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Arthroscopy a possible option for femoroacetabular impingement cases
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HOLLYWOOD, Fla. — Arthroscopic management of femoroacetabular impingement has shown that it might be an appropriate option for many cases, according to a study presented here.
The findings were presented by J.W. Thomas Byrd, MD, at the 2010 Annual Meeting of the Arthroscopy Association of North America.
According to Byrd, the results accomplished with arthroscopic management were “at least comparable” to published reports of open methods, with the advantages of being a less invasive approach.
“Femoroacetabular impingement is a common cause of joint pathology, and I think cam impingement in particular has a proclivity for active, young adult males,” Byrd said. “These are people who are pushing their bodies beyond their diminished physiological limits.”
“You can certainly have impingement morphology without having impingement pathology, so I do not think every abnormal radiograph needs immediate surgical intervention,” he added. “The flip side of that is: I do think it is ill-advised to delay intervention for a protracted period of time in the presence of worsening symptoms. I think our observations … support this need for intervention.”
Study methods and parameters
Byrd said the purpose of his study was to report the results of early experience in the arthroscopic management of femoroacetabular impingement with a two-year follow-up.
Patients undergoing hip arthroscopy were prospectively assessed with a modified Harris Hip score at 3, 12, 24, 60 and 120 months. Thus far, Byrd said, 752 patients have undergone arthroscopic correction of femoroacetabular impingement (FAI). The study he presented consisted of the first 100 such patients to have a 2-year follow-up.
For this 100-patient cohort, Byrd reported 63 cam, 18 pincer and 19 combined lesions. There were 97 acetabular articular lesions (53 grade IV, 39 grade III and five grade I), 23 femoral lesions (11 grade IV, 11 grade III and one grade II) and 92 labral tears.
Arthroscopic ability
In all, the median improvement was 20 points, with a preoperative score of 65 and a postoperative score of 85. Seventy-nine of the results recorded were “good” or “excellent,” he reported. Those with associated femoral lesions did at least as well, with a median improvement of 23 points.
Eighteen patients underwent microfracture, with a median improvement of 21 points (preoperative score: 64, postoperative score: 85).
“None of these patients were converted to a total hip arthroplasty, and from my perspective I think that suggests that we are doing a pretty good job in selecting the right patients for the operation,” Byrd said. “However, six of these patients underwent repeat arthroscopy, which suggests that our early technical skills needed improvement.”
- Reference:
Byrd JWT, Jones KS. Arthroscopic management of femoroacetabular impingement with two year follow-up. Paper SS-30. Presented at the 2010 Annual Meeting of the Arthroscopy Association of North America. May 20-23, 2010. Hollywood, Fla.
