Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 1/2010

01.01.2010 | Clinical Research

Arthroscopic Treatment of Femoroacetabular Impingement of the Hip: A New Technique to Access the Joint

verfasst von: Monika Horisberger, MD, Alexander Brunner, MD, Richard F. Herzog, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Femoroacetabular impingement has been established as an important cause of groin pain and limitation of range of motion in young, active patients and a possible cause for early osteoarthritis of the hip. Open surgery is a well-recognized approach for treatment and probably the standard for most surgeons, but recent reports regarding arthroscopic treatment procedures suggest comparable results. We present a technique that provides a way to securely penetrate the joint capsule and evaluate the clinical results of this technique in patients with femoroacetabular impingement. Between 2004 and 2007, we prospectively followed a cohort of 105 hips (88 patients; 60 males, 28 females) who underwent surgery for symptomatic cam or mixed femoroacetabular impingement. All patients were evaluated for the Nonarthritic Hip Score, clinical parameters, visual analog scale pain score, initial radiographic degenerative changes, and alpha angle. At a minimum followup of 1.3 years (average, 2.3 years; range, 1.3–4.1 years), all clinical outcome measures improved. The Nonarthritic Hip Score improved from 56.7 points (range, 15–92.5 points) to 84.6 points (range, 47.5–100 points). Nine patients (8.6%) underwent THA during followup. The outcome measures after arthroscopic therapy for femoroacetabular impingement seem comparable to those reported after open procedures.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literatur
1.
Zurück zum Zitat Beaulé PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.CrossRefPubMed Beaulé PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.CrossRefPubMed
2.
Zurück zum Zitat Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–1292.PubMed Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–1292.PubMed
3.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
4.
Zurück zum Zitat Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.CrossRefPubMed Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.CrossRefPubMed
5.
Zurück zum Zitat Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24:1135–1145.PubMed Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24:1135–1145.PubMed
6.
Zurück zum Zitat Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–587.PubMed Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–587.PubMed
7.
Zurück zum Zitat Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739–746.CrossRefPubMed Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739–746.CrossRefPubMed
8.
Zurück zum Zitat Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extraarticular structures. Arthroscopy. 1995;11:418–423.PubMedCrossRef Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extraarticular structures. Arthroscopy. 1995;11:418–423.PubMedCrossRef
9.
Zurück zum Zitat Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC. The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res. 2003;406:75–83.CrossRefPubMed Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC. The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res. 2003;406:75–83.CrossRefPubMed
10.
Zurück zum Zitat Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(suppl 2, pt 1):36–53CrossRefPubMed Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(suppl 2, pt 1):36–53CrossRefPubMed
11.
Zurück zum Zitat Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.CrossRefPubMed Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.CrossRefPubMed
12.
Zurück zum Zitat Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.CrossRefPubMed Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.CrossRefPubMed
13.
Zurück zum Zitat 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.PubMed 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.PubMed
14.
Zurück zum Zitat Griffin DR, Villa RN. Complications of arthroscopy of the hip. J Bone Joint Surg Br. 1999;81:604–606.CrossRefPubMed Griffin DR, Villa RN. Complications of arthroscopy of the hip. J Bone Joint Surg Br. 1999;81:604–606.CrossRefPubMed
15.
Zurück zum Zitat Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular impingement. Arthroscopy. 2006;22:95–106.PubMed Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular impingement. Arthroscopy. 2006;22:95–106.PubMed
16.
Zurück zum Zitat Ilizaliturri VM Jr. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res. 2009;467:760–768.CrossRefPubMed Ilizaliturri VM Jr. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res. 2009;467:760–768.CrossRefPubMed
17.
Zurück zum Zitat Ilizaliturri VM Jr, Orozco-Rodriguez L, Acosta-Rodríguez E, Camacho-Galindo J. Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up. J Arthroplasty. 2008:23;226–234.CrossRefPubMed Ilizaliturri VM Jr, Orozco-Rodriguez L, Acosta-Rodríguez E, Camacho-Galindo J. Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up. J Arthroplasty. 2008:23;226–234.CrossRefPubMed
18.
Zurück zum Zitat Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.CrossRefPubMed Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.CrossRefPubMed
19.
