Combined Arthroscopic and Modified Open Approach for Cam Femoroacetabular Impingement: A Preliminary Experience

Purpose

We report our case series of patients undergoing surgical treatment (femoral osteoplasty) for symptomatic cam femoroacetabular impingement (FAI). Clinical results using a modified Heuter anterior approach combined with adjunctive hip arthroscopy are presented.

Methods

A chart review of 16 hips (14 consecutive patients) was conducted. Radiographic parameters (α angle, head-neck offset, and Tönnis grade) were compared preoperatively and postoperatively. Clinical features (range of motion, provocative testing, and Harris hip score) were assessed.

Results

At 2.0 years, mean hip flexion improved from 94.1° to 110.0° (P < .01) and internal rotation from 7.1° to 12.3° (P = .02). The mean α angle improved from 64.5° to 43.3° (P < .01), whereas the mean femoral head-neck offset improved from 1.9 to 9.6 mm (P < .01). The mean Harris hip score improved from 63.8 to 76.1 (P = .01). No deterioration in overall radiographic Tönnis grades was present at last follow-up.

Conclusions

The combination of hip arthroscopy with a limited anterior approach (Heuter) is a useful technique for patients with cam or cam-dominant FAI lesions. We believe the limited anterior approach with open osteoplasty presents a reasonable alternative to arthroscopic methods of osteoplasty with minimal drawbacks in the event that total hip arthroplasty is indicated in the future.

Level of Evidence

Level IV, therapeutic case series.

Key Words: Femoroacetabular impingement, Labral tear, Osteoarthritis, Hip arthroscopy, Osteoplasty, Acetabular retroversion