingement. Due to its high sustainability and minimal invasiveness, the single-stage AMIC procedure can reduce total treatment time and minimise morbidity while providing the same beneficial effects as the two-stage MACI intervention.

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Section: Introductionmentioning

confidence: 99%

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

Mancini

Fontana²

2014

International Orthopaedics (SICOT)

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“…In many cases patients have a combination of cam and pincer FAI [6,9,14]. Therefore, surgical intervention by an open, arthroscopic or combined techniques [15][16][17] aims to reduce the severity of the impingement, relieve pain and possibly increase motion.…”

Section: Introductionmentioning

confidence: 99%

The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

Alshameeri

Khanduja

2014

International Orthopaedics (SICOT)

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Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to reconcile the contradictions in some of these results, and therefore no coherent conclusions could be drawn. In this short article, we attempt to explain some of the abnormal kinematic and kinetic patterns associated with FAI by highlighting similarities between the gait seen in early osteoarthritis (OA) and that of FAI. We also propose an approach for future research in this field and emphasise the importance of quantifying early OA in FAI based on magnetic resonance imaging (MRI) scans and the amount of chondral damage seen during open or arthroscopic surgery.

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“…[13] The rate of excellent and good clinical results following SSHD in FAI has been about 80% in the published studies performed in adults. [14] Arthroscopic group patients only have better improvement in general health related quality of life scores than SSHD group patients. [15] In the present study, all hips had mixed type FAI with moderate to severe clinical, radiological, and intraoperative findings and an arthroscopic treatment could have been difficult to overcome all the bony and soft tissue alterations in most of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] According to the results of the published studies in which the number of hips has ranged from 19 to 60 and the mean follow-up has ranged from 2 years to 5.2 years, treatment of FAI by SSHD provides a significant improvement in the early functional outcome of the adult patients. [13] The rate of excellent and good clinical results following SSHD in FAI has been about 80% in the published studies performed in adults.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

İnan

Harmanşa

Ömeroğlu

2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada tek bir merkezde güvenli cerrahi kalça dislokasyonu (GCKD) tekniği kullanılarak karışık tipteki femoroasetabüler sıkışma (FAS) tedavisinde edinilen deneyim değerlendirildi. Hastalar ve yöntemler: Çalışmada Ekim 2009 -Ekim 2014 tarihleri arasında kliniğimizde GCKD tekniği ile tedavi edilen 21 hastanın (7 erkek, 14 kadın; ort. yaş 33.8±10.6 yıl; dağılım 19-52 yıl) 22 kalçası geriye dönük olarak değerlendirildi. Ameliyat öncesi ve son Harris kalça skorları (HKS) ve alfa açıları karşılaştırıldı. Yaş, cinsiyet, taraf, sıkışma testleri, ameliyat öncesi HKS, tümsek ve kıskaç tip FAS radyografik göstergeleri ve ameliyat sırasındaki eklem bulguları en son işlevsel sonuçlar üzerindeki etkileri yönünden değerlendirildi. Bulgular: Semptomların ortalama süresi 29.5 aydı. Kalçanın fleksiyonu ve iç rotasyonu ile ortaya çıkan kasık ağrısı başlıca semptomdu. Tüm kalçalara radyografik olarak "karışık tipte FAS" tanısı konuldu. Yirmi iki kalçanın ortalama izlem süresi 48 aydı. Ameliyat öncesi ve en son ortalama HKS arasındaki farklılık istatistiksel olarak anlamlıydı (60.0'a karşın 87.6 puan, p<0.001). Yirmi iki kalçadan ortalama HKS'si 95.0 puan olan 17 kalçada (%77) tedavi yeterli olarak değerlendirildi. Ameliyat öncesi HKS'si 60 puanın altında olan kalçalar yetersiz sonuca biraz daha fazla yatkındı. Araştırılan hasta bağımlı, klinik, radyografik değişkenler ve ameliyat sırasındaki eklem bulguları içinde düz bir grafideki koksa profunda belirtisi daha yüksek bir yetersiz sonuç oranı ile ilişkili bulundu (p= 0.040). Sonuç: Güvenli cerrahi kalça dislokasyonu işlemi ortalama dört yıllık izlem sonrasında %77'lik bir başarı oranına sahiptir. Koksa profunda belirtisi yetersiz klinik sonuç ile bağlantılıdır. Ameliyat öncesi 60 puanın altındaki bir HKS klinik sonuç üzerinde negatif belirleyici bir değişken olarak görünmektedir.Anahtar sözcükler: Femoroasetabüler sıkışma; işlevsel sonuç; cerrahi kalça dislokasyonu; tedavi. ABSTRACT Objectives:This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. Patients and methods: In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Results: Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 8...

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Femoroacetabular impingement syndrome management: arthroscopy or open surgery?

Abstract: Although open and minimally invasive procedures allow athletes to return to professional sports activity, they are contraindicated in patients with severe osteoarthritis and cartilage degeneration.

Cited by 65 publications

References 62 publications

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

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