Results of Arthroscopic Treatment of Patients With Femoroacetabular Impingement Depending on the Type of Hip Deformity

Abstract

Background. Femoroacetabular impingement (FAI) is one of the most common causes of pain syndrome and limited mobility in the hip joint among young and middle-aged individuals.

The aims of this study: 1) To evaluate the impact of the type of hip joint deformity in patients with FAI on treatment outcomes; 2) To identify the type of hip joint deformity that is optimal for correction using arthroscopy; 3) To determine the impact of the acetabular structure in conditions of borderline dysplasia on the treatment outcome.

Methods. A retrospective uncontrolled single-center study was conducted, including 121 patients (135 hip joints), among them 49 (40.5%) women and 72 (59.5%) men. Patients were divided into four groups based on the type of deformity. The first group included 33 (24.4%) joints with cam-type FAI, the second group — 72 (53.4%) joints with mixed-type, the third group — 17 (12.6%) joints with dysplasia (LCEA-O<25°) and cam-type deformity of the femoral head-neck junction, and the fourth group — 13 (9.6%) joints with a combination of dysplasia, cam-type deformity, and retroversion of the acetabulum. All patients underwent physical examination and radiographic diagnostics. In patients with borderline dysplasia, the version of the acetabulum was additionally assessed. The iHOT-33 and HOS scales were used to evaluate the preoperative status and postoperative results.

Results. The best treatment outcome was achieved in the first group of patients, which was statistically significantly different from the results in the third group. The treatment outcomes in the second group of patients did not show statistically significant differences from the first group according to the HOS questionnaire, but differed according to the iHOT-33 scale. The treatment outcomes in the fourth group of patients were almost indistinguishable on the iHOT-33 scale from the first group and on the HOS scale from the second group. In the third group, a statistically significant result on the HOS-Sport subscale was achieved in only 30% of patients, while in other groups it was not less than 58%. Other scales showed a slight superiority of treatment results in the first and fourth groups compared to the second and third groups. In the first years after surgery, all groups of patients showed a significant improvement in sports activity, but after 2 years, there was a tendency for a decrease in patients in the second and third groups.

Conclusion. The highest results of arthroscopic treatment were shown by patients in the first group with isolated cam-type deformity, slightly worse were results by patients in the second group (with mixed-type). In patients with borderline dysplasia, the effectiveness of arthroscopy depended on the structure of the anterior wall of the acetabulum. The worst result was observed in patients with borderline dysplasia and insufficiently developed anterior wall of the acetabulum — in that group of patients, it is worth preferring isolated periacetabular osteotomy or in combination with arthroscopy.

Keywords

femoroacetabular impingement / hip arthroscopy / acetabular dysplasia / acetabular retroversion

References

[1] Leunig M., Casillas M.M., Hamlet M., Hersche O., Nötzli H., Slongo T. et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71(4):370-375. doi: 10.1080/000164700317393367.

[2] 1.Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000 Aug;71(4):370-5. doi: 10.1080/000164700317393367. PMID: 11028885.

[3] Myers S.R., Eijer H., Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;(363):93-99.

[4] 2.Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999 Jun;(363):93-9. PMID: 10379309.

[5] Ganz R., Parvizi J., Beck M., Leunig M., Nötzli H., Siebenrock K.A. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112-120. doi: 10.1097/01.blo.0000096804.78689.c2.

[6] 3.Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003 Dec;(417):112-20. doi: 10.1097/01.blo.0000096804.78689.c2. PMID: 14646708.

[7] Hanzlik S., Riff A.J., Wuerz T.H., Abdulian M., Gurin D., Nho S.J. et al. The Prevalence of Cam Morphology: A Cross-Sectional Evaluation of 3,558 Cadaveric Femora. Front Surg. 2021;7:588535. doi: 10.3389/fsurg.2020.588535.

[8] 4.Hanzlik S, Riff AJ, Wuerz TH, Abdulian M, Gurin D, Nho SJ, Salata MJ. The Prevalence of Cam Morphology: A Cross-Sectional Evaluation of 3,558 Cadaveric Femora. Front Surg. 2021 Jan 21;7:588535. doi: 10.3389/fsurg.2020.588535. PMID: 33553238; PMCID: PMC7859647.

[9] Griffin D.R., Dickenson E.J., O’Donnell J., Agricola R., Awan T., Beck M. et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176. doi: 10.1136/bjsports-2016-096743.

