Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Abstract

To describe the functional results of arthroscopic treatment in patients with femoroacetabular impingement (FAI) and subspine impingement (SSI) evaluated with a 3-dimensional (3D) dynamic study. Methods: This was a retrospective observational study of patients with a diagnosis of FAI and SSI, evaluated with a 3D dynamic computed tomography scan with Move Forward software, who underwent hip arthroscopy between February 2015 and December 2017. Measurements of the alpha angle, femoral anteversion, acetabular anteversion, lateral center-edge angle, and Tönnis angle were extracted from the 3D dynamic study. Functionality was evaluated using the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after surgery. Results: We analyzed 22 hips in 17 patients (9 female and 8 male patients) with an average age of 34.6 AE 14.3 years. Of the 22 hips, 15 had cam morphology, 6 had mixed morphology, and 1 had pincer morphology. Of the hips, 11 had a type I spine, 10 had type II, and 1 had type III. The average alpha angle, Tönnis angle, femoral anteversion, and acetabular anteversion were 61.9 AE 11.1 , 2.5 AE 6.4 , 8.8 AE 6.8 , and 15.1 AE 7.1 , respectively. The median lateral center-edge angle was 38.1 (interquartile range, 32.6-43.5). At 1-year follow-up, a decrease in the Western Ontario McMaster Universities Osteoarthritis Index score (P ¼ .001) and an increase in the flexion angle (P < .001) were observed. No cases needed posterior surgical revision because of persistent pain. Conclusions: Arthroscopic treatment provides symptom relief and good functional results in patients with FAI and SSI. Level of Evidence: Level IV, therapeutic case series.

Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review

“…[ 1 ] 2020 III Sweden Retrospective 23.4 y 551 HAGOS, iHOT-12, HSAS 3 77 ARTHROSCOPIC Aguilera-Bohórquez, B. [ 2 ] 2020 IV Colombia Retrospective 12 n 17 WOMAC 1 47 ARTHROSCOPIC Atzmon, R. [ 3 ] 2019 III Israel Retrospective 50 a n 64 HOS, mHHS, satisfaction 2 74 ARTHROSCOPIC Avnieli, I. B.…”

The case of ‘A Rhino Horn’: case report and proposal for modification to the Hetsroni and Kelly classification

“…The classification of AIIS morphology has established the Type III morphology as the AIIS prominence extending beyond the acetabular rim, but no difference was described between the 2 mm projection and the 40 mm projection [ 2 , 23 ]. Moreover, the larger type III AIIS was associated with more limitation in the ROM and consequently, limitations in activities that require deep hip flexion as weightlifting [ 3 , 4 , 11 ]. Excellent results have been published with arthroscopic treatment of subspine impingement [ 5 , 11 , 12 , 24 ] but no distinction has been made regarding arthroscopic treatment management of type II and type III AIIS morphology.…”

“…Moreover, the larger type III AIIS was associated with more limitation in the ROM and consequently, limitations in activities that require deep hip flexion as weightlifting [ 3 , 4 , 11 ]. Excellent results have been published with arthroscopic treatment of subspine impingement [ 5 , 11 , 12 , 24 ] but no distinction has been made regarding arthroscopic treatment management of type II and type III AIIS morphology. Furthermore, different management strategies should be considered if we compare type III morphology that extend up to 1 cm beyond the acetabulum and those that extend beyond 1 cm.…”

“…Treatment should be commenced with conservative means like anti-inflammatory medication, physical therapy and activity modification. If this fails however, surgical treatment has demonstrated good clinical results [ 11 ]. Arthroscopic and open approaches have both been described with good outcomes [ 12 ].…”

Editorial Commentary: Hip Subspine Impact: Is There a Synergistic Effect Between Subspine Impact and Femoroacetabular Impingement?

“…Especially considering that type I-II AIIS may produce abnormal contact due to dynamic alteration of the "hip" and type III AIIS due to morphologic alteration (prominent AIIS). 5,6 In my opinion, all studies reported in the current literature, [2][3][4]7,8 lead us in the right direction to reach a deeper understanding of the synergistic effect between SSI and FAI. At this point, we could also ask ourselves if the coexistence of both pathologies would define a new entity.…”