Arthroscopic assisted mini-open approach of the hip: Early multicentric experience

Abstract

BACKGROUND:

Surgical treatment of femoroacetabular impingement is becoming accepted worldwide, owing to improvements in clinical results and quality of life. In addition to treatment by surgical dislocation or arthroscopy, arthroscopic assisted mini-open approach was postulated to treat this pathology.

OBJECTIVE:

The aim of this study was to analyze early results of the first consecutive 72 cases of femoroacetabular impingement treated using the arthroscopic assisted mini-open approach in two different centers by two surgeons trained by a senior surgeon experienced in the technique.

METHODS:

Seventy-two consecutive cases of femoroacetabular impingement were operated in arthroscopic assisted mini-open approach technique in two different centers. After a mean follow-up time of 15 months (range 6-24 months), the Western Ontario and McMaster Universities Arthritis Index, Hip disability and Osteoarthritis Outcome Score and University of California, Los Angeles activity score, alpha angle and Wiberg angle were obtained.

RESULTS:

In both centers, all three scores showed significantly better results at follow-up time than preoperatively. The Western Ontario and McMaster Universities Arthritis Index increased from 64.3 to 91.4 (A) and from 68.1 to 89 (B). The Hip disability and Osteoarthritis Outcome Score increased from 59.5 to 94.4 (A) and from 62.1 to 93.8 (B). The University of California, Los Angeles activity score increased from 5.2 to 8.1 (A) and from 5.3 to 8.4 (B). The alpha angle and the Wiberg angle were significantly reduced after osteoplasty. The overall complication rate was low.

CONCLUSIONS:

Early results of this study show a good clinical and radiological outcome; therefore, the arthroscopic assisted mini-open approach can be used as an alternative in treating femoroacetabular impingement.

Keywords

Arthroscopic assisted mini-open approach femoroacetabular impingement learning curve

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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. 2005; 87: 1012-1018.

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.

Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: An integrated mechanical concept. Clin Orthop Relat Res. 2008; 466: 264-272.

Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: The role of hip impingement. Clin Orthop Relat Res. 2004; 429: 170-177.

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.

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.

Siebenrock KA, Gautier E, Woo AK, Ganz R. Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma. 2002; 16: 543-552.

Beaule 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.

Hoppe DJ, de Sa D, Simunovic N et al. The learning curve for hip arthroscopy: A systematic review. Arthroscopy. 2014; 30(3): 389-397.

10.

Dietrich F, Ries C, Eiermann C, Miehlke W, Sobau C. Complications in hip arthroscopy: necessity of supervision during the learning curve. Knee Surg Sports Traumatol Arthrosc. 2014; 22(4): 953-958.

11.

Möckle G, Labs K. Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases. Orthopade. 2014; 43(1): 6-15.

12.

Matsuda DK, Gupta N, Hanami D. Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement. Arthrosc Tech. 2014; 3(2): e197-204.

13.

Ribas M, Ginebreda I, Candioti L, Vilarrubias JM. Surgical treatment of the anterior femoroacetabular impingement syndrome of the hip. J Bone Joint Surg Br. 2005; 87(Suppl. 1): 84c.

14.

Nötzli HP, Wyss TF, Stoecklin CH, Schmidt MR, Treiber K, Hodler. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002; 84(4): 556-560.

15.

Armbuster TG, Guerra J Jr, Resnick D, et al. The adult hip: An anatomic study, part I: the bony landmarks. Radiology. 1978; 128(1): 1-10.

16.

Ribas M, Ledesma R, Cardenas C, Marin-Peña O, Toro J, Caseres E. Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage. Hip Int. 2010; 20(Suppl. 7): 36-42.

17.

Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clin Sports Med. 2006; 25: 327-335.

18.

Rath E, Sherman H, Sampson TG, Ben Tov T, Maman E, Amar E. The incidence of heterotopic ossification in hip arthroscopy. Arthroscopy. 2013; 29(3): 427-433.

19.

Beckmann JT, Wylie JD, Kapron AL, Hanson JA, Maak TG, Aoki SK. The effect of NSAID prophylaxis and operative variables on heterotopic ossification after hip arthroscopy. J Sports Med. 2014; 42(6): 1359-1364.

20.

Amar E, Warschawski Y, Sampson TG, Atoun E, Steinberg EL, Rath E. Capsular closure does not affect development of heterotopic ossification after hip arthroscopy. Arthroscopy. 2014; 14: 734-738.

21.

Nielsen TG, Miller LL, Lund B, Christiansen SE, Lind M. Outcome of arthroscopic treatment for symptomatic femoroacetabular impingement. BMC Musculoskelet Disord. 2014; 15: 394.

22.

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(1): 69-79.