[10] 5.Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016 Oct;50(19):1169-76. doi: 10.1136/bjsports-2016-096743. PMID: 27629403.

[11] Gatz M., Driessen A., Eschweiler J., Tingart M., Migliorini F. Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study. Eur J Orthop Surg Traumatol. 2020;30(7):1151-1162. doi: 10.1007/s00590-020-02675-6.

[12] 6.Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study. Eur J Orthop Surg Traumatol. 2020 Oct;30(7):1151-1162. doi: 10.1007/s00590-020-02675-6. Epub 2020 May 7. PMID: 32382825; PMCID: PMC7505824.

[13] Domb B.G., Chen S.L., Go C.C., Shapira J., Rosinsky P.J., Meghpara M.B. et al. Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients. Am J Sports Med. 2021;49(1):112-120. doi: 10.1177/0363546520968896.

[14] 7.Domb BG, Chen SL, Go CC, Shapira J, Rosinsky PJ, Meghpara MB, Maldonado DR, Lall AC. Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients. Am J Sports Med. 2021 Jan;49(1):112-120. doi: 10.1177/0363546520968896. Epub 2020 Nov 5. PMID: 33151746.

[15] Flecher X., Wettstein M., May O. Limitations of arthroscopy for managing coxa profunda. Orthop Traumatol Surg Res. 2019;105(8S):S267-S274. doi: 10.1016/j.otsr.2019.09.016.

[16] 8.Flecher X, Wettstein M, May O. Limitations of arthroscopy for managing coxa profunda. Orthop Traumatol Surg Res. 2019 Dec;105(8S):S267-S274. doi: 10.1016/j.otsr.2019.09.016. Epub 2019 Oct 28. PMID: 31672415.

[17] Cvetanovich G.L., Levy D.M., Weber A.E., Kuhns B.D., Mather R.C. 3rd, Salata M.J. et al. Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage? Am J Sports Med. 2017;45(9): 2116-2124. doi: 10.1177/0363546517702855.

[18] 9.Cvetanovich GL, Levy DM, Weber AE, Kuhns BD, Mather RC 3rd, Salata MJ, Nho SJ. Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage? Am J Sports Med. 2017 Jul;45(9):2116-2124. doi: 10.1177/0363546517702855. Epub 2017 Apr 25. PMID: 28441511.

[19] Evans P.T., Redmond J.M., Hammarstedt J.E., Liu Y., Chaharbakhshi E.O., Domb B.G. Arthroscopic Treatment of Hip Pain in Adolescent Patients With Borderline Dysplasia of the Hip: Minimum 2-Year Follow-Up. Arthroscopy. 2017;33(8):1530-1536. doi: 10.1016/j.arthro.2017.03.008.

[20] 10.Evans PT, Redmond JM, Hammarstedt JE, Liu Y, Chaharbakhshi EO, Domb BG. Arthroscopic Treatment of Hip Pain in Adolescent Patients With Borderline Dysplasia of the Hip: Minimum 2-Year Follow-Up. Arthroscopy. 2017 Aug;33(8):1530-1536. doi: 10.1016/j.arthro.2017.03.008. Epub 2017 May 12. PMID: 28506617.

[21] Christensen J.C., Marland J.D., Miller C.J., Horton B.S., Whiting D.R., West H.S. Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations. J Hip Preserv Surg. 2019;6(1): 25-32. doi: 10.1093/jhps/hnz011.

[22] 11.Christensen JC, Marland JD, Miller CJ, Horton BS, Whiting DR, West HS. Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations. J Hip Preserv Surg. 2019 Mar 20;6(1):25-32. doi: 10.1093/jhps/hnz011. PMID: 31069092; PMCID: PMC6501448.

[23] Yoon S.J., Lee S.H., Jang S.W., Jo S. Hip Arthroscopy of a Painful Hip with Borderline Dysplasia. Hip Pelvis. 2019;31(2):102-109. doi: 10.5371/hp.2019.31.2.102.

[24] 12.Yoon SJ, Lee SH, Jang SW, Jo S. Hip Arthroscopy of a Painful Hip with Borderline Dysplasia. Hip Pelvis. 2019 Jun;31(2):102-109. doi: 10.5371/hp.2019.31.2.102. Epub 2019 May 30. PMID: 31198777; PMCID: PMC6546675.

