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Arthroscopy shows good results for FAI treatment in pediatric, adolescent patients
Pediatric and adolescent patients treated for femoroacetabular impingement with hip arthroscopy showed good results at 5-year follow-up, according to researchers from the Steadman Philippon Research Institute.
In 60 patients between 11 years and 16 years of age, modified Harris Hip Scores increased from mean 57 to mean 91 at mean 3-year follow-up, according to the abstract. While clinical scores showed improvement, 13% of patients needed a second procedure for treatment of capsulolabral adhesions. Researchers also reported a significant association between age and alpha angle.
“Hip arthroscopy in the pediatric and adolescent population is a safe procedure, with excellent clinical outcomes at 2 to 5 years,” Marc J. Philippon, MD, wrote in the abstract.
Cam and pincer impingement was found in 10% and 15% of patients, respectively, while 75% of patients had a mixed impingement type. The femoral physis was closed in 71%, open in 10% and partially closed in 19% of patients, according to the abstract. Patients were excluded from the study if they had previous hip surgery or if they had a center-edge angle below 25°.
Perspective
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I appreciate the authors’ continued contribution to furthering our understanding about surgical outcomes for femoroacetabular impingement (FAI). My own observations align with the findings of this study that adolescents undergoing arthroscopic surgery for symptomatic FAI do at least as well as their adult counterparts.
The authors performed cam decompression but did not have deformities in this series extending into an open physeal region. We have performed arthroscopic surgery on several 12-year to 14-year old patients with cam deformities requiring femoroplasty into the region of open physes with concomitant resection of the adjacent stabilizing perichondral ring and have not observed iatrogenic slipped capital femoral epiphyses (SCFE). This does not mean physeal complications cannot occur and we do not recommend engaging the physis without cause. But we lean toward comprehensive treatment of pediatric FAI rather than either intentionally delayed surgery or a staged approach with delayed femoroplasty at or near physeal closure. Time will tell which approach is best, but ongoing and potentially irreversible damage in the pediatric active patient who may not be amenable to sport modification deserves consideration. For this same reason, we counsel the parents of our pediatric patients with bilateral FAI deformities to closely monitor their asymptomatic hip and to contact us for further evaluation within a few months if significant symptoms develop.
Finally, the management of SCFE and anterior inferior iliac apophyseal avulsions is evolving; the former may cause secondary cam FAI and the latter, secondary pincer (subspine) FAI. The tolerance of acceptability of residual displacement/deformity with either condition may tighten and early corrective intervention in the form of femoroplasty/femoral osteotomy and spinoplasty respectively may have beneficial utility if secondary FAI develops.