Systematic Review With Video Illustration
Open Surgical Dislocation Versus Arthroscopy for Femoroacetabular Impingement: A Comparison of Clinical Outcomes

https://doi.org/10.1016/j.arthro.2010.11.008Get rights and content

Purpose

Over the last decade, the surgical treatment of femoroacetabular impingement (FAI) has evolved as surgical techniques through arthroscopy, open surgical dislocation, and combined approaches have been developed. The purpose of this systematic review was to evaluate and compare the clinical results of available surgical approaches for FAI.

Methods

A review of the literature was performed through the PubMed database and related articles' reference lists. Inclusion criteria were (1) all patients treated for FAI, (2) Level I, II, III, or IV study design, and (3) written in the English language. Case reports and studies involving patients with acetabular dysplasia were excluded.

Results

Overall, 1,299 articles fit our keyword search criteria. Of these, 26 articles reported clinical outcomes, using 3 surgical modalities: open surgical dislocation, arthroscopic, and combined approaches. In compiling the data in these articles, we analyzed the outcomes of a total 1,462 hips in 1,409 patients. The most published surgical method was arthroscopy, which included 62% of the patients. Labral repair was performed more frequently in open surgical dislocation (45%) and combined approach (41%) procedures than in arthroscopies (23%). Mean improvement in the modified Harris hip score after surgery was 26.4 for arthroscopy, 20.5 for open surgical dislocation, and 12.3 for the combined approach. A higher rate of return to sport was reported for arthroscopy in professional athletes than for open surgical dislocation. Overall complication rates were 1.7% for the arthroscopic group, 9.2% for the open surgical dislocation group, and 16% in the combined approach group.

Conclusions

All 3 surgical approaches led to consistent improvements in patient outcomes. Because a wide variety of subjective hip questionnaires were used, direct comparisons could not be made in many cases, and none of the approaches could be clearly shown to be superior to the others. However, it seems that, overall, the arthroscopic method had the lowest complication and fastest rehabilitation rate.

Level of Evidence

Level III, systematic review.

Section snippets

Methods

Two independent reviewers (I.B.B. and T.W.S.) performed a search on PubMed for articles that contained at least 1 of the following terms: hip impingement, hip arthroscopy, femoral acetabular impingement, femoroacetabular impingement, surgical dislocation, or hip pain. The search was limited to articles that were published between 1999, the year FAI was described, and June 2010.1 In addition, reference lists from the relevant articles were retrieved to identify any additional studies of

Results

Of the 1,299 articles found according to our keywords, a total of 26 fit our inclusion criteria. Eight studies reported the use of the open surgical dislocation11, 12, 13, 14, 15, 16, 17, 18; fifteen, the use of the arthroscopic technique3, 4, 5, 6, 7, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28; and four, the combined mini-open arthroscopic-assisted method.7, 8, 9, 29 One study had 2 groups: (1) arthroscopic and (2) combined arthroscopic and mini-open.7 Eight were prospective studies, whereas

Discussion

Over the last decade, there has been significant development in the understanding and treatment of FAI. Today, FAI is considered a bony morphologic variant predisposing the joint to intra-articular pathology that may become symptomatic.5 It has been shown that labral tears and chondral lesions may be common pain generators that result from FAI. Hence, it has been proposed that surgical treatment should not only address the intra-articular pathology, which is the source of pain, but should also

Conclusions

Surgical treatment of FAI has shown consistent positive outcomes with all 3 approaches reviewed in this article. The heterogeneous use of different outcome scores makes direct comparisons difficult. However, the arthroscopic method showed the greatest short-term improvement in mHHS and the lowest rate of complications. It is likely that all 3 approaches may have valuable roles in the treatment of FAI. An understanding of the advantages and disadvantages of each, as well as knowledge of each

References (44)

  • R. Fry et al.

    Labral base refixation in the hip: Rationale and technique for an anatomic approach to labral repair

    Arthroscopy

    (2010)
  • S.R. Myers et al.

    Anterior femoroacetabular impingement after periacetabular osteotomy

    Clin Orthop Relat Res

    (1999)
  • R. Ganz et al.

    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)
  • M.J. Philippon et al.

    Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up

    J Bone Joint Surg Br

    (2009)
  • M.J. Philippon et al.

    Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: A preliminary report

    J Pediatr Orthop

    (2008)
  • J.W. Byrd et al.

    Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement

    Clin Orthop Relat Res

    (2009)
  • F. Laude et al.

    Femoroacetabular impingement treatment using arthroscopy and anterior approach

    Clin Orthop Relat Res

    (2009)
  • K.A. Siebenrock et al.

    Anterior femoro-acetabular impingement due to acetabular retroversionTreatment with periacetabular osteotomy

    J Bone Joint Surg Am

    (2003)
  • M. Beck et al.

    Anterior femoroacetabular impingement: Part IIMidterm results of surgical treatment

    Clin Orthop Relat Res

    (2004)
  • P.E. Beaule et al.

    Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement

    J Bone Joint Surg Am

    (2007)
  • M. Bizzini et al.

    Femoroacetabular impingement in professional ice hockey players: A case series of 5 athletes after open surgical decompression of the hip

    Am J Sports Med

    (2007)
  • N. Espinosa et al.

    Treatment of femoro-acetabular impingement: Preliminary results of labral refixation

    J Bone Joint Surg Am

    (2006)

    • Cited by (0)

    B.G.D. is a consultant of Arthrex. The other authors report no conflict of interest.

    Note: To access the video accompanying this report, visit the February issue of Arthroscopy at www.arthroscopyjournal.org.

    View full text
    Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.