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Outcomes 2 to 5 Years Following Hip Arthroscopy for Femoroacetabular Impingement in the Patient Aged 11 to 16 Years

      Purpose

      The purpose of this study was to evaluate clinical outcomes after treatment for femoroacetabular impingement in the pediatric and adolescent population with a minimum of 2 years' follow-up.

      Methods

      Prospectively collected data on 60 consecutive pediatric and adolescent patients (65 hips), aged 16 years or younger, who underwent hip arthroscopy were retrospectively analyzed. Patients were excluded if they had previous surgery on the hip and if they presented a center-edge angle below 25°.

      Results

      The mean age at the time of surgery was 15 years (range, 11 to 16 years), and 31% of patients were boys and 69% were girls. The femoral physis was open in 10% of patients, partially closed in 19%, and closed in 71%. Cam impingement was found in 10% of cases, pincer impingement in 15%, and mixed type in 75%. The mean center-edge angle was 36° (95% confidence interval [CI], 34° to 38°), and the mean alpha angle was 64° (95% CI, 60° to 69°). There was a significant association between age and alpha angle (r = 0.324, P = .02). After the index procedure, 8 patients (all girls) needed second-look diagnostic arthroscopies because of intra-articular adhesions. At a mean follow-up of 3 years (range, 2 to 5 years) with 91% follow-up, the modified Harris Hip Score increased from a mean of 57 (95% CI, 51 to 62) to a mean of 91 (95% CI, 88 to 94) (P < .001). The median rating for patient satisfaction with outcome was 10 (range, 5 to 10).

      Conclusions

      Hip arthroscopy in the pediatric and adolescent population is a safe procedure, with excellent clinical outcomes at 2 to 5 years. In this study there was an association between alpha angle and age. Clinical scores showed a significant improvement after surgery; however, 13% of patients did require a second procedure for capsulolabral adhesions.

      Level of Evidence

      Level IV, therapeutic case series.
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      References

