Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much?

• Published in: Arthroscopy Vol. 33; no. 4; pp. 773 - 779
• Main Authors: Tjong, Vehniah K., M.D, Gombera, Mustafa M., M.D, Kahlenberg, Cynthia A., M.D, Patel, Ronak M., M.D, Han, Brian, M.D, Deshmane, Prashant, M.D, Terry, Michael A., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Acetabuloplasty - methods; Acetabuloplasty - rehabilitation; Acetabulum - diagnostic imaging; Acetabulum - surgery; Activities of Daily Living; Adolescent; Adult; Arthroscopy - methods; Decompression, Surgical - methods; Female; Femoracetabular Impingement - diagnostic imaging; Femoracetabular Impingement - rehabilitation; Femoracetabular Impingement - surgery; Follow-Up Studies; Hip Joint - surgery; Humans; Male; Middle Aged; Orthopedics; Patient Satisfaction; Radiography; Registries; Reoperation; Treatment Outcome; Young Adult
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2016.10.022

Purpose To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions. Methods A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair. Preoperative α-angle, degree of radiographic degenerative changes, and presence of a crossover sign were recorded. Clinical outcomes were assessed with the modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and patient satisfaction score (out of 10) at a minimum 2-year follow-up. Results Clinical follow-up was obtained at a mean follow-up of 37.2 months (range, 27.9-79.2 months). Patients with Tönnis grade 0 and I findings had significantly higher mHHS (83.5 vs 71.5, P  = .01), HOS-SSS (81.3 vs 59.9, P  = .02), and iHOT-12 scores (71.1 vs 58.8, P  = .04) compared to patients with Tonnis grade II changes. However, patient satisfaction scores (8.0 vs 7.2, P  = .45) were no different. No significant difference was noted between unilateral and bilateral hip patient outcome scores. Patient age and preoperative α-angles did not correlate with any outcome scores (all R2 <0.05). There were no cases of revision surgery or progression to arthroplasty. Conclusions Isolated acetabular decompression may adequately address the underlying impingement in combined-type FAI while avoiding the risks associated with femoral-sided decompression. Good to excellent patient-reported outcomes and satisfaction scores were noted with significantly higher scores in patients with minimal arthritic change. Patient age and preoperative α-angle had less effect on postoperative outcomes. Level of Evidence Level IV, therapeutic case series.