Improved clinical scores seen with arthroscopic treatment of FAI in young patients

Issue: May 2011

SAN FRANCISCO — Hip arthroscopy is a safe procedure that can provide excellent clinical outcomes in adolescent patients with femoroacetabular impingement, according to the results of a recently presented study.

Henry B. Ellis, MD, presented the results here at the 2011 Annual Meeting of the Arthroscopy Association of North America.

The investigators retrospectively reviewed the clinical outcomes and revision rates of 70 consecutive patients aged 16 years old or younger who underwent hip arthroscopy for femoroacetabular impingement (FAI) with subsequent labral tears and chondral lesions. The patients had a minimum 2-years follow-up.

Impingement types and treatments

The group had a mean age of 15 years and included 48 female patients. Overall, 10% of patients had preoperative cam impingement, 15% had pincer-type impingement and 75% had mixed-type impingement. “Our surgical technique was very similar to that previously described in adults,” Ellis said. Patients were placed on a traction table, and surgeons used two portals during the procedure. Limited osteoplasty, Ellis noted, was performed on those who displayed a cam lesion with an open physis.

Fifty-six patients underwent femoral head-neck osteoplasty, with rim trimming performed in 55 patients. Labral tears — found in all patients — were repaired in 83% of cases. Remaining labral tears, Ellis said, were debrided. Seven patients had grade 3 or 4 chondral defects on the femoral head. Three patients had such defects on the acetabulum. All of these defects, the study noted, were treated with chondroplasty.

Revisions

During a mean follow-up of 3 years, investigators discovered that the mean Harris hip score increased from 60 preoperatively to 93 postoperatively. On a patient satisfaction scale of 1 to 10, patients had a median score of 10.

The investigators found that eight patients, who were girls, required revision arthroscopy for adhesions at the capsule/labral junction. Following these revisions, patients had a median satisfaction score of 9.

“Arthroscopic treatment of FAI in the adolescent population is a safe procedure,” Ellis said. “Our clinical outcomes and patient satisfaction were excellent, and gradually increased over a 2-year postoperative period. Females tended to have a higher rate of second surgery.”

Reference:

Ellis HB, et al. Clinical outcomes following hip arthroscopy for femoroacetabular impingement in adolescents. Paper SS-36. Presented at the 2011 Annual Meeting of the Arthroscopy Association of North America. April 14-16. San Francisco.
Disclosure: Ellis has no financial disclosures.

It is important to note that these were mostly skeletally-mature individuals with 90% partially or completely closed physes. Thus, they were not advocating this procedure in skeletal immaturity and, in fact, avoided correcting the cam lesion if the capital physis was open. The one question I have about their methodology is how many patients who would have qualified for inclusion were lost to follow-up. It is important to know to interpret the validity of the outcomes.

– J.W. Thomas Byrd, MD
Moderator

Disclosure: He is a paid consultant for Smith & Nephew and A2 Surgical; receives research support from Smith & Nephew; is on the editorial/governing board for Arthroscopy and is a board member or a committee appointment for the Arthroscopy Association of North America, the American Orthopaedic Society for Sports Medicine, and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine.

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