Surgical treatment of femoroacetabular impingement (FAI) of the hip has been pioneered over the last decade, initially using an open surgical dislocation approach. In recent years, there has been an accelerating transition toward arthroscopic treatment, which may offer shorter recovery time and less post-operative pain. Advocates of the open approach have suggested that superior access and precision of bone work may still offer improved long-term results over the arthroscopic approach. To our knowledge, no study has prospectively compared the results of open and arthroscopic treatment. The purpose of this study was to prospectively compare surgical outcomes for open surgical dislocation vs. arthroscopic approaches to FAI.
All surgical dislocations performed for FAI over a six month period (group I) were compared to a matched control group of hip arthroscopies (group 2). All procedures were performed for labral tear in the setting of FAI, and all included labral refixation, as well as either osteoplasty, acetabuloplasty, or both. All procedures, both open and arthroscopic, were performed by a single surgeon. All patients were asked to complete four subjective questionnaires preoperatively, and at three, six, and 12 months post-operatively.
There were three patients in group 1, and seven in group 2, with similar average age and gender distribution. At average follow-up of eight months for group 1 the average scores improved from 59.4 to 70.8 for modified Harris Hip Score (HHS), 59.7 to 73.5 for Hip Outcomes Score Activities of Daily Living (HOS ADL), 46.0 to 65.7 for HOS Sports Subscale, 66.9 to 77.1 for Non-Arthritic Hip Score (NAHS). At average follow-up of 3.6 months for group 2 the average scores improved from 60.3 to 88.4 for HHS (p<0.05), 72.2 to 94.4 for HOS ADL, 49.4 to 81.6 for HOS Sports Subscale, 65.0 to 90.5 for NAHS (p<0.05). There were trends toward greater improvement in all scores in group 2 than in group 1.
The results demonstrated improvements in all scores for both groups. While no significant difference was shown between the two groups, there was a trend toward greater improvements at early follow-up with the arthroscopic approach. Currently both open surgical dislocation and arthroscopic approaches remain valid options in treatment of FAI. Further follow-up of this study group is necessary to compare the long-term outcomes of the two approaches.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.