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Is acetabular osteoplasty always required in mixed impingement?

Hingsammer, Andreas ; Lee, Cara ; LaReau, Justin ; Kalish, Leslie ; Kim, Young-Jo

In: European Journal of Orthopaedic Surgery & Traumatology, 2015, vol. 25, no. 2, p. 331-338

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    Titre
    • Is acetabular osteoplasty always required in mixed impingement?
    Auteur
    • Hingsammer, Andreas. Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
    • Lee, Cara. Department of Orthopaedic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
    • LaReau, Justin. Hinsdale Orthopaedic Associates, Hinsdale, IL, USA
    • Kalish, Leslie. Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
    • Kim, Young-Jo. Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Orthopaedic Surgery & Traumatology, 2015, vol. 25, no. 2, p. 331-338. Springer Paris
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:333080
    Summary
    Background: Mixed femoroacetabular impingement (FAI) is typically managed with both femoral and acetabular rim osteoplasties, but it has not been reported if the rim osteoplasty is always required. Hypothesis/purpose: We hypothesized that mixed FAI managed by femoral or combined femoral and acetabular osteoplasties will both attain satisfactory clinical results, provided intraoperative impingement-free functional motion is attained. Methods: We retrospectively reviewed 30 hips (23 patients, mean age at surgery 24.3years, mean follow-up time 1.6years) with mixed FAI who underwent surgical dislocation of the hip and had femoral osteochondroplasty with rim trim (RT, n=21) or no rim trim (NRT, n=9). Physical examination results and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were evaluated. Results: Mean (±SD) WOMAC pain scores improved from 6.56 (±2.96) to 2.33 (±3.64) in the NRT group (p=.002) and from 6.86 (±4.15) to 3.86 (±3.95) in the RT group (p=.014). Function improved in both groups, but the difference was significant only for the NRT group (p<.001). Over 50% of patients in both groups had resolution of impingement sign. Internal rotation increased from 8.6° (±11.8) to 20.0° (±10.4) in the NRT group (p=.043) and from 4.0° (±12.1) to 18.6° (±14.0) in the RT group (p<.001). Both groups had increased flexion post-operatively to normal range, but the change was only significant for the RT group (p=.02). Both groups had insignificant decreases in external rotation. Conclusion: Satisfactory clinical outcomes were seen in hips with mixed impingement, regardless of whether RT was performed, provided impingement-free functional motion was attained and no severe cartilage damage was seen.