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Arthroscopic debridement can improve hip pain caused by intra-articular adhesions
Scarring from previous surgery can in crease the difficulty of the arthroscopic procedure.
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Arthroscopic release of intra-articular adhesions can improve symptoms of persistent pain in patients previously treated with surgical hip dislocation for femoroacetabular impingement syndrome, according to a study by researchers in Switzerland.
Andreas Krueger, MD, and colleagues investigated outcomes for 16 patients treated with arthroscopic adhesiolysis for persistent hip pain without either osseous or cartilaginous alterations. The patients averaged 33.5 years of age, and all had previously undergone open surgical hip dislocation to treat femoroacetabular impingement syndrome an average of 1.5 years prior.
Surgeons initially performed osteochondroplasty of the head-neck junction in all cases, and performed acetabular rim resection with labrum reattachment in nine patients, according to the study, published in Arthroscopy.
All patients had preoperative MRIs to confirm the presence of intra-articular adhesions, which were subsequently debrided arthroscopically. "At arthroscopy, all reattached labra were stable," the authors wrote.
"In the cases without preservation of the labrum at the index operation, the joint capsule was attached at the level of the acetabular rim and synovitis was noticed. All patients had adhesions between the neck of the femur and joint capsule or between the labrum and capsule," they reported.
Overall, 13 of the 16 patients (81%) showed either an improvement in pain or were pain-free.
At 1 year follow-up, the mean Merle d'Aubign? score had improved from 13 points preoperatively to 16 points. Pain scores showed the most improvement, which increased from three points preoperatively to five points at final follow-up according to the study.
Massive thickening of the capsule technically limited the arthroscopic procedure in three patients, the authors noted.
"Hip arthroscopy after previous surgery can be demanding because of scarring," they wrote. However, "If the adhesions can be released, good results can be achieved."
For more information:
- Krueger A, Leunig M, Siebenrock KA, Beck M. Hip arthroscopy after previous surgical hip dislocation for femoroacetabular impingement. Arthroscopy. 2007;23:1285-1289.