Outcomes After Management of Subspine and Femoroacetabular Impingement Using a Direct Anterior Mini-Open Approach

Abstract

Background: Subspine impingement (SSI) has been commonly managed with arthroscopic decompression. However, arthroscopic decompression is a demanding technique, as under- or over-resection of the anterior inferior iliac spine (AIIS) could lead to inferior outcomes. An anterior mini-open approach has also been used in the management of femoroacetabular impingement (FAI), and it could provide adequate visualization of the anterior hip joint without a long learning curve. Purpose/Hypothesis: The objective of the current study was to compare the outcomes of SSI patients with FAI who underwent arthroscopic subspine decompression and osteoplasty with a group undergoing subspine decompression and osteoplasty using a modified direct anterior mini-open approach. It was hypothesized that there would be no significant difference in outcomes between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of SSI patients who underwent decompression surgery (arthroscopic or mini-open) at our institution from June 1, 2015 to December 31, 2016. Both groups underwent the same postoperative rehabilitation protocol. Preoperative and 2-year postoperative patient-reported outcomes were compared using the modified Harris Hip Score (mHHS), International Hip Outcome Tool–33 (iHOT–33), and Hip Outcome Score—Activities of Daily Living (HOS–ADL). Major and minor complications as well as reoperation rates were recorded. Results: Included were 47 patients (49 hips) who underwent subspine decompression using an anterior mini-open approach and 35 patients (35 hips) who underwent arthroscopic subspine decompression. There were no differences in demographic and radiological parameters between the groups, and patients in both groups showed significant improvement in all outcome scores at follow-up. The pre- to postoperative improvement in outcome scores was also similar between groups (mini-open vs arthroscopy: mHHS, 26.30 vs 27.04 [ P = .783]; iHOT–33, 35.76 vs 31.77 [ P = .064]; HOS–ADL, 26.09 vs 22.77 [ P = .146]). In the mini-open group, 10 of the 47 patients had temporary meralgia paresthetica, and fat liquefaction was found in 1 female patient. There were no reoperations in the mini-open group. Conclusion: Subspine decompression using the anterior mini-open approach had similar outcomes to arthroscopic decompression in the management of SSI. The lateral femoral cutaneous nerve should be protected carefully during use of the anterior mini-open approach.

Iliocapsularis: An exploration of the muscle and its omission in education

“…To further evaluate the ICm prevalence in the human body, one redundant donor data set was excluded in addition to 14 publications, which were either reviews, technical notes, or case studies. A total of 13 studies, published between 1950 and February 14th, 2022, investigated the prevalence of the ICm in a total of 521 anterior human hips (Babst et al, 2011; Baker et al, 2022; Elvan et al, 2019; Fagotti et al, 2020; Haefeli et al, 2015; Konno et al, 2021; Lawrenson et al, 2017; Lawrenson et al, 2020; Philippon et al, 2014; Walters et al, 2014; Wang et al, 2021; Ward et al, 2000; Xu et al, 2021). The ICm was present in 99%, or 518, hips which are in line with a recently published systematic review and meta‐analysis that analyzed dissection results of six studies, reporting a pooled‐prevalence rate of 98.7% (Keet et al, 2021).…”

“…ATBs. The surveys suggest that the muscle is rarely appreciated by general clinicians and anatomy educators, while the recent PRL suggests that hip-specific surgeons, who must account for the muscle's presence and functional importance when performing anterior hip procedures, have come to prioritize the muscle over the past decade (Camenzind et al, 2018;Fagotti et al, 2020;Harris, 2016;Konno et al, 2021;Philippon et al, 2014;Siebenrock et al, 2015;Spiker et al, 2021;Xu et al, 2021). In contrast to these conflicting findings, the ICm was a constant in the dissections performed in this study in all previous surgical and dissection studies, Note: A positive result in the educator survey was recorded by including iliocapsularis in the answer to the question "Which of the following structures do you teach to your students?…”

“…Of the 28 publications mentioning the ICm, 19 highlighted the morphology and proposed functional roles of the muscle (Babst et al, 2011;Baker et al, 2022;Das & Singh, 1950;Elvan et al, 2019;Haefeli et al, 2015;Hammoud et al, 2014;Keet et al, 2021;Konno et al, 2021;Lawrenson et al, 2017Lawrenson et al, , 2019Lawrenson et al, , 2020Philippon et al, 2014;Pourcho et al, 2015;Retchford et al, 2013;Ricci & Özçakar, 2019;Saito et al, 2021;Walters et al, 2014;Wang et al, 2021;Ward et al, 2000). Nine additional studies reported the presence of the ICm using clinical scenarios consisting of surgical interventions and diagnostic imaging (Agten et al, 2016;Camenzind et al, 2018;Fagotti et al, 2020;Harris, 2016;Kalhor et al, 2021;Siebenrock et al, 2015;Spiker et al, 2021;Wyatt et al, 2017;Xu et al, 2021). To further evaluate the ICm prevalence in the human body, one redundant donor data set was excluded in addition to 14 publications, which were either reviews, technical notes, or case studies.…”

A caparison between ultrasound-guided AIIS injection and radiography in diagnosis of subspine impingement in patients with FAI

“…Recently, Xu et al reported to use extra-articular subspine corticosteroid injection to diagnosis of SSI. Patients who experienced a signi cant relief underwent subspine decompression and acquired signi cant improvement [21] . Based on the existing evidence, we considered that using ultrasound-guided AIIS injection on the diagnosis of SSI with extra-articular symptoms was feasible and effective.…”