THE RIBAS MINI OPEN PROCEDURE FOR THE TREATMENT OF FEMOROACETABULAR IMPINGEMENT. MIDTERM RESULTS IN 117 CONSECUTIVE CASES

Abstract

Introduction: Femoroacetabular impingement (FAI) has been recently recognized as the main cause of hip pain in sportsmen. We analyse if clinical and functional results of surgical treatment are influenced by preoperative degenerative hip changes.

Materials and Methods: A series of 117 consecutive Ribas mini open procedures (mini open femoroacetabular osteoplasty with labral refixation) were performed in 115 sportsmen with confirmed clinical, radiographic, and MR-arthrography diagnosis of FAI, and were evaluated with a minimum follow up of 4 years (range: 4 – 6,5). According to Tönnis Grade for preoperative radiological degenerative hip stage, the hips were divided into 3 groups: group A/Tönnis 0: 32 hips; group B/Tönnis 1: 61 hips; group C/Tönnis 2: 24 hips. A Combined Clinical Score (CCS), which includes Impingement test, Merle D’Aubigné and WOMAC scores, was used to evaluate the patients before surgery and at 6 weeks, 3 months, 6 months and every year after operation. Satisfactory and unsatisfactory results were obtained and collected. SPSS 10.0 software (SPSS INC, Chicago, Ill) was used for statistical analysis and comparisons were performed by means of chi-squared and Wilcoxon tests; p< 0,05 was considered to be significant.

Results: With CCS method, satisfactory results were obtained in group A (Tönnis 0) in 93,4% of the cases at 12 months, in 96,5% at 24 months, and in 97,8% at the latest follow up of 48 months; in group B (Tönnis 1) satisfactory results were observed in 91,3% of the cases at 12 months, in 91,2% at 24 months, and in 93,6% at 48 months; in group C (Tönnis 2) satisfactory results were obtained in 58,3% of the cases at 12 months, in 55,3% at 24 months, and in 50,1% at 48 months. Differences between groups A and C, as like between groups B and C, were significant (p< 0,001), but not between groups A and B (p> 0,05).

Conclusions: Midterm results of the Ribas mini open procedure for the treatment of femoroacetabular impingement are encouraging, expecially in hips not exceeding Tönnis Grade 1 osteoarthrosis, as results depend directly on degenerative state. If symptomatic patients are treated in early stages, excellent expectancies can be obtained with this procedure already at midterm. In addition, instruction of general physicians and specialists in the diagnosis of FAI is of paramount importance.