Orthopedics

KOHALA COAST, Hawaii — Arthroscopic hip surgery may be advantageous for most — but not all patients with femoroacetabular impingement — according to an orthopedist from the Kaiser-Permanente WLA Medical Center.

“FAI [Femoroacetabular impingement] may arguably now be the number one indication for hip arthroscopy,” Dean K. Matsuda, MD, said during his presentation at Orthopedics Today Hawaii 2010, here. He noted that surgeons should scrutinize labral tears to ensure that they are not cases of FAI or dysplasia.

“Open and arthroscopic procedures that treat the structural cause appear to be effective at reducing pain and improving function,” he said. “And, because there are better outcomes with less cartilage damage for arthritis, it supports the idea of an early referral for early treatment. The arthroscopic option [also] offers advantages of minimally invasive surgery.”

Matsuda said that hip arthroscopy can be beneficial for patients with symptomatic FAI and those with bilateral symptomatic FAI. Recent research has also indicated that patients with FAI and osteoarthritis should have fairly mild arthritis in order to get good results with the procedure.

While some have studies have shown that hip arthroscopy can be helpful for patients with FAI and dysplasia, others have argued against treating these patients with the procedure. Matsuda said that surgeons must make a proper diagnosis to determine whether patients have impingement or dysplasia.

“The key is to avoid making a shallow socket any more shallow by rim trimming or by removing a hypertrophic labrum and potentially destabilizing the hip,” he said. And, if indicated, a staged peri-acetabular osteotomy (PAO) could follow without having to open the joint or potentially destabilize the hip by taking down the reflected head of the rectus femoris.

In addition, surgeons remain divided as to whether the procedure can be useful for patients with asymptomatic FAI. Reinhold Ganz, MD, has stated that the connection between FAI and secondary osteoarthrosis is strong enough to merit prophylactic surgery "as there is not a better time than time zero" to address the pathology, Matsuda noted.

“I do not currently offer prophylactic surgery on patients,” Matsuda said. “With that said, I am not sure that it is wrong to operate on a young athlete that may benefit from an asymptomatic FAI surgery and, if so, the arthroscopic option is attractive.”

He predicted that FAI surgery will continue to evolve towards minimally invasive techniques and that the indications for FAI surgery will become more refined.

“I think that improved tools and techniques will permit more widespread application of hip arthroscopy,” Matsuda said. He also noted that the American Academy of Orthopaedic Surgeons has stated that hip arthroscopy is growing rapidly and the number of procedures will double in 2013.

• Reference:

Matsuda DK. Update on hip arthroscopy. Presented at Orthopedics Today Hawaii 2010. Jan. 10-13, 2010. Kohala Coast, Hawaii.