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. 2015 Jul 3;50(4):430-7.
doi: 10.1016/j.rboe.2015.06.011. eCollection 2015 Jul-Aug.

Extracapsular approach for arthroscopic treatment of femoroacetabular impingement: clinical and radiographic results and complications

Bruno Dutra Roos  1 , Milton Valdomiro Roos  1 , Antero Camisa Júnior  1 , Ezequiel Moreno Ungaretti Lima  1 , Diego Paulo Gyboski  1 , Lucas Schirmer Martins  1
Affiliations

Extracapsular approach for arthroscopic treatment of femoroacetabular impingement: clinical and radiographic results and complications

Bruno Dutra Roos et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objectives: To evaluate the clinical and radiographic results and complications relating to patients undergoing arthroscopic treatment for femoroacetabular impingement by means of an extracapsular approach.

Methods: Between January 2011 and March 2012, 49 patients (50 hips) underwent arthroscopic treatment for femoroacetabular impingement, performed by the hip surgery team of the Orthopedic Hospital of Passo Fundo, Rio Grande do Sul. Forty patients (41 hips) fulfilled all the requirements for this study. The mean follow-up was 29.1 months. The patients were assessed clinically by means of the Harris Hip score, as modified by Byrd (MHHS), the Non-Arthritic Hip score (NAHS) and the internal rotation of the hip. Their hips were also evaluated radiographically, with measurement of the CE angle, dimensions of the joint space, alpha angle, neck-head index, degree of arthrosis and presence of heterotopic ossification of the hip.

Results: Out of the 41 hips treated, 31 (75.6%) presented good or excellent clinical results. There was a mean postoperative increase of 22.1 points for the MHHS, 21.5 for the NAHS and 16.4̊ for the internal rotation of the hip (p < 0.001). Regarding the radiographic evaluation, correction to normal values was observed for the alpha angle and neck-head index, with a mean postoperative decrease of 32.9̊ and mean increase of 0.10, respectively (p < 0.001).

Conclusion: Arthroscopic treatment of femoroacetabular impingement by means of an extracapsular approach presented satisfactory clinical and radiographic results over a mean follow-up of 29.1 months, with few complications.

Objetivos: Avaliar os resultados clínicos e radiográficos e as complicações relativos a pacientes submetidos a tratamento artroscópico de impacto femoroacetabular com o uso da abordagem extracapsular.

Métodos: Entre janeiro de 2011 e março de 2012, 49 pacientes (50 quadris) foram submetidos a tratamento artroscópico de impacto femoroacetabular pela Equipe de Cirurgia do Quadril do Hospital Ortopédico de Passo Fundo (RS). Preencheram todos os requisitos necessários para este trabalho 40 pacientes (41 quadris). O seguimento médio foi de 29,1 meses. Os pacientes foram avaliados pelo Harris Hip Score modificado por Byrd (MHHS), Non-Arthritic Hip Score (NAHS) e quanto à rotação interna do quadril. Também foram avaliados radiograficamente. Aferiu-se o ângulo CE, a dimensão do espaço articular, o ângulo alfa, o índice colo-cabeça, o grau de artrose e a presença de ossificação heterotópica do quadril.

Resultados: Dos 41 quadris tratados, 31 (75,6%) apresentaram resultados clínicos bons ou excelentes. Observou-se um aumento médio pós-operatório de 22,1 pontos para o MHHS, 21,5 para o NAHS e 16,4° na rotação interna do quadril (p < 0,001). Quanto à avaliação radiográfica, observou-se correção para índices considerados normais do ângulo alfa e índice colo-cabeça, com diminuição média de 32,9o e aumento médio pós-operatório de 0,10, respectivamente (p < 0,001).

Conclusão: O tratamento artroscópico do impacto femoroacetabular com o uso da abordagem extracapsular apresentou resultados clínicos e radiográficos satisfatórios em seguimento médio de 29,1 meses, com poucas complicações.

Keywords: Arthroscopy; Femoroacetabular impingement/diagnosis; Femoroacetabular impingement/etiology; Femoroacetabular impingement/treatment.

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Figures

Fig. 1
Fig. 1
Arthroscopic image of the left hip during operation to treat FAI, by means of an extracapsular approach. Exposure of the joint capsule (JC) and identification of the reflex portion of the rectus femoris muscle (RF). The anatomical location of this muscle generally marks the proximity of the labrum of the hip, below the capsule.
Fig. 2
Fig. 2
Image during operation, after the capsule has been opened, identifying the labrum of the hip (L) and the femoral neck-head transition (NHT).
Fig. 3
Fig. 3
Image during operation showing resection of the cam-type deformity and identifying the femoral head (FH) and femoral neck (FN).
Fig. 4
Fig. 4
Male patient aged 32 years. Preoperative internal rotation of 5°. (A, B) Preoperative radiographs showing FAI of cam type, θCE: 27° and θα: 68°. (C, D) Radiographs produced 3 years and 2 months after the operation, in which femoral osteochondroplasty had been performed in association with labral debridement. The patient evolved well, to internal rotation of 18°, with normalization of θα.
Fig. 5
Fig. 5
Male patient aged 37 years. Internal rotation of 0°. (A, B) Preoperative radiographs showing FAI of mixed type, θCE: 32°, θα: 78° and crossing of the acetabular lines. (C, D) Radiographs produced 1 year and 3 months after the operation, in which femoral osteochondroplasty had been performed in association with labral refixation. The patient evolved well, to internal rotation of 15°, with normalization of θα.
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