Arthroscopic treatment of pincer-type femoroacetabular impingement performing acetabuloplasty without labral detachment

Abstract

Objectives: In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described withlabral detachment. However, when the chondrolabral junction remains intact, acetabuloplasty and labral refixationcan be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patientstreated with arthroscopic acetabuloplasty without labral detachment. Method(s): During the study period, we retrospectively analyzed 44 patients with pincer-type o combinedimpingement and an intact chondroblabral junction, with an average followup of 32 months (range: 27-38). Weexcluded patients with CAM-type impingement and previous hip pathology. Radiographs were analyzed to defineimpingement and classify grade of osteoarthritis. Clinical evaluation consisted of preoperative and postoperativemodified Harris Hip Score (mHHS) and WOMAC as well as postoperative Visual Analogue Scale (VAS) of pain andsatisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Result(s): Mean preoperative anterior and lateral center-edge angles were 35degree and 29degree, respectively. Meanpreoperative alfa angle was 52degree. Crossover sign was found in 82% of cases. mHHS changed from 51.06 (SD 4.81)preoperatively to 84.97 (SD 12.79) postoperatively. Preoperative WOMAC was 29.18 (SD 8) and postoperative,13.10 (SD 11). Postoperative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparingpatients with Tonnis 0 to those with Tonnis 1, the former showed better results regarding postoperative mHHS(89.9s vs 77.85, p=0.03), pain VAS (1.5 vs 6.3, p=0.03) and satisfaction VAS (8.2 vs 6.3, p=0.01). PostoperativeWOMAC was slightly better for Tonnis 0 patients (8.31 vs 19.3, p=0.05). No differences were found in preoperativeWOMAC and mHHS. Three of 44 patients required a second surgical procedure and were considered failures.Survival was 100% at 24 months and 76% at 40 months (95%CI: 35%-98%). Conclusion(s): Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes in all theevaluated scores. Slight degenerative changes on radiographs correlated with poorer clinical outcomes, exhibitingbetter results in patients without osteoarthritis.