Surgical hip dislocation is more powerful than arthroscopy for achieving high degrees of acetabular correction in pincer type impingement - 27/09/19

Doi : 10.1016/j.otsr.2019.08.009

Sufian S. Ahmad ^a,⁎, ^{^{1
The authors contributed equally to this work.}} , Maximilian Heilgemeir ^b,^{^{1
The authors contributed equally to this work.}}, Helen Anwander ^c, Martin Beck ^d
^a BG-Center for Trauma & Reconstructive Surgery, Eberhard-Karls University of Tübingen, Hoppe Seyler Strasse, 72076 Tübingen, Germany
^b Sonnenhof Orthopaedic Center, Buchserstrasse 30, CH-3006 Bern, Switzerland
^c Department of Orthopaedics & Traumatology, Inselspital, University of Bern, Bern, Switzerland
^d Department of Orthopaedics & Traumatology, Luzerner Kantonsspital, Luzern, Switzerland

^⁎Corresponding author.

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Abstract

Background

With the development of hip arthroscopy (HA), a shift away from surgical hip dislocation (SHD) is becoming a noticeable reality. It was the aim of this study to examine whether SHD provides a benefit over HA regarding its corrective power in the treatment of femoroacetabular impingement (FAI).

Hypothesis

It was hypothesized that SHD provides the more powerful tool for acetabular correction in FAI surgery compared to HA.

Method

The examined cohort consisted of 85 hips of which 31 (36%) underwent a high degree of acetabular correction which was defined as a correction of >2 standard deviations from the population mean. A lateral center edge angle (LCE) correction>12° or an acetabular index (AI) correction>8° were therefore considered to high correction. A logistic regression model was applied to determine factors influencing high correction in FAI surgery. Subsequent adjustment was performed using a multivariate model.

Results

After adjusting for pre-operative acetabular orientation, SHD showed a pronounced influence on the likelihood of achieving the adequate degree of high acetabular correction (odds ratio (OR) 10.0 confidence interval (C.I) 2.3 to 44.0, p=0.002). On the other hand, SHD showed no influence on femoral correction (p=n.s).

Conclusion

Surgical hip dislocation is a powerful modality for achieving high degrees of acetabular correction in the situation of a femoroactabular conflict, being defined as an LCE correction of>12° or AI correction of>8°. The reason for these results may be seen in the excellent exposure and the improved possibility of performing dynamic intra-operative examination to verify the results. The benefits are only limited to large acetabular correction. These findings should provide a helpful tool for decision making in clinical practise.