Advertisement

Hip Arthroscopy for Femoroacetabular Impingement and Concomitant Labral Tears: A Minimum 2-Year Follow-Up Study

      Purpose

      The present study investigated the minimum 2-year outcomes of hip arthroscopy for femoroacetabular impingement (FAI) and concomitant labral tears in Asian patients.

      Methods

      Patients who underwent hip arthroscopy for both FAI and concomitant labral tears between January 2012 and December 2017 were included. Patients with hip osteoarthritis of Tönnis grade ≥2, previous hip surgery, or followed for less than 2 years were excluded. Clinical assessments were performed using the modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the rates of achieving threshold values of the minimal clinically important difference and patient acceptable symptomatic state at the latest follow-up. Plain radiographs were acquired pre- and postoperatively for radiologic assessments.

      Results

      A total of 73 patients (90 hips, 58 male, 15 female; mean age 34.4 years) who underwent hip arthroscopy for FAI and concomitant labral tears were enrolled. Forty-three hips (47.8%) had cam-type, 7 (7.8%) had pincer-type, and 40 (44.4%) had mixed-type FAI. The mean follow-up duration was 5.2 years. In cam- and mixed-type FAI hips, the mean α angle significantly decreased from 66.7 ± 8.28° preoperatively to 44.9 ± 3.78° postoperatively (95% confidence interval [CI] 19.6°-22.8°; P < .001). The mean modified Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index increased from 74.8 ± 13.2 and 75 ± 12.7 preoperatively to 93 ± 8.1 (95% CI 15.4-20.9; P = .001) and 89.4 ± 8.4 postoperatively (95% CI 11.8-17; P = .001), respectively. Seventy-four hips (82.2%) crossed the minimal clinically important difference, and 85 hips (94.4%) had achieved the patient acceptable symptomatic state. There were 2 cases of pudendal nerve palsy and 1 case of sciatic nerve palsy. No additional surgeries were required.

      Conclusions

      Hip arthroscopy can be an effective treatment for FAI and concomitant labral tears in Asian patients as demonstrated in this study, with improved PRO scores and reoperation rates. Longer-term studies with larger cohorts are necessary.

