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Despite good FAI arthroscopic outcomes, more can be learned about the treatment
The procedure has a steep learning curve, and reattaching the labrum intraoperatively, when it is not damaged, is challenging.
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ORLANDO, Fla., USA — Researchers found good outcomes with arthroscopic surgery for femoroacetabular impingement, but the procedure is not appropriate for every patient, according to a recent presentation.
“[Femoroacetabular impingement] is definitely associated with premature osteoarthritis [OA], and we are beginning to understand it and how to evaluate it,” Fares S. Haddad, FRCS (Orth), of University College Hospital and The Princess Grace Hospital in London, said at the Current Concepts in Joint Replacement Winter Meeting.
“But there is still a great deal to learn. Perhaps, the most important message is that not all femoroacetabular impinged hips need surgery. But at this stage, there are good outcomes from appropriate arthroscopic femoroacetabular impingement [FAI] intervention,” Haddad, an Orthopaedics Today Europe Editorial Board member said.
Need for multicenter studies
Arthroscopic surgery has emerged as the standard treatment for FAI, Haddad said in his presentation. He noted that median patient satisfaction was nine on a scale of one to 10, at 2 year minimum follow-up of 122 patients who underwent hip arthroscopy for FAI with associated chondrolabral dysfunction. That study was conducted by Marc J. Philippon, MD, and colleagues.
Haddad noted that J.W. Thomas Byrd, MD, and colleagues reported 90% success with arthroscopic treatment at a minimum 1-year follow-up of 200 patients with cam-type FAI, but Haddad noted in his talk that “most patients had articular cartilage damage at the time of surgery.”
In their as yet unpublished study of 186 patients treated for FAI who had reached the 3-year follow-up, Haddad and colleagues found overall hip scores improved, but 28 patients had significant chondral defects and showed no improvement with arthroscopic treatment.
Age as a factor
The literature also shows that patients older than 50 years have worse outcomes, Haddad noted, with 20% of them going on to have total hip replacement.
“We need to evaluate [arthroscopy] further in multicenter studies and in registry data, which we have started in the United Kingdom,” Haddad said. “We still do not have enough information.”
The procedure is technically challenging and has a steep learning curve, he said.
Technical pearls
Patients with FAI must be selected carefully for arthroscopic management because long-term results and the natural history of arthroscopy for FAI have not been studied. Haddad said not all classic symptoms will point to FAI and FAI does not always lead to OA, however surgery can benefit patients with less than Tönnis grade 2 chondral damage.
The labrum itself may not be damaged. Instead, it may be the junction between the labrum and acetabular chondral surface that is problematic. Research has shown re-attaching the labrum, rather than removing it, improves mid-term outcomes and hip scores. However, this technique is more challenging.
“It is much more complex, because we have to preserve the labrum, take it out of the way and then reattach the labrum,” Haddad said. “[It] takes more time to re-attach the labrum with anchors, and that is the latest frontier in terms of hip arthroscopy — getting that right.”
Orthopaedic surgeons have definitely improved their ability to identify cam lesions. When resecting these cases, it is important to have an assistant “move the hip whilst you are looking in the joint” to make sure there is no longer a conflict at the chondrolabral junction, Haddad said. – by Renee Blisard Buddle
- References:
- Byrd JWT. Clin Orthop Relat Res. 2009; doi:10.1007/s11999-008-0659-8.
- Haddad FS. Paper #46. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2012; Orlando, Fla., USA
- Philippon MJ. J Bone Joint Surg Br. 2009; doi:10.1302/0301-620X.91B1.21329.
- For more information:
- Fares S. Haddad, FRCS, can be reached at 42-52 Nottingham Place, London, England W1U 5NY United Kingdom; email: fareshaddad@aol.com.
Disclosure: Haddad has no relevant financial disclosures.