Treatment of Femoroacetabular Impingement with a Mini-open Direct Anterior Approach

Abstract

Background: The opinion about best methods of femoroacetabular impingement (FAI) treatment are not consistent. Operative treatment of this condition may be arthroscopic, but open procedures with osteotomy of the greater trochanter and hip dislocation has been used. The present study evaluates the benefits of the mini-open direct anterior approach (DAA) in treating patients with FAI, with is a procedure available for most orthopedic surgeons.

Materials and methods: 39 patients treated for FAI (25 men and 14 women) at an average age of 29.3 years (range 18-46 years) were reviewed in this retrospective study. The mean followup was 45 months, (range 24-55 months). The hip impingement test was positive in all patients. The diagnosis of FAI was confirmed on anteroposterior and lateral hip view radiographs. All patients were operated with mini-open DAA. The outcomes were assessed with the Harris Hip Score, Short-Form 36 Health Survey and VAS score. Preoperative osteoarthritis was assessed according to Tönnis score.

Results: At the final followup, improvement was noted compared to preoperative status in Harris Hip Score (P < 0.00001), visual analog scale score (P < 0.001), and Short-Form-36 score (P < 0.001). Nineteen patients returned to their previous sports activities. No major complications occurred. One patient developed heterotopic ossification and three patients developed temporary postoperative meralgia paresthetica. Five patients from the treatment group required total hip arthroplasty for severe osteoarthritis.

Conclusions: Mini-open DAA is a safe and effective procedure for the treatment of FAI that gives good relief of symptoms and allows a successful return to preoperative activity levels. Further research with a longer followup period is needed to evaluate the influence of surgery on natural history of FAI.

Keywords: Acetabulum; Femoroacetabular impingement; arthroscopic surgical procedures; cam type; cartilage; cartilage lesion; direct anterior approach; labrum tear; minimal access surgical procedures; pincer type.