Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

Abstract

PurposeWe report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years.Materials and MethodsBetween May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared.ResultsAcetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area.ConclusionOpen surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.

Observations on the Present and the Future of Hip Surgery

“…In this sense, the direct anterior approach (DAA) has gained wide popularity in the last few years because of its intrinsic minimal operative trauma to the hip joint and because of the positive impact on implants' survival, which is achieved independently from body habitus, age [10] and bony anatomy [11][12][13]. However, since the DAA has gained popularity, many surgeons have experienced its effectiveness in the management of hip diseases, either performing a mini-open preservative procedure for slipped capital femoral epiphysis [14] or performing neck reshaping for femoral-acetabular impingement [15]. Given the expertise developed by surgeons in this field, more complex anatomy and surgical cases are managed through the extended anterior approach, above all when the pathology affects the anterior aspect of the hip, as in the case of flexion contractures of the hips or calcifications in the context of the psoas muscle or anterior to the capsulae [16,17].…”