Open surgical dislocation and arthroscopic treatment are comparable for femoroacetabular impingement

Though the long-term results are similar, arthroscopy patients fare better short-term.

An arthroscopic approach to femoroacetabular impingement offers better short-term improvement that could potentially allow for a quicker return to sport, according to a recently presented study.

Benjamin G. Domb, MD, presented his group’s findings at the 29th Annual Meeting of the Arthroscopy Association of North America in Hollywood, Florida.

Domb noted that open surgery’s advantages in the treatment of femoroacetabular impingement (FAI) include greater visualization and full access, but its disadvantages and complications include soft tissue damage and trochanteric osteotomy. Arthroscopic surgery, on the other hand, is less invasive and allows for faster rehabilitation, but has the potential for traction complications and neuropraxia.

Benjamin G. Domb

“The purpose of our study, therefore, was to perform a prospective, single-surgeon comparison between open surgical dislocation vs. arthroscopic treatment of FAI,” Domb said, adding that the team expected faster recovery for the arthroscopic approach, but hypothesized that long-term outcomes for the open approach may show benefits of slightly greater precision in bony resections.

Two separate groups

Domb’s study included 289 patients who had preservation hip surgery performed by the senior author. Inclusion criteria consisted of patients younger than 30 years old who had combined cam and pincer impingement, while exclusion criteria consisted of workers’ compensation, hip dysplasia, and previous hip surgery other than diagnostic arthroscopy.

Two groups were utilized by the study: A group that underwent open surgical dislocation (five patients) and a group that underwent arthroscopic treatment (23 patients). Patient outcomes, Domb reported, were prospectively collected using four hip-specific questionnaires.

“Labral treatment options included selective labral debridement, a looped single-stitch refixation, or a labral base refixation,” Domb said. “In the open group, all patients had a labral refixation, and in the arthroscopic group all patients except four had a labral refixation.”

Domb noted that all of the patients in both groups had labral tears, with the open group displaying a tendency toward larger tears. More anchors were used on average in the open group, and all patients in the open group had labral refixation. In the arthroscopic group, 19 out of 23 patients had labral refixation, while the remaining four had underwent debridement.

Arthroscopy better in the short-term

At 3-months follow-up, the arthroscopic group tended to show greater improvement, Domb said, noting that this difference was not significant.

“At 3 months early follow-up, there were differences between the groups in that the arthroscopic group had greater improvement in all scores,” he said. “None of these differences achieved statistical significance.”

Domb added that at an average follow-up of 9.9 months, scores were equivalent with the exception of the hip outcome score sports-specific subscale, where the arthroscopic group had a tendency toward greater improvement. Improvements in that group tended to be greater (mean of 40-point improvement) than those in the open group (mean of 21-point improvement).

“No significant differences were found in the outcomes, but at 3 months follow-up the arthroscopic group tended to show greater improvement,” Domb told Orthopedics Today. “The early difference was attributed to faster rehabilitation and absence of trochanteric osteotomy.”

“Both open surgical dislocation and arthroscopic approach are viable options,” he concluded. “The arthroscopic approach may allow a faster recovery and return to sport. A long-term study is currently underway.” – by Robert Press

Reference:

• Domb BG, Boster I, Smith TW. Open surgical dislocation versus arthroscopic treatment of femoro-acetabular impingement: A prospective comparison of a single surgical clinical results. Paper SS-31. Presented at the 29th Annual Meeting of the Arthroscopy Association of North America. May 20-23, 2010. Hollywood, Florida.

• Benjamin G. Domb, MD, can be reached at bendomb@gmail.com.
  Disclosure: Domb received research support from and is a consultant for Arthrex, Inc.