Arthroscopic Treatment of Femoroacetabular Impingement in Patients over 60 Years Old: Preliminary Report of a Pilot Study

Abstract

The objective was to evaluate short-term outcomes of patients of more than 60 years old, who underwent arthroscopic treatment for femoroacetabular impingement (FAI). The study design was a nonrandomized controlled clinical trial; this was a prospective study in 15 patients (15 hips) over 60 years old. Inclusion criteria were symptomatic FAI, no prior surgeries of the affected hip, and osteoarthritis Tonnis classification grade I or II. Exclusion criteria were multiple or large (≥5 mm) chondral defects or subchondral bone cysts in the acetabulum or the femoral head seen on magnetic resonance imaging (MRI). Radiographs and MRI arthrograms were used for the imaging assessment in all cases. Procedures performed arthroscopically included labrum resection, acetabuloplasty, and femoral osteoplasty in all cases. The Harris Hip Score was applied preoperatively and 2 years postoperatively. At 2 years postoperatively, the average increase in the Harris Hip Score was 21 points (mainly pain reduction) from a mean preoperative score of 66 points to a mean postoperative score of 87 points; this difference was significant (P < 0.05). Three cases (20%) had poor outcomes and required a total hip replacement during the first year after the surgery. Poor results were associated with Tonnis grade II osteoarthritis and Outerbridge grade III or IV chondral defects. Arthroscopic treatment of FAI of patients over 60 years old showed a significant Harris Hip Score increase as a result of excellent and good short-term clinical results in most of the patients of our study. Nevertheless, despite strict selection criteria for very well-selected patients, we observed an early failure rate of up to 20%.

Keywords: arthroscopy; cysts; femoroacetabular impingement; osteoarthritis.

Figure 1.

(A) Preoperative anterior-posterior (AP) view of the left hip of a 62-year-old female. There is a coxa profunda and overcover of the femoral head. There are radiological signs of calcification of the posterosuperior labrum. This patient had a preoperative Harris Hip Score of 67. (B) Two-year postoperative AP view of the left hip. Overcover of the femoral head was eliminated. The postoperative Harris Hip Score was 86.

Figure 2.

(A) Preoperative anterior-posterior (AP) view of the left hip of a 69-year-old male. Pincer-type impingement as a result of a coxa profunda. The preoperative Harris Hip Score was 65. (B) Two-year postoperative AP view. There is normal coverage and preservation of the joint space. The postoperative Harris Hip Score was 86.