Abstract
Background
Femoroacetabular impingement (FAI) may be a predisposing factor in progression of osteoarthritis. The use of hip arthroscopy is in its infancy with very few studies currently reported. Early reports show favourable results for treatment of young patients with FAI. This prospective study over a larger age spectrum represents a significant addition to this expanding field of minimally invasive surgery.
Methods
Over a twenty-two month period all patients undergoing interventional hip arthroscopy were recorded on a prospective database. Patient demographics, diagnosis, operative intervention and complications were noted. Patients were scored pre-operatively and postoperatively at 6 months and 1 year using the McCarthy score.
Results
94 patients met the criteria for inclusion in this study. Median age was 39 (15–66) years with 57.4% female, 16 patients were over the age of 50 years. At operation, 50 patients had a labral tear, 70 had cam impingement and 62 had chondral damage, with 21 of these deemed severe (grade 3 or 4). For all patients a mean increase in the McCarthy score of 14.6 (p=<0.0001) was seen at 6 months and 19.1 (p=0.0002) at 1 year postoperatively. For those over 50 years, at 6 months an increase of 11.9 (p=0.08) was seen, improving to 33.8 (p=<0.0001) at 1 year. Eight patients underwent THR, of these, 2 were over 50 years of age. All of this group of patients had chondral damage (50% judged as severe at arthroscopy). At 6 months postoperatively these patients had severe pain and their mean score worsened by −16.3 (p=0.2). Few complications were seen, 7 patients had tight access (5 males), 3 of which received chondral scuffing and 1 had the procedure abandoned, 1 patient had groin labral bruising and 2 patients had transient parasthesia.
Conclusions
Patients see a gradual and significant improvement post hip arthroscopy, with symptoms continuing to improve until 1 year. This is a well-tolerated procedure with a low complication rate and the opportunity for treatment of a range of hip pathology. Patients over the age of 50 gain a significant improvement from this procedure. Two groups of patients who gain no improvement are those with inflammatory arthropathy and those with dysplastic acetabulae.