[25] Богопольский О.Е. Инструментальная диагностика и предоперационное планирование артроскопии тазобедренного сустава при фемороацетабулярном импинджмент-синдроме: лекция. Травматология и ортопедия России. 2021;27(4):155-168. doi: 10.21823/2311-2905-1636. Bogopolskiy O.E. Instrumental Diagnosis and Preoperative Planning of Hip Arthroscopy in Femoroacetabular Impingement Syndrome: Lecture. Traumatology and Orthopedics of Russia. 2021;27(4): 155-168. (In Russian). doi: 10.21823/2311-2905-1636.

[26] 13.Bogopolskiy OE. Instrumental Diagnosis and Preoperative Planning of Hip Arthroscopy in Femoroacetabular Impingement Syndrome: Lecture. Traumatology and Orthopedics of Russia. 2021;27(4):155-168. (In Russian). doi.10.21823/2311-2905-1636.

[27] Outerbridge R.E. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43-B:752-757. doi: 10.1302/0301-620X.43B4.752.

[28] 14.OUTERBRIDGE RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961 Nov;43-B:752-7. doi: 10.1302/0301-620X.43B4.752. PMID: 14038135.

[29] Beck M., Kalhor M., Leunig M., Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012-1018. doi: 10.1302/0301-620X.87B7.15203.

[30] 15.Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005 Jul;87(7):1012-8. doi: 10.1302/0301-620X.87B7.15203. PMID: 15972923.

[31] Nwachukwu B.U., Chang B., Fields K., Rebolledo B.J., Nawabi D.H., Kelly B.T. et al. Defining the «Substantial Clinical Benefit» After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med. 2017;45(6):1297-1303. doi: 10.1177/0363546516687541.

[32] 16.Nwachukwu BU, Chang B, Fields K, Rebolledo BJ, Nawabi DH, Kelly BT, Ranawat AS. Defining the "Substantial Clinical Benefit" After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med. 2017 May;45(6):1297-1303. doi: 10.1177/0363546516687541. Epub 2017 Feb 1. PMID: 28298057.

[33] Philippon M.J., Briggs K.K., Carlisle J.C., Patterson D.C. Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res. 2013;471(8):2492-2496. doi: 10.1007/s11999-012-2779-4.

[34] 17.Philippon MJ, Briggs KK, Carlisle JC, Patterson DC. Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res. 2013 Aug;471(8):2492-6. doi: 10.1007/s11999-012-2779-4. PMID: 23292888; PMCID: PMC3705033.

[35] Rosinsky P.J., Chen J.W., Glein R.M., Jimenez A.E., Brayboy C., Domb B.G. Lateral to Medial Joint Space Ratio is Predictive of Survivorship After Primary Hip Arthroscopy. Arthroscopy. 2023;39(2):300-307. doi: 10.1016/j.arthro.2022.06.025.

[36] 18.Rosinsky PJ, Chen JW, Glein RM, Jimenez AE, Brayboy C, Domb BG. Lateral to Medial Joint Space Ratio is Predictive of Survivorship After Primary Hip Arthroscopy. Arthroscopy. 2023 Feb;39(2):300-307. doi: 10.1016/j.arthro.2022.06.025. Epub 2022 Jul 7. PMID: 35810975.

[37] Thomas G.E., Palmer A.J., Batra R.N., Kiran A., Hart D., Spector T. et al. Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study. Osteoarthritis Cartilage. 2014;22(10):1504-1510. doi: 10.1016/j.joca.2014.06.038.

[38] 19.Thomas GE, Palmer AJ, Batra RN, Kiran A, Hart D, Spector T, Javaid MK, Judge A, Murray DW, Carr AJ, Arden NK, Glyn-Jones S. Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study. Osteoarthritis Cartilage. 2014 Oct;22(10):1504-10. doi: 10.1016/j.joca.2014.06.038. Epub 2014 Jul 15. PMID: 25047637.

[39] Kyin C., Maldonado D.R., Go C.C., Shapira J., Lall A.C., Domb B.G. Mid- to Long-Term Outcomes of Hip Arthroscopy: A Systematic Review. Arthroscopy. 2021;37(3):1011-1025. doi: 10.1016/j.arthro.2020.10.001.

[40] 20.Kyin C, Maldonado DR, Go CC, Shapira J, Lall AC, Domb BG. Mid- to Long-Term Outcomes of Hip Arthroscopy: A Systematic Review. Arthroscopy. 2021 Mar;37(3):1011-1025. doi: 10.1016/j.arthro.2020.10.001. Epub 2020 Nov 18. PMID: 33220468.