      Level of Evidence

      Level IV, case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Corten K.
        • Ganz R.
        • Chosa E.
        • Leunig M.
        Bone apposition of the acetabular rim in deep hips: A distinct finding of global pincer impingement.
        J Bone Joint Surg Am. 2011; 93: 10-16
        • Nho S.J.
        • Magennis E.M.
        • Singh C.K.
        • Kelly B.T.
        Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes.
        Am J Sports Med. 2011; 39: 14S-19S
        • Choi S.M.
        • Park M.S.
        • Ju B.C.
        • Yoon S.J.
        Alterations in range of motion and clinical outcomes after femoroplasty in Asians.
        J Am Acad Orthop Surg. 2018; 26: e181-e190
        • Ganz R.
        • Leunig M.
        • Leunig-Ganz K.
        • Harris W.H.
        The etiology of osteoarthritis of the hip: An integrated mechanical concept.
        Clin Orthop Relat Res. 2008; 466: 264-272
        • Greaves L.L.
        • Gilbert M.K.
        • Yung A.C.
        • Kozlowski P.
        • Wilson D.R.
        Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MR study.
        J Biomech. 2010; 43: 858-863
        • Mella C.
        • Villalon I.E.
        • Nunez A.
        • Paccot D.
        • Diaz-Ledezma C.
        Hip arthroscopy and osteoarthritis: Where are the limits and indications?.
        SICOT J. 2015; 1: 27
        • Massa E.
        • Kavarthapu V.
        The expanding role of hip arthroscopy in modern day practice.
        Indian J Orthop. 2019; 53: 8-14
        • Menge T.J.
        • Briggs K.K.
        • Dornan G.J.
        • McNamara S.C.
        • Philippon M.J.
        Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.
        J Bone Joint Surg Am. 2017; 99: 997-1004
        • Frangiamore S.J.
        • Mannava S.
        • Briggs K.K.
        • McNamara S.
        • Philippon M.J.
        Career length and performance among professional baseball players returning to play after hip arthroscopy.
        Am J Sports Med. 2018; 46: 2588-2593
        • Sansone M.
        • Ahldén M.
        • Jonasson P.
        • et al.
        Good results after hip arthroscopy for femoroacetabular impingement in top-level athletes.
        Orthop J Sports Med. 2015; 3 (2325967115569691)
        • Casartelli N.C.
        • Leunig M.
        • Maffiuletti N.A.
        • Bizzini M.
        Return to sport after hip surgery for femoroacetabular impingement: A systematic review.
        Br J Sports Med. 2015; 49: 819-824
        • Lee J.W.
        • Hwang D.S.
        • Kang C.
        • Hwang J.M.
        • Chung H.J.
        Arthroscopic repair of acetabular labral tears associated with femoroacetabular impingement: 7-10 years of long-term follow-up results.
        Clin Orthop Surg. 2019; 11: 28-35
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • et al.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Ilizaliturri Jr., V.M.
        • Byrd J.W.
        • Sampson T.G.
        • et al.
        A geographic zone method to describe intra-articular pathology in hip arthroscopy: Cadaveric study and preliminary report.
        Arthroscopy. 2008; 24: 534-539
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43-B: 752-757
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Wolfson T.S.
        • Ryan M.K.
        • Begly J.P.
        • Youm T.
        Outcome trends after hip arthroscopy for femoroacetabular impingement: When do patients improve?.
        Arthroscopy. 2019; 35: 3261-3270
        • 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
        • Minkara A.A.
        • Westermann R.W.
        • Rosneck J.
        • Lynch T.S.
        Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.
        Am J Sports Med. 2019; 47: 488-500
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • et al.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; 417: 112-120
        • Leunig M.
        • Ganz R.
        Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis.
        Unfallchirurg. 2005; 108 ([in German]): 12-17
        • Perets I.
        • Chaharbakhshi E.O.
        • Mu B.
        • et al.
        Hip arthroscopy in patients ages 50 years or older: Minimum 5-year outcomes, survivorship, and risk factors for conversion to total hip replacement.
        Arthroscopy. 2018; 34: 3001-3009
        • Öhlin A.
        • Ahldén M.
        • Lindman I.
        • et al.
        Good 5-year outcomes after arthroscopic treatment for femoroacetabular impingement syndrome.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1311-1316
        • Perets I.
        • Chaharbakhshi E.O.
        • Shapira J.
        • et al.
        Hip Arthroscopy for femoroacetabular impingement and labral tears in patients younger than 50 years: Minimum five-year outcomes, survivorship, and risk factors for reoperations.
        J Am Acad Orthop Surg. 2019; 27: e173-e183
        • Thomas D.D.
        • Bernhardson A.S.
        • Bernstein E.
        • Dewing C.B.
        Hip arthroscopy for femoroacetabular impingement in a military population.
        Am J Sports Med. 2017; 45: 3298-3304
        • Gupta A.
        • Redmond J.M.
        • Stake C.E.
        • Dunne K.F.
        • Domb B.G.
        Does primary hip arthroscopy result in improved clinical outcomes? 2-year clinical follow-up on a mixed group of 738 consecutive primary hip arthroscopies performed at a high-volume referral center.
        Am J Sports Med. 2016; 44: 74-82
        • Allen K.D.
        Racial and ethnic disparities in osteoarthritis phenotypes.
        Curr Opin Rheumatol. 2010; 22: 528-532
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Nevitt M.C.
        • Xu L.
        • Zhang Y.
        • et al.
        Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: The Beijing osteoarthritis study.
        Arthritis Rheum. 2002; 46: 1773-1779
        • NCD Risk Factor Collaboration (NCD-RisC)
        Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults.
        Lancet. 2017; 390: 2627-2642
        • Zhan C.
        • Kaczmarek R.
        • Loyo-Berrios N.
        • Sangl J.
        • Bright R.A.
        Incidence and short-term outcomes of primary and revision hip replacement in the United States.
        J Bone Joint Surg Am. 2007; 89: 526-533
        • Kim H.A.
        • Koh S.H.
        • Lee B.
        • et al.
        Low rate of total hip replacement as reflected by a low prevalence of hip osteoarthritis in South Korea.
        Osteoarthritis Cartilage. 2008; 16: 1572-1575
        • Lee W.Y.
        • Hwang D.S.
        • Noh C.K.
        Descriptive epidemiology of patients undergoing total hip arthroplasty in Korea with focus on incidence of femoroacetabular impingement: Single center study.
        J Korean Med Sci. 2017; 32: 581-586
        • Ha Y.C.
        • Kim K.C.
        • Shin Y.E.
        Patient satisfaction after arthroscopic repair of acetabular labral tears.
        Clin Orthop Surg. 2014; 6: 159-164
        • Bedi A.
        • Kelly B.T.
        Femoroacetabular impingement.
        J Bone Joint Surg Am. 2013; 95: 82-92
        • Jang S.A.
        • Cho Y.H.
        • Byun Y.S.
        • et al.
        Arthroscopic treatment of cam type femoroacetabular impingement: short term results.
        Hip Pelvis. 2014; 95: 29-35