An arthroscopic approach to femoroacetabular impingement offers better
short-term improvement that could potentially allow for a quicker return to
sport, according to a recently presented study.
Benjamin G. Domb, MD, presented his groups findings at the
Meeting of the Arthroscopy Association of North America in Hollywood,
Domb noted that open surgerys advantages in the treatment of
impingement (FAI) include greater visualization and full access, but its
disadvantages and complications include soft tissue damage and
osteotomy. Arthroscopic surgery, on the other hand, is less invasive and
allows for faster rehabilitation, but has the potential for traction
complications and neuropraxia.
The purpose of our study, therefore, was to perform a prospective,
single-surgeon comparison between open surgical dislocation vs. arthroscopic
treatment of FAI, Domb said, adding that the team expected faster
recovery for the arthroscopic approach, but hypothesized that long-term
outcomes for the open approach may show benefits of slightly greater precision
in bony resections.
Two separate groups
Dombs study included 289 patients who had preservation hip surgery
performed by the senior author. Inclusion criteria consisted of patients
younger than 30 years old who had combined cam and pincer impingement, while
exclusion criteria consisted of workers compensation, hip dysplasia, and
previous hip surgery other than diagnostic arthroscopy.
Two groups were utilized by the study: A group that underwent open
surgical dislocation (five patients) and a group that underwent arthroscopic
treatment (23 patients). Patient outcomes, Domb reported, were prospectively
collected using four hip-specific questionnaires.
Labral treatment options included selective labral debridement, a
looped single-stitch refixation, or a labral base refixation, Domb said.
In the open group, all patients had a labral refixation, and in the
arthroscopic group all patients except four had a labral refixation.
Domb noted that all of the patients in both groups had
tears, with the open group displaying a tendency toward larger tears. More
anchors were used on average in the open group, and all patients in the open
group had labral refixation. In the arthroscopic group, 19 out of 23 patients
had labral refixation, while the remaining four had underwent debridement.
Arthroscopy better in the short-term
At 3-months follow-up, the arthroscopic group tended to show greater
improvement, Domb said, noting that this difference was not significant.
At 3 months early follow-up, there were differences between the
groups in that the arthroscopic group had greater improvement in all
scores, he said. None of these differences achieved statistical
Domb added that at an average follow-up of 9.9 months, scores were
equivalent with the exception of the hip outcome score sports-specific
subscale, where the arthroscopic group had a tendency toward greater
improvement. Improvements in that group tended to be greater (mean of 40-point
improvement) than those in the open group (mean of 21-point improvement).
No significant differences were found in the outcomes, but at 3
months follow-up the arthroscopic group tended to show greater
improvement, Domb told Orthopedics Today. The early difference was
attributed to faster rehabilitation and absence of trochanteric
Both open surgical dislocation and arthroscopic approach are
viable options, he concluded. The arthroscopic approach may allow a
faster recovery and return to sport. A long-term study is currently
underway. by Robert Press
- Domb BG, Boster I, Smith TW. Open surgical dislocation versus
arthroscopic treatment of femoro-acetabular impingement: A prospective
comparison of a single surgical clinical results. Paper SS-31. Presented at the
29th Annual Meeting of the Arthroscopy Association of North America. May 20-23,
2010. Hollywood, Florida.
- Benjamin G. Domb, MD, can be reached at
Disclosure: Domb received research support from and is a consultant
for Arthrex, Inc.