Download PDF
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2023; 64(01): e11-e16
DOI: 10.1055/s-0043-1760861
Original Article

Evaluation of the Mini-open Treatment for CAM-type Femoroacetabular Impingement

Article in several languages: español | English
Martín Salgado 
1   Departamento de Traumatología y Ortopedia, Hospital Dr. Sotero del Rio, Clinica MEDS, Santiago, Chile
2   Equipo de Cirugía Reconstructiva Articular, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
,
Carolina Avilés 
1   Departamento de Traumatología y Ortopedia, Hospital Dr. Sotero del Rio, Clinica MEDS, Santiago, Chile
,
Felipe Fernández
1   Departamento de Traumatología y Ortopedia, Hospital Dr. Sotero del Rio, Clinica MEDS, Santiago, Chile
,
María Loreto Letelier 
3   Departamento de Traumatología y Ortopedia, Universidad de Chile, Santiago, Chile
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To describe and evaluate the results of the treatment of femoroacetabular impingement (FAI) with the unassisted mini-open approach in a defined population.

Materials and Methods We performed a prospective clinical and functional assessment of fifty young patients with CAM-type FAI, with very low sports demand, treated by the unassisted mini-open approach. We included patients older than 18 years of age, with a diagnosis of symptomatic FAI, complete radiologic study, and positive lidocaine test. We excluded patients with previous hip pathology. We compared the pre- and postoperative modified Harris Hip Score (MHHS) (through the Wilcoxon test) and the pre- and postoperative scores on the Visual Analogue Scale (VAS) (through the Friedman analysis of variance [ANOVA] test). significance was established as p < 0.05. In total, 50 patients met the described inclusion criteria: 33 male and 17 female subjects.

Results The average age was of 36.8 ±  6.5 years. The average alfa angle was of 62.6° ±  5.6°. All patients had grade-1 Tonnis index osteoarthritis. In total, 39 patients had level 3 of activity (according to the Tegner scale). The mean follow-up was of 27.3 ±  6.2 (minimum of 12) months. The score on the MHHS improved from a preoperative median of 60.5 (range: 30.8–84.7) points to a postoperative median of 96.8 (range: 91.3–100) points (p < 0.001). All patients presented a significant decrease in pain, with a median VAS score of 0 at 1 year of follow-up.

Conclusions This technique presents good clinical and functional outcomes in patients with low sports demand. There is a lack of studies showing the advantages and limitations of the mini-open approach concerning the resection of larger bumps or in other locations.

Level of Evidence: 4.

Keywords

femoracetabular impingement/surgery - femoracetabular impingement/complications - treatment outcome - humans - minimally-invasive surgical procedures - postoperative complications


Publication History

Received: 28 August 2021

Accepted: 28 September 2022

Article published online:
18 May 2023

© 2023. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referencias

  • 1 Satpathy J, Kannan A, Owen JR, Wayne JS, Hull JR, Jiranek WA. Hip contact stress and femoral neck retroversion: a biomechanical study to evaluate implication of femoroacetabular impingement. J Hip Preserv Surg 2015; 2 (03) 287-294
    CrossrefPubMedGoogle Scholar
  • 2 Fairley J, Wang Y, Teichtahl AJ. et al. Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage 2016; 24 (10) 1682-1696
    CrossrefPubMedGoogle Scholar
  • 3 Egger AC, Frangiamore S, Rosneck J. Femoroacetabular Impingement: a review. Sports Med Arthrosc Rev 2016; 24 (04) e53-e58
    CrossrefPubMedGoogle Scholar
  • 4 Keogh MJ, Batt ME. A review of femoroacetabular impingement in athletes. Sports Med 2008; 38 (10) 863-878
    CrossrefPubMedGoogle Scholar
  • 5 Bedi A, Kelly BT. Femoroacetabular impingement. J Bone Joint Surg Am 2013; 95 (01) 82-92
    CrossrefPubMedGoogle Scholar
  • 6 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417) 112-120
    CrossrefPubMedGoogle Scholar
  • 7 Kyin C, Maldonado DR, Go CC, Shapira J, Lall AC, Domb BG. Mid- to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy 2021; 37 (03) 1011-1025
    CrossrefPubMedGoogle Scholar
  • 8 Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med 2019; 47 (02) 488-500
    CrossrefPubMedGoogle Scholar
  • 9 Barton C, Banga K, Beaulé PE. Anterior Hueter approach in the treatment of femoro-acetabular impingement: rationale and technique. Orthop Clin North Am 2009; 40 (03) 389-395
    CrossrefPubMedGoogle Scholar
  • 10 Ribas M, Marín-Peña OR, Regenbrecht B, De La Torre B, Vilarrubias JM. Hip osteoplasty by an anterior minimally invasive approach for active patients with femoroacetabular impingement. Hip Int 2007; 17 (02) 91-98
    CrossrefPubMedGoogle Scholar
  • 11 Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Relat Res 2009; 467 (03) 747-752
    CrossrefPubMedGoogle Scholar
  • 12 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 13 Kemp JL, Collins NJ, Makdissi M, Schache AG, Machotka Z, Crossley K. Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. Br J Sports Med 2012; 46 (09) 632-643
    CrossrefPubMedGoogle Scholar
  • 14 Botser IB, Smith Jr TW, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 2011; 27 (02) 270-278
    CrossrefPubMedGoogle Scholar
  • 15 Kalairajah Y, Azurza K, Hulme C, Molloy S, Drabu KJ. Health outcome measures in the evaluation of total hip arthroplasties–a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 2005; 20 (08) 1037-1041
    CrossrefPubMedGoogle Scholar
  • 16 Boone GR, Pagnotto MR, Walker JA, Trousdale RT, Sierra RJ. Caution Should be Taken in Performing Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Patients Over the Age of 40. HSS J 2012; 8 (03) 230-234
    CrossrefPubMedGoogle Scholar
  • 17 Fayad TE, Khan MA, Haddad FS. Femoroacetabular impingement: an arthroscopic solution. Bone Joint J 2013; 95-B (11, Suppl A) 26-30
    CrossrefPubMedGoogle Scholar
  • 18 Zingg PO, Ulbrich EJ, Buehler TC, Kalberer F, Poutawera VR, Dora C. Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results. Arch Orthop Trauma Surg 2013; 133 (01) 69-79
    CrossrefPubMedGoogle Scholar
  • 19 Gupta AK, Abrams GD, Nho SJ. What's New in Femoroacetabular Impingement Surgery: Will We Be Better in 2023?. Sports Health 2014; 6 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 20 Clohisy JC, McClure JT. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J 2005; 25: 164-171
    PubMedGoogle Scholar
  • 21 Hartmann A, Günther KP. Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results. Arch Orthop Trauma Surg 2009; 129 (08) 1001-1009
    CrossrefPubMedGoogle Scholar
  • 22 Ribas M, Ledesma R, Cardenas C, Marin-Peña O, Toro J, Caceres E. Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage. Hip Int 2010; 20 (Suppl. 07) S36-S42
    CrossrefPubMedGoogle Scholar
  • 23 Parvizi J, Huang R, Diaz-Ledezma C, Og B. Mini-open femoroacetabular osteoplasty: how do these patients do?. J Arthroplasty 2012; 27 (8, Suppl) 122-5.e1
    CrossrefPubMedGoogle Scholar