Zurück zum Zitat Khanduja V, Villar R. The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1035–1040.CrossRefPubMed Khanduja V, Villar R. The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1035–1040.CrossRefPubMed
20.
Zurück zum Zitat Krueger A, Leunig M, Siebenrock KA, Beck M. Hip arthroscopy after previous surgical hip dislocation for femoroacetabular impingement. Arthroscopy. 2007;23:1285–1289.PubMedCrossRef Krueger A, Leunig M, Siebenrock KA, Beck M. Hip arthroscopy after previous surgical hip dislocation for femoroacetabular impingement. Arthroscopy. 2007;23:1285–1289.PubMedCrossRef
21.
Zurück zum Zitat Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–546.PubMedCrossRef Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–546.PubMedCrossRef
22.
Zurück zum Zitat MacDonald SJ, Garbuz D, Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplasty. 1997;8:3–9. MacDonald SJ, Garbuz D, Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplasty. 1997;8:3–9.
23.
Zurück zum Zitat Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. J Bone Joint Surg Am. 2005;87:273–279.CrossRefPubMed Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. J Bone Joint Surg Am. 2005;87:273–279.CrossRefPubMed
24.
Zurück zum Zitat Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1):84–91.CrossRefPubMed Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1):84–91.CrossRefPubMed
25.
Zurück zum Zitat Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.CrossRefPubMed Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.CrossRefPubMed
26.
Zurück zum Zitat Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, 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.CrossRefPubMed Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, 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.CrossRefPubMed
27.
Zurück zum Zitat Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.PubMed Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.PubMed
28.
Zurück zum Zitat Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.CrossRefPubMed Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.CrossRefPubMed
29.
Zurück zum Zitat Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15:908–914.CrossRefPubMed Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15:908–914.CrossRefPubMed
30.
Zurück zum Zitat Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. 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.CrossRefPubMed Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. 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.CrossRefPubMed
31.
Zurück zum Zitat Philippon MJ, Funke EL, Munzinger U. Complications in hip arthroscopy. Arthroscopy. 1996;12:156–159. Philippon MJ, Funke EL, Munzinger U. Complications in hip arthroscopy. Arthroscopy. 1996;12:156–159.
32.
Zurück zum Zitat Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–1047.CrossRefPubMed Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–1047.CrossRefPubMed
33.
Zurück zum Zitat Sampson TG. Arthroscopic treatment of femoroacetabular impingement: a proposed technique with clinical experience. Instr Course Lect. 2006;55:337–346.PubMed Sampson TG. Arthroscopic treatment of femoroacetabular impingement: a proposed technique with clinical experience. Instr Course Lect. 2006;55:337–346.PubMed
34.
Zurück zum Zitat Stähelin L, Stähelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy. 2008;24:51–57.PubMedCrossRef Stähelin L, Stähelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy. 2008;24:51–57.PubMedCrossRef
35.
Zurück zum Zitat Sussmann PS, Ranawat AS, Lipman J, Lorich DG, Padgett DE, Kelly BT. Arthroscopic versus open osteoplasty of the head-neck junction: a cadaveric investigation. Arthroscopy. 2007;23:1257–1264.PubMedCrossRef Sussmann PS, Ranawat AS, Lipman J, Lorich DG, Padgett DE, Kelly BT. Arthroscopic versus open osteoplasty of the head-neck junction: a cadaveric investigation. Arthroscopy. 2007;23:1257–1264.PubMedCrossRef
36.
Zurück zum Zitat Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res. 2008;466:273–280.CrossRefPubMed Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res. 2008;466:273–280.CrossRefPubMed
37.
Zurück zum Zitat Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationships with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMed Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationships with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMed
38.
Zurück zum Zitat Wettstein M, Dienst M. [Arthroscopic treatment of femoroacetabular impingement] [in German]. Orthopäde. 2006;35:85–93.CrossRefPubMed Wettstein M, Dienst M. [Arthroscopic treatment of femoroacetabular impingement] [in German]. Orthopäde. 2006;35:85–93.CrossRefPubMed
Metadaten
Titel
Arthroscopic Treatment of Femoroacetabular Impingement of the Hip: A New Technique to Access the Joint
verfasst von
Monika Horisberger, MD
Alexander Brunner, MD
Richard F. Herzog, MD
Publikationsdatum
01.01.2010
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 1/2010
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-1005-5

Weitere Artikel der Ausgabe 1/2010

Clinical Orthopaedics and Related Research® 1/2010 Zur Ausgabe

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Discontinuation of Warfarin Is Unnecessary in Total Knee Arthroplasty

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.