[41] Said H.G., Masoud M.A., Morsi M.M.A., El-Assal M.A. Outcomes of hip arthroscopy for femoroacetabular impingement: The effect of morphological type and chondrolabral damage. SICOT J. 2019;5:16. doi: 10.1051/sicotj/2019012.

[42] 21.Said HG, Masoud MA, Morsi MMA, El-Assal MA. Outcomes of hip arthroscopy for femoroacetabular impingement: The effect of morphological type and chondrolabral damage. SICOT J. 2019;5:16. doi: 10.1051/sicotj/2019012. Epub 2019 May 22. PMID: 31115316; PMCID: PMC6530372.

[43] Murata Y., Fukase N., Dornan G., Martin M., Soares R., Pierpoint L. et al. Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021;9(8):23259671211015973. doi: 10.1177/23259671211015973.

[44] 22.Murata Y, Fukase N, Dornan G, Martin M, Soares R, Pierpoint L, Philippon MJ. Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021 Aug 6;9(8):23259671211015973. doi: 10.1177/23259671211015973. PMID: 34395680; PMCID: PMC8358532.

[45] Harris J.D., Lewis B.D., Park K.J. Hip Dysplasia. Clin Sports Med. 2021;40(2):271-288. doi: 10.1016/j.csm.2020.11.004.

[46] 23.Harris JD, Lewis BD, Park KJ. Hip Dysplasia. Clin Sports Med. 2021 Apr;40(2):271-288. doi: 10.1016/j.csm.2020.11.004. Epub 2021 Jan 19. PMID: 33673886.

[47] Bolia I.K., Briggs K.K, Locks R., Chahla J., Utsunomiya H., Philippon M.J. Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study. Arthroscopy. 2018;34(8):2347-2352. doi: 10.1016/j.arthro.2018.03.012.

[48] 24.Bolia IK, Briggs KK, Locks R, Chahla J, Utsunomiya H, Philippon MJ. Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study. Arthroscopy. 2018 Aug;34(8):2347-2352. doi: 10.1016/j.arthro.2018.03.012. Epub 2018 May 3. PMID: 29730219.

[49] Chen S., Zhang L., Mei Y., Zhang H., Hu Y., Chen D. Role of the Anterior Center-Edge Angle on Acetabular Stress Distribution in Borderline Development Dysplastic of Hip Determined by Finite Element Analysis. Front Bioeng Biotechnol. 2022;10:823557. doi: 10.3389/fbioe.2022.823557.

[50] 25.Chen S, Zhang L, Mei Y, Zhang H, Hu Y, Chen D. Role of the Anterior Center-Edge Angle on Acetabular Stress Distribution in Borderline Development Dysplastic of Hip Determined by Finite Element Analysis. Front Bioeng Biotechnol. 2022 Mar 1;10:823557. doi: 10.3389/fbioe.2022.823557. PMID: 35299631; PMCID: PMC8921530.

[51] Chaharbakhshi E.O., Hartigan D.E., Perets I., Domb B.G. Is Hip Arthroscopy Effective in Patients With Combined Excessive Femoral Anteversion and Borderline Dysplasia? A Match-Controlled Study. Am J Sports Med. 2019;47(1):123-130. doi: 10.1177/0363546518812859.

[52] 26.Chaharbakhshi EO, Hartigan DE, Perets I, Domb BG. Is Hip Arthroscopy Effective in Patients With Combined Excessive Femoral Anteversion and Borderline Dysplasia? A Match-Controlled Study. Am J Sports Med. 2019 Jan;47(1):123-130. doi: 10.1177/0363546518812859. PMID: 30781991.

[53] Lee M.S., Fong S., Owens J.S., Mahatme R.J., Kim D.N., Gillinov S.M. et al. Outcomes After Concomitant Hip Arthroscopy and Periacetabular Osteotomy: A Systematic Review. Orthop J Sports Med. 2023 Apr 25;11(4):23259671231160559. doi: 10.1177/23259671231160559.

[54] 27.Lee MS, Fong S, Owens JS, Mahatme RJ, Kim DN, Gillinov SM, Moran J, Simington J, Islam W, Abu S, Jimenez AE. Outcomes After Concomitant Hip Arthroscopy and Periacetabular Osteotomy: A Systematic Review. Orthop J Sports Med. 2023 Apr 25;11(4):23259671231160559. doi: 10.1177/23259671231160559. PMID: 37123992; PMCID: PMC10134132.

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