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Open vs arthroscopic femoroacetabular impingement surgery yielded similar improvement in pain, function
Patients should be made aware that both open and arthroscopic FAI surgeries are effective, associated with substantial clinical improvement in most cases.
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DALLAS — Although treatment of femoroacetabular impingement has historically been performed through an open surgical hip dislocation procedure, arthroscopic treatment has now emerged as the dominant surgical approach.
A comparative multicenter study showed both open and arthroscopic treatment of femoroacetabular impingement (FAI) were equivalent with respect to pain relief and functional improvement, according to results presented at the American Association of Hip and Knee Surgeons Annual Meeting.
“The study suggests that the procedures are equally effective and surgical treatment decision-making should be guided by patient, disease and surgeon-specific factors,” John C. Clohisy, MD, Daniel C. and Betty B. Viehmann Distinguished Professor of Orthopedic Surgery, chief of adult reconstruction and hip preservation and vice chair of the department of orthopedic surgery at Washington University School of Medicine in St. Louis, said.
Arthroscopic vs open treatment
To study FAI treatment results, Clohisy and colleagues from the Academic Network of Conservational Hip Outcomes Research (ANCHOR) used the ANCHOR FAI-1 prospective cohort to establish 128 matched pairs of patients treated with hip arthroscopy who were matched to patients undergoing open surgical hip dislocation for treatment of symptomatic FAI.
“Our primary outcome was the final modified Harris Hip Score [mHHS] at a minimum 1-year follow-up with an average 4 years follow-up,” Clohisy said. The hip disability and osteoarthritis outcome score (HOOS) pain subscale score and composite failure measure were considered the secondary outcomes.
Source: John C. Clohisy, MD
The researchers defined failure of treatment as conversion to total hip replacement, any type of revision surgery, failure to meet the minimal clinically important difference of the mHHS and failure to meet the patient-acceptable symptom state of the HOOS pain subscale.
“Our final modified Harris Hip Score was not different between the two groups and showed clinically important improvements in pain relief and improved function for both the arthroscopic and open interventions,” Clohisy said.
Similarly, the investigators found no differences in the final HOOS pain subscale or in the composite failure rate between the two groups.
Clohisy told Orthopedics Today the equivalency of the procedures should encourage surgeons to make “surgical approach decisions based on the structural deformity characteristics and the ability to surgically correct the impingement deformity.”
“For example, if the disease can be treated with arthroscopy, that is probably preferable. But, if it is a more complex hip impingement problem that may not be accessible with arthroscopic techniques, the open procedure should be strongly considered because it enables the surgeon to have wider exposure, more flexibility and enhanced surgical power in terms of the deformity correction,” Clohisy said.
Unknown cause of failure
The results showed overall encouraging clinical outcomes and no differences in the composite failure rate between arthroscopic and open surgery. Nevertheless, Clohisy emphasized that the failure rate was about 20% in both groups.
“Historically, the most common reason for hip impingement surgery failure was inadequate correction of the impingement problem,” Clohisy said. “The surgical correction in these cases, in general, is acceptable, as all the surgeons are experienced hip preservation specialists. Therefore, there are other factors associated with suboptimal outcomes that need to be better defined.”
He said that although the majority of patients being treated for FAI do well, patients should be aware of the possibility that they may have some residual hip-related symptoms or limitations following treatment.
“It is important that we continue to investigate our diagnostic and treatment strategies to better understand the 20% failure rate and provide improved, more consistent outcomes in the future,” Clohisy said. “This is a current focus of the ANCHOR group and obtaining that information is important in terms of improving surgical decision-making and patient counseling regarding FAI surgery,” he said. –by Casey Tingle
- Reference:
- Nepple JJ, et al. Paper 40. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.
- For more information:
- John C. Clohisy, MD, can be reached at 660 Euclid Ave., Saint Louis, MO 63110; email: williamsdia@wustl.edu.
Disclosure: Clohisy reports he received a clinical research grant from Zimmer Biomet.