Cam-type femoro-acetabular impingement: Mid-term functional results and joint awareness of arthroscopic, mini-open and surgical dislocation techniques

Abstract

Objective: To evaluate the mid-term results of three different surgical techniques utilized for the treatment of femoro-acetabular impingement, by means of functional outcomes and joint awareness.

Materials and Methods: 53 patients were selected retrospectively, treated by one of the three surgical techniques: hip arthroscopy (HA), anterolateral mini open (AMO) or surgical hip dislocation (SHD). Patients with <12 months of follow-up were excluded. Median follow-up period was 57.5 months (range 16-256 months). Primary outcome measures were the Forgotten Joint Score (FJS), Harris Hip Score (HHS) and UCLA activity index. Surgical success was determined as FJS≥70 and a regression analysis was performed on different radiological and clinical parameters for the risk of failure.

Results: Mean post-operative FJS was 74.5 (±13.8) for the HA group, 72.6 (±17) for the AMO group and 52.7 (±24) for the SHD group (p=0.023). Pre-operative and post-operative HHS and UCLA were similar. Post-operative alpha angles were similar (p=0.597). Regression analysis results showed two factors affecting surgical success: pre-operative Tönnis stage (adjusted OR±95% CI: 0.091±0.005-0.659 ; p=0.023) and type of surgery performed (HA: adjusted OR±95% CI: 11.2±1.2-50.5, p=0.029; for AMO: adjusted OR±95% CI: 7.2 ±1.1-48.8, p=0.041).

Conclusion: Despite allowing more complete assessment of the hip joint, SHD results in inferior outcomes when evaluated with FJS.Three surgical approaches provide similar radiological and functional results if evaluated with conventional outcome scores of HHS and UCLA.