Arthroscopy proved safe, effective for young patients with FAI, open physis

Asheesh Bedi

TORONTO — Investigators at two centers who studied skeletally immature patients with femoroacetabular impingement or FAI that was treated arthroscopically found this patient population was at risk for recurrent FAI when the patient’s growth plate was open. However, they concluded that an arthroscopic procedure without physis sparing used to treat this pathology was associated with a high rate of return to sports and was safe and effective.

At the American Orthopaedic Society for Sports Medicine Annual Meeting, Asheesh Bedi, MD, presented the retrospective study findings for 39 hips with FAI in 28 patients whose mean age was 15 years. The patients were treated without physis-sparing techniques between 2009 and 2016. Bedi and his colleagues reported the treatments performed were typically mixed, which consisted of cam or acetabular resection osteoplasty.

During the mean follow-up of 1.5 years, two patients required revision or subsequent hip arthroscopy.

“FAI-corrective procedures in this patient population with partially or completely open growth plates had significant improvement at short-term follow-up. We did not see any evidence of growth disturbance or [avascular necrosis] AVN in our series. Osseous decompression without sparing the physis at this age group appears to be safe, and further outcome studies are necessary to define the longer-term outcomes in this population,” Bedi said.

The overall return to play in the patients was 93%. Bedi noted, for example, 32% of patients who played basketball and 25% of patients who played ice hockey returned to their preinjury levels of play.

“When we looked at a multivariate analysis the only preoperative predictor of a greater improvement in modified Harris Hip Score (mHHS) was a larger preop [lateral center edge angle] LCEA or pincer type deformity by the mHHS. By the VAS, it was actually the [anteroposterior] AP alpha-angle deformity,” Bedi said.

The mHHS improved from 69.4 points preoperatively to 92.4 points postoperatively. The VAS score for pain had a mean 3.5-point decrease in the same time period. The changes in both scores were statistically significant. – by Susan M. Rapp

Reference:

Ross JR, et al. Paper #152. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.

Disclosure: Bedi reports he is a paid consultant for Arthrex.