        • Beck M.
        • Kalhor M.
        • Leunig M.
        • Ganz R.
        Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip.
        J Bone Joint Surg Br. 2005; 87: 1012-1018
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Nötzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; : 112-120
        • Wagner S.
        • Hofstetter W.
        • Chiquet M.
        • et al.
        Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement.
        Osteoarthritis Cartilage. 2003; 11: 508-518
        • Tannast M.
        • Goricki D.
        • Beck M.
        • Murphy S.B.
        • Siebenrock K.A.
        Hip damage occurs at the zone of femoroacetabular impingement.
        Clin Orthop Relat Res. 2008; 466: 273-280
        • Philippon M.J.
        • Schenker M.L.
        Arthroscopy for the treatment of femoroacetabular impingement in the athlete.
        Clin Sports Med. 2006; 25: 299-308
        • Wenger D.R.
        • Kishan S.
        • Pring M.E.
        Impingement and childhood hip disease.
        J Pediatr Orthop B. 2006; 15: 233-243
        • Spencer S.
        • Millis M.B.
        • Kim Y.-J.
        Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique.
        J Pediatr Orthop. 2006; 26: 281-285
        • Leunig M.
        • Casillas M.M.
        • Hamlet M.
        • et al.
        Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis.
        Acta Orthop Scand. 2000; 71: 370-375
        • Bowen J.R.
        • Kumar V.P.
        • Joyce J.J.
        • Bowen J.C.
        Osteochondritis dissecans following Perthes' disease.
        Clin Orthop Relat Res. 1986; : 49-56
        • Snow S.W.
        • Keret D.
        • Scarangella S.
        • Bowen J.R.
        Anterior impingement of the femoral head: A late phenomenon of Legg-Calvé-Perthes' disease.
        J Pediatr Orthop. 1993; 13: 286-289
        • Kocher M.S.
        • Kim Y.-J.
        • Millis M.B.
        • et al.
        Hip arthroscopy in children and adolescents.
        J Pediatr Orthop. 2005; 25: 680-686
        • Siebenrock K.A.
        • Wahab K.H.A.
        • Werlen S.
        • Kalhor M.
        • Leunig M.
        • Ganz R.
        Abnormal extension of the femoral head epiphysis as a cause of cam impingement.
        Clin Orthop Relat Res. 2004; : 54-60
        • Philippon M.J.
        • Weiss D.R.
        • Kuppersmith D.A.
        • Briggs K.K.
        • Hay C.J.
        Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players.
        Am J Sports Med. 2010; 38: 99-104
        • Philippon M.J.
        • Briggs K.K.
        • Yen Y.M.
        • Kuppersmith D.A.
        Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up.
        J Bone Joint Surg Br. 2009; 91: 16-23
        • Brunner A.
        • Horisberger M.
        • Herzog R.F.
        Sports and recreation activity of patients with femoroacetabular impingement before and after arthroscopic osteoplasty.
        Am J Sports Med. 2009; 37: 917-922
        • Peters C.L.
        • Erickson J.
        The etiology and treatment of hip pain in the young adult.
        J Bone Joint Surg Am. 2006; 88: 20-26
        • Friend L.
        • Kelly B.T.
        Femoroacetabular impingement and labral tears in the adolescent hip: Diagnosis and surgical advances.
        Curr Opin Pediatr. 2009; 21: 71-76
        • Ilizaliturri V.M.
        • Nossa-Barrera J.M.
        • Acosta-Rodriguez E.
        • Camacho-Galindo J.
        Arthroscopic treatment of femoroacetabular impingement secondary to pediatric hip disorders.
        J Bone Joint Surg Br. 2007; 89: 1025-1030
        • Nötzli H.P.
        • Siebenrock K.A.
        • Hempfing A.
        • Ramseier L.E.
        • Ganz R.
        Perfusion of the femoral head during surgical dislocation of the hip.
        J Bone Joint Surg Br. 2002; 84: 300-304
        • DeAngelis N.A.
        • Busconi B.D.
        Hip arthroscopy in the pediatric population.
        Clin Orthop Relat Res. 2003; : 60-63
        • Schindler A.
        • Lechevallier J.J.
        • Rao N.S.
        • Bowen J.R.
        Diagnostic and therapeutic arthroscopy of the hip in children and adolescents: Evaluation of results.
        J Pediatr Orthop. 1995; 15: 317-321
        • El-Sayed A.M.M.
        Treatment of early septic arthritis of the hip in children: Comparison of results of open arthrotomy versus arthroscopic drainage.
        J Child Orthop. 2008; 2: 229-237
        • Holgersson S.
        • Brattström H.
        • Mogensen B.
        • Lidgren L.
        Arthroscopy of the hip in juvenile chronic arthritis.
        J Pediatr Orthop. 1981; 1: 273-278
        • Futami T.
        • Kasahara Y.
        • Suzuki S.
        • Seto Y.
        • Ushikubo S.
        Arthroscopy for slipped capital femoral epiphysis.
        J Pediatr Orthop. 1992; 12: 592-597
        • Akkari M.
        • Santili C.
        • Braga S.R.
        • Polesello G.C.
        Trapezoidal bony correction of the femoral neck in the treatment of severe acute-on-chronic slipped capital femoral epiphysis.
        Arthroscopy. 2010; 26: 1489-1495
        • Kuklo T.R.
        • Mackenzie W.G.
        • Keeler K.A.
        Hip arthroscopy in Legg-calve-Perthes disease.
        Arthroscopy. 1999; 15: 88-92
        • Philippon M.J.
        • Yen Y.-M.
        • Briggs K.K.
        • Kuppersmith D.A.
        • Maxwell R.B.
        Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: A preliminary report.
        J Pediatr Orthop. 2008; 28: 705-710
        • Philippon M.J.
        • Maxwell R.B.
        • Johnston T.L.
        • Schenker M.
        • Briggs K.K.
        Clinical presentation of femoroacetabular impingement.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1041-1047
        • Clohisy J.
        • Carlisle J.
        • Beaule P.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66
        • Wiberg G.
        Studies on dysplastic acetabula and congenital subluxation of the hip joint.
        Acta Chir Scand. 1939; 83: 58
        • Nötzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Philippon M.J.
        • Christensen J.C.
        • Wahoff M.S.
        Rehabilitation after arthroscopic repair of intra-articular disorders of the hip in a professional football athlete.
        J Sport Rehabil. 2009; 18: 118-134
        • Larson C.M.
        • Giveans M.R.
        Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.
        Arthroscopy. 2009; 25: 369-376
        • Scuderi S.
        • Giaccone M.
        • Falletto E.
        • et al.
        So-called “dense-vascularised” peritoneal adhesions: Clinical and aetiopathogenetic considerations.
        Chir Ital. 2009; 61 (in Italian): 627-633
        • Nwachukwu B.U.
        • McFeely E.D.
        • Nasreddine A.Y.
        • Krcik J.A.
        • Frank J.
        • Kocher M.S.
        Complications of hip arthroscopy in children and adolescents.
        J Pediatr Orthop. 2011; 31: 227-231