Abstract
Femoro-acetabular impingement (FAI) is an increasingly diagnosed cause of hip pain in young patients. It may progress to cause labral injury and chondral damage within the hip.
Surgery can be undertaken arthroscopically but is not universally available. Open approach to the hip with surgical dislocation, labral surgery and impingement lesion reduction is an acceptable alternative. Described by Ganz in 2001 the approach must conserve the postero-lateral blood supply to the femoral head and neck, to minimize the risk of Avascular Necrosis (AVN). Ganz recommended a sliding trochanteric osteotomy to widen access, and an anterior capsulotomy avoiding dissection postero-lateral to the femoral neck. To date there has been no published support for the Hardinge-type antero-lateral approach.
We describe a series of 26 consecutive patients with FAI, all managed by open osteochondroplasty during 2008 via a modified anterolateral approach and capsule preserving exposure. Trochanteric osteotomy was not undertaken.
The series contained 14 males and 12 females with mean ages of 33 and 29 respectively. Patients were assessed both clinically and using the Non Arthritic Hip Score (NAHS). Assessments were undertaken pre-operatively and at 8 and 16 weeks post-operatively. The mean NAHS pre-op was 54. This improved to 87 at 16 weeks. 77% of our patients achieved a NAHS of 75 or greater indicating a good or excellent result. Three patients had poor outcome and progression of osteoarthritic symptoms. There were no complications from the osteochondroplasty and all patients were Trendelenberg negative by 16 weeks.
We believe hip osteochondroplasty can be safely and effectively undertaken via an anterolateral approach, without a trochanteric osteotomy.
The abstracts were prepared by Major N. J. Ward ramc. Correspondence should be addressed to him at nickjward72@hotmail.com
