Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques

Addai, Daniel; Zarkos, Jacqueline; Pettit, Matthew; Kumar, Karadi Hari Sunil; Khanduja, Vikas

doi:10.1302/2046-3758.109.bjr-2020-0443.r1

Cited by 15 publications

(9 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bony femoral impingement on the anterior-inferior (femoral 4 to 5 o'clock position) aspect of the femoral neck could be important for patients undergoing hip arthroscopy or open hip preservation surgery (surgical hip dislocation or anterior mini open approach). 48 Planning of cam resection or rim trimming before hip arthroscopy should be evaluated carefully in FAI patients with decreased FV who report hip pain in flexion, especially for patients with pincer-type FAI or mixed-type FAI (because of the low impingement-free flexion). Impingement simulation is based on patient-specific 3D models of the hip joint.…”

Section: Discussionmentioning

confidence: 99%

Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Boschung

Faulhaber

Kiapour

et al. 2023

Bone & Joint Research

View full text Add to dashboard Cite

Aims Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients. Methods A retrospective study involving 24 patients (37 hips) with FAI and femoral retroversion (femoral version (FV) < 5° per Murphy method) was performed. All patients were symptomatic (mean age 28 years (SD 9)) and had anterior hip/groin pain and a positive anterior impingement test. Cam- and pincer-type subgroups were analyzed. Patients were compared to an asymptomatic control group (26 hips). All patients underwent pelvic CT scans to generate personalized CT-based 3D models and validated software for patient-specific impingement simulation (equidistant method). Results Mean impingement-free flexion of patients with mixed-type FAI (110° (SD 8°)) and patients with pincer-type FAI (112° (SD 8°)) was significantly (p < 0.001) lower compared to the control group (125° (SD 13°)). The frequency of extra-articular subspine impingement was significantly (p < 0.001) increased in patients with pincer-type FAI (57%) compared to cam-type FAI (22%) in 125° flexion. Bony impingement in maximal flexion was located anterior-inferior at femoral four and five o’clock position in patients with cam-type FAI (63% (10 of 16 hips) and 37% (6 of 10 hips)), and did not involve the cam deformity. The cam deformity did not cause impingement in maximal flexion. Conclusion Femoral impingement in maximal flexion was located anterior-inferior distal to the cam deformity. This differs to previous studies, a finding which could be important for FAI patients in order to avoid exacerbation of hip pain in deep flexion (e.g. during squats) and for hip arthroscopy (hip-preservation surgery) for planning of bone resection. Hip impingement in flexion has implications for daily activities (e.g. putting on shoes), sports, and sex. Cite this article: Bone Joint Res 2023;12(1):22–32.

show abstract

Section: Discussionmentioning

confidence: 99%

Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Boschung

Faulhaber

Kiapour

et al. 2023

Bone & Joint Research

View full text Add to dashboard Cite

show abstract

“…9 The success in addressing FAIS by surgical hip dislocation has been shown to be equivalent to hip arthroscopy in both survivorship and hip-specific patient reported outcomes at mid-term follow-up in a systematic review. 29,30 Steppacher et al 31 has shown an 80% 10year survivorship after surgical hip dislocation for the treatment of FAIS. More recently in a propensitymatched analysis of hip arthroscopy versus surgical hip dislocation, Nepple et al 32 reported no significant difference in postoperative patient reported outcomes after surgery, revision to total hip arthroplasty (surgical hip dislocation 3.1% compared to arthroscopy 0%, P ¼ .12), or persistent symptoms (surgical hip dislocation 24.4% compared to arthroscopy 21.9%, P ¼ .55).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Coxa Profunda With Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction

Klosterman

Zacharias

Dooley

et al. 2022

Arthroscopy Techniques

View full text Add to dashboard Cite

“…In addition, the pooled incidence of surgical complications was 1%, which is almost the same as the overall complication rate after hip arthroscopy for FAIS in adolescents, 29 and slightly lower than the pooled rate of all complications (4%) in adults. 1 …”

Section: Discussionmentioning

confidence: 99%

Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis

Kobayashi

Kamono

Yamamoto

et al. 2022

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Subspine impingement, or anterior inferior iliac spine (AIIS) impingement, is a type of extra-articular pathology associated with femoroacetabular impingement syndrome and often requires subsequent arthroscopic surgery. Purpose: To examine the diagnostic accuracy, prevalence, and clinical outcomes of arthroscopic treatment for AIIS impingement. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was applied. We searched for studies on the prevalence, diagnostic accuracy, and results of surgical treatment for AIIS impingement. For each included study, data synthesis and statistical analysis were performed to identify pooled prevalence, calculate clinical outcome scores, and estimate adverse events. The QUADAS (a quality assessment tool for diagnostic accuracy studies) was used to assess the quality of the diagnostic accuracy studies, and the Risk of Bias Assessment tool for Nonrandomized Studies was used to assess the quality of the studies on arthroscopic treatment efficacy. Results: Out of an initial 791 studies, 23 were included. AIIS impingement was diagnosed by plain radiography with 76% to 86% sensitivity, 3-dimensional computed tomography with 80% to 81.8% sensitivity, magnetic resonance imaging with 80% sensitivity, and ultrasound with 92.5% sensitivity. For patients who underwent hip arthroscopy, the pooled prevalence of AIIS impingement was 18%. Significant improvement between pre- and postoperative clinical outcomes was observed: 25.75 points for the modified Harris hip score (mHHS), 46.88 points for the Hip Outcome Score–Sport subscale, 20.85 points for the Nonarthritic Hip Score, and -2.92 points for the pain visual analog scale. The minimal clinically important difference on the mHHS was exceeded by 94% of patients. The pooled incidence of surgical complications was 1%. Of 6 included studies on diagnostic accuracy, 2 were identified as having a low risk of bias, and 4 included >2 factors with a high risk of bias. All 9 included studies on treatment outcomes had at least 1 factor with a high risk of bias. Conclusion: Several imaging modalities assist in the diagnosis of AIIS impingement. The overall prevalence of AIIS impingement in patients that underwent hip arthroscopy was 18%. Clinical outcomes after arthroscopic AIIS decompression were generally favorable, with a relatively low rate of surgical complications.

show abstract

Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques

Cited by 15 publications

References 88 publications

Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Treatment of Coxa Profunda With Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction

Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About