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Is acetabular osteoplasty always required in mixed impingement?
Andreas M Hingsammer1, Cara Beth Lee, Justin LaReau
1Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland, andreashingsammer@hotmail.com.
Summary
For mixed femoroacetabular impingement (FAI), acetabular rim osteoplasty may not always be necessary. Satisfactory clinical outcomes were achieved with or without rim trimming, provided impingement-free motion was attained.
Area of Science:
- Orthopedic Surgery
- Hip Arthroscopy
- Femoroacetabular Impingement
Background:
- Mixed femoroacetabular impingement (FAI) is a hip condition often treated with both femoral and acetabular rim osteoplasties.
- The necessity of acetabular rim osteoplasty in all mixed FAI cases has not been definitively established.
Purpose of the Study:
- To investigate whether satisfactory clinical results can be achieved in mixed FAI patients treated with femoral osteoplasty alone or combined with acetabular osteoplasty.
- To determine if achieving intraoperative impingement-free functional motion is the key factor for successful outcomes.
Main Methods:
- Retrospective review of 30 hips in 23 patients with mixed FAI who underwent surgical hip dislocation.
- Patients were divided into two groups: femoral osteochondroplasty with rim trim (RT, n=21) and without rim trim (NRT, n=9).
- Evaluation included physical examinations and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores.
Main Results:
- Both NRT and RT groups showed significant improvements in WOMAC pain scores (p=.002 and p=.014, respectively).
- Functional improvement was significant in the NRT group (p < .001).
- Both groups experienced increased internal rotation and flexion, with resolution of the impingement sign in over 50% of patients.
Conclusions:
- Satisfactory clinical outcomes in mixed FAI are achievable irrespective of acetabular rim trimming (RT).
- The primary determinant of success appears to be the attainment of impingement-free functional motion during surgery.
- Absence of severe cartilage damage is also a critical factor for favorable outcomes.
