[Application efficacy of proximal anterior-distal anterolateral accessory in hip arthroscopic surgery]

Objective: To explore the application effects of the proximal anterior-distal anterolateral accessory (PA-DALA) in hip arthroscopy for treating common hip diseases. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent hip arthroscopic surgery at the Chinese People×s Liberation Army General Hospital from January 2018 to December 2023. The diseases included femoral acetabular impingement syndrome (FAI), ankylosing spondylitis (AS), synovial chondromatosis (SC), and pigmented villonodular synovitis (PVNS). Based on the different surgical approaches, the patients were divided into two groups: the control group underwent the conventional distal anterolateral approach (DALA) commonly used in hip arthroscopy, while the observation group received the PA-DALA approach. The application effects of the PA-DALA in hip arthroscopic surgery for common hip disorders were evaluated, and the incidence of intraoperative complications, postoperative wound healing, and functional scores such as the visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and International Hip Outcome Tool-12 (iHOT-12) at various follow-up time points before and after surgery (1, 3, 6 months and 1 year after surgery) were compared between the two groups. Results: A total of 102 patients with effective follow-up are included in the study, comprising 71 males and 31 females, aged (37.3±13.1) years. There were 34 cases in the control group, and 68 patients in observation group. In the control group, the preoperative VAS score of pain was (6.2±2.3) points, which decreased to (3.1±1.7) points one year after surgery; the preoperative mHHS score was (36.3±12.9) points, which increased to (77.7±9.3) points one year after surgery; and the preoperative iHOT-12 score was (29.5±15.4) points, which raised to (69.2±16.9) points one year after surgery. In the observation group, the preoperative VAS score of pain was (6.0±1.2) points, which decreased to (1.8±1.6) points one year after surgery; the preoperative mHHS score was (38.8±12.2) points, which increased to (81.0±9.5) points one year after surgery; and the preoperative iHOT-12 score was (32.8±12.6) points, which raised to (74.6±12.6) points one year after surgery. The VAS scores, mHHS scores, and iHOT-12 scores of both groups at all postoperative time points showed significant improvement when compared with those preoperative scores (all P<0.05). The observation group demonstrated a greater advantage in alleviating postoperative pain [VAS at one year after the operation: (1.8±1.6) vs (3.1±1.7) points] (P<0.001). In the control group, 3 patients experienced intraoperative complications, specifically involving perforation of the outer edge of the acetabular cortex during anchor placement, resulting in unstable anchor fixation with a success rate of 91.18%(31/34), but in the observation group, no such complications occurred, and the anchor placement success rate was 100%(68/68), it was significantly higher than that in the control group (P=0.049). Both groups of patients healed well postoperatively and were discharged from the hospital successfully. Conclusions: The PA-DALA approach can fulfill the requirements for establishing surgical approaches in hip arthroscopy for common hip diseases. Compared with the conventional DALA approach, the PA-DALA approach enhances the safety and success rate of anchor placement.