Assessment of arthroscopic management of femoroacetabular impingement. A prospective multicenter study - 28/10/10

Doi : 10.1016/j.otsr.2010.08.002

J.-E. Gédouin ^a,^⁎ , O. May ^b,^c, N. Bonin ^d, A. Nogier ^e, T. Boyer ^e, H. Sadri ^f, R.-N. Villar ^g, F. Laude ^h
the French Arthroscopy Society
^a Nouvelles cliniques nantaises, 3, rue Eric-Tabarly, 44277 Nantes, France
^b Médipôle Garonne, 45, rue de Gironis, 31300 Toulouse, France
^c Service d’orthopédie C, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France
^d Clinique de la Sauvegarde, 25, avenue des Sources, 69009 Lyon, France
^e Institut Nollet, 23, rue Brochant, 75017 Paris, France
^f Clinique de Montchosi, 10, chemin des Allinges, 1006 Lausanne, Switzerland
^g Wellington Hospital, Wellington Place, South Building, St John’s Wood, London NW8 9LE, UK
^h Centre médicochirurgical, 36, boulevard St-Marcel, 75005 Paris, France

Corresponding author.

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Summary

Introduction

Surgical treatment of femoroacetabular impingement can be performed under arthroscopic control, to limit associated morbidity. Encouraged by recent good reports, arthroscopy is replacing alternative techniques for this indication.

Hypothesis

Arthroscopy enables femoroacetabular impingement to be corrected with a low rate of associated morbidity.

Aim of study

To assess the indications for and quality of the technique and its impact on preliminary results and complications. To investigate preoperative prognostic factors.

Patient and methods

One hundred and eleven hips in 110 patients (78 male, 32 female; mean age, 31 years) were operated on under arthroscopic control for femoroacetabular impingement, by six senior surgeons. Sixty-five patients showed no radiographic sign of osteoarthritis, and 36 showed grade-1 early osteoarthritis on the Tönnis scale.

Results

Mean WOMAC score rose from 60.3 preoperatively to 83 (p<0.001) at a mean 10 months’ FU (range, 6–18 mo). Seventy-seven percent of patients were satisfied or very satisfied with their result. Patients with early osteoarthritis had significantly lower WOMAC and satisfaction scores than those free of osteoarthritis. Operative crossover to open surgery occurred in only one case. Five patients (4%) had revision: total hip replacement or resurfacing. There were seven complications (6%): three cases of heterotopic ossification, one of crural palsy, one of pudendal palsy, one of labium majus necrosis, and one non-displacement stress fracture of the femoral head/neck junction (managed by non-weight-bearing). There was no palsy of the territory of the lateral cutaneous nerve of the thigh.

Discussion

Results confirmed the efficacy and low associated morbidity of arthroscopy in the management of femoroacetabular impingement. Short-term functional results matched those of the literature. Planning and assessment seem not yet to be fully standardized. Preoperative osteoarthritis on X-ray was associated with poorer functional results. This attitude does not seem to be indicated for hips showing evolved osteoarthritis (>grade 1).