Outcomes Following Surgical Management of Femoroacetabular Impingement: a Systematic Review and Meta-analysis of Different Surgical Techniques

Overview

Journal Bone Joint Res

Date 2021 Sep 7

PMID 34488425

Citations 10

Authors

Daniel Addai

Jacqueline Zarkos

Matthew Pettit

Karadi Hari Sunil Kumar

Vikas Khanduja

Affiliations

Soon will be listed here.

Abstract

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.

Citing Articles

Current understanding of articular cartilage lesions in femoroacetabular impingement syndrome.

Li Z, Yu J, An P, Zhang W, Tian K J Orthop Surg Res. 2024; 19(1):886.

PMID: 39734214 PMC: 11684245. DOI: 10.1186/s13018-024-05322-6.

No Effect of Cigarette Smoking in the Outcome of Arthroscopic Management for Femoroacetabular Impingement: A Systematic Review.

Lucenti L, Maffulli N, Bardazzi T, Pipino G, Pappalardo G, Migliorini F J Clin Med. 2024; 13(23).

PMID: 39685673 PMC: 11642028. DOI: 10.3390/jcm13237214.

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19.

Migliorini F, Maffulli N, Shukla T, DAmbrosi R, Singla M, Vaish A J Orthop Surg Res. 2024; 19(1):135.

PMID: 38347592 PMC: 10860242. DOI: 10.1186/s13018-024-04556-8.

Current concepts in the diagnosis and management of Os Acetabuli.

Yoshitani J, Schoyer B, Shah A, Khanduja V Int Orthop. 2024; 48(3):657-666.

PMID: 38195946 PMC: 10901947. DOI: 10.1007/s00264-023-06078-0.

Hip joint contact pressure and force: a scoping review of in vivo and cadaver studies.

Dantas P, Goncalves S, Grenho A, Mascarenhas V, Martins J, Tavares da Silva M Bone Joint Res. 2023; 12(12):712-721.

PMID: 38043570 PMC: 10693937. DOI: 10.1302/2046-3758.1212.BJR-2022-0461.R2.

References

Murata Y, Uchida S, Utsunomiya H, Hatakeyama A, Nakamura E, Sakai A . A Comparison of Clinical Outcome Between Athletes and Nonathletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement. Clin J Sport Med. 2017; 27(4):349-356. DOI: 10.1097/JSM.0000000000000367. View

Thomee R, Jonasson P, Thorborg K, Sansone M, Ahlden M, Thomee C . Cross-cultural adaptation to Swedish and validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) for pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2013; 22(4):835-42. DOI: 10.1007/s00167-013-2721-7. View

Larson C, Giveans M, Stone R . Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012; 40(5):1015-21. DOI: 10.1177/0363546511434578. View

Nakano N, Lisenda L, Jones T, Loveday D, Khanduja V . Complications following arthroscopic surgery of the hip: a systematic review of 36 761 cases. Bone Joint J. 2017; 99-B(12):1577-1583. DOI: 10.1302/0301-620X.99B12.BJJ-2017-0043.R2. View

Botser I, Smith Jr T, Nasser R, Domb B . Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011; 27(2):270-8. DOI: 10.1016/j.arthro.2010.11.008. View

Kunze K, Nwachukwu B, Beck E, Chahla J, Gowd A, Rasio J . Preoperative Duration of Symptoms Is Associated With Outcomes 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy. 2020; 36(4):1022-1029. DOI: 10.1016/j.arthro.2019.08.032. View

Joseph R, Pan X, Cenkus K, Brown L, Ellis T, Di Stasi S . Sex Differences in Self-Reported Hip Function Up to 2 Years After Arthroscopic Surgery for Femoroacetabular Impingement. Am J Sports Med. 2015; 44(1):54-9. PMC: 5142445. DOI: 10.1177/0363546515610535. View

Hufeland M, Kruger D, Haas N, Perka C, Schroder J . Arthroscopic treatment of femoroacetabular impingement shows persistent clinical improvement in the mid-term. Arch Orthop Trauma Surg. 2016; 136(5):687-91. DOI: 10.1007/s00402-016-2427-7. View

Sundemo D, Hamrin Senorski E, Karlsson L, Horvath A, Juul-Kristensen B, Karlsson J . Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med. 2019; 5(1):e000620. PMC: 6863654. DOI: 10.1136/bmjsem-2019-000620. View

10.

Gupta A, Redmond J, Stake C, Finch N, Dunne K, Domb B . Does the femoral cam lesion regrow after osteoplasty for femoroacetabular impingement? Two-year follow-up. Am J Sports Med. 2014; 42(9):2149-55. DOI: 10.1177/0363546514541782. View

11.

Kaldau N, Brorson S, Holmich P, Lund B . Good midterm results of hip arthroscopy for femoroacetabular impingement. Dan Med J. 2018; 65(6). View

12.

Imam S, Khanduja V . Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop. 2011; 35(10):1427-35. PMC: 3174304. DOI: 10.1007/s00264-011-1278-7. View

13.

Griffin D, Dickenson E, ODonnell J, Agricola R, Awan T, Beck M . The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016; 50(19):1169-76. DOI: 10.1136/bjsports-2016-096743. View

14.

Ezechieli M, De Meo F, Bellotti V, Cardenas C, Astarita E, Cavaliere P . Arthroscopic assisted mini-open approach of the hip: Early multicentric experience. Technol Health Care. 2016; 24(3):359-65. DOI: 10.3233/THC-151127. View

15.

Kierkegaard S, Mechlenburg I, Lund B, Romer L, Soballe K, Dalgas U . Is hip muscle strength normalised in patients with femoroacetabular impingement syndrome one year after surgery?: Results from the HAFAI cohort. J Sci Med Sport. 2018; 22(4):413-419. DOI: 10.1016/j.jsams.2018.10.004. View

16.

Nwachukwu B, Fields K, Chang B, Nawabi D, Kelly B, Ranawat A . Preoperative Outcome Scores Are Predictive of Achieving the Minimal Clinically Important Difference After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med. 2016; 45(3):612-619. DOI: 10.1177/0363546516669325. View

17.

Espinosa N, Rothenfluh D, Beck M, Ganz R, Leunig M . Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006; 88(5):925-35. DOI: 10.2106/JBJS.E.00290. View

18.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

19.

Gicquel T, Gedouin J, Krantz N, May O, Gicquel P, Bonin N . Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: a prospective study after a mean follow-up of 4.6 (4.2-5.5) years. Orthop Traumatol Surg Res. 2014; 100(6):651-6. DOI: 10.1016/j.otsr.2014.07.008. View

20.

Matsuda D, Carlisle J, Arthurs S, Wierks C, Philippon M . Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011; 27(2):252-69. DOI: 10.1016/j.arthro.2010.09.011. View