Background: The acetabular labrum provides a sealing function and a degree of hip joint stability. Limited, short-term follow-up studies suggest that labral refixation/preservation leads to superior outcomes compared with labral debridement/excision.
Purpose: To compare the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI).
Study Design: Cohort study; Level of evidence, 3.
Methods: We reported on patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with a cohort of patients who underwent labral refixation. To better match the 2 groups, only patients with labral pincer- or combined-type FAI were included. In the first 44 hips, the labrum was focally excised/debrided (group 1); in the next 50 hips, the labrum was refixed (group 2). Outcomes were measured with the modified Harris Hip Score (HHS), Short Form 12 (SF-12), and a visual analog scale (VAS) for pain preoperatively and postoperatively. Preoperative and postoperative radiographs were obtained to evaluate bony resection.
Results: The mean age was 32 years in group 1 and 28 years in group 2 with a mean follow-up of 42 months (range, 24-72 months). Preoperative mean subjective outcome scores were not significantly different between groups. At a mean 3.5 years’ follow-up, subjective outcomes were significantly improved (P < .01) for both groups compared with preoperative scores. The HHS (P = .001), SF-12 (P = .041), and VAS pain scores (P = .004) were all significantly better for the refixation group compared with the debridement group at the most recent follow-up. At a mean 3.5 years’ follow-up, good to excellent results were noted in 68% of the focal excision/debridement group and 92% of the refixation group (P = .004).
Conclusion: Although other factors may have influenced these results, labral refixation compared with an earlier cohort of focal labral excision/debridement resulted in better HHS, SF-12, and VAS pain outcomes and a greater percentage of good to excellent results at a mean 3.5-year follow-up.
Background: Minimally invasive techniques to treat femoroacetabular impingement (FAI), snapping hip syndrome, and peritrochanteric space disorder (PSD) were developed to reduce complications and recovery time. Although a multitude of studies have reported on the incidence of heterotopic ossification (HO) after open procedures of the hip, there is little known about the rate of HO after hip arthroscopy.
Hypotheses: The incidence of HO after hip arthroscopy is comparable with that after open surgical dislocation of the hip and can be reduced with the addition of indomethacin to an existing nonsteroidal anti-inflammatory medication prophylaxis protocol.
Study Design: Cohort study; Level of evidence, 3.
Methods: Between July 2008 and July 2010, 616 primary hip arthroscopies were performed to treat FAI and PSD. In July 2009, indomethacin was added in the acute postoperative period to an existing HO prophylactic protocol of naproxen administered for 30 days postoperatively. Postoperative radiographs were reviewed to detect the presence and classify the size and location of HO. Odds ratios and logistic regression explored predictor variables and their relationships with HO, with P < .05 defined as significant.
Results: Twenty-nine (21 male, 8 female) of 616 (4.7%) hip procedures developed HO postoperatively. Brooker classification of HO was 18 grade I, 4 grade II, 6 grade III, and 1 grade IV. Mean follow-up was 13.2 months (range, 2.9-26.5 months). Rate of HO for cases with and without indomethacin for prophylaxis was 1.8% (6/339) and 8.3% (23/277), respectively. This difference was statistically significant (P < .05), and patients who underwent protocol 1 were 4.36 times more likely to develop HO postoperatively than those who had protocol 2. The majority of cases of HO (72.4%) occurred in male patients, and all cases occurred in the setting of osteoplasty performed for symptomatic FAI. We were not able to demonstrate statistically significant clinical risk factors that were predictive for the development of postoperative HO. However, the data clearly demonstrate that the performance of arthroscopic osteoplasty with a capsular cut in male patients represented the majority of cases, who are likely the group at highest risk. Seven cases (~1%) required revision procedures to excise HO. There were no cases of recurrence of HO after excision, whether it was performed open or arthroscopically.
Conclusion: The addition of indomethacin is effective in reducing the incidence of HO after hip arthroscopy and should be especially considered in male patients who undergo osteoplasty for correction of symptomatic FAI.
Background: Intraoperative labral injury during the establishment of the first portal in hip arthroscopy has been reported to be as high as 20%.
Purpose: The purpose of the study was to prospectively identify the incidence of acetabular labral injuries that occurred while using a current technique for the establishment of portals during hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between the years 2008 and 2010, data were prospectively collected for all patients undergoing hip arthroscopic surgery. Patients with previous labral resection or Tonnis grade greater than 1 were excluded. Patients were positioned supine, traction was applied, and portals were established. The anterolateral portal was created first by venting the joint with a spinal needle and then re-entering the joint with the same needle with the bevel side facing the labrum. Next, the midanterior portal was created under vision. A thorough examination of the acetabular labrum was conducted arthroscopically through multiple viewing portals, and labral injuries related to the establishment of portals were identified and noted.
Results: A total of 300 patients were included in the study; only 2 patients (0.67%) suffered intraoperative labral injuries at the study period. One injury occurred during revision arthroscopy, while the second involved a hyperplastic labrum in a dysplastic hip. No patient with normal hip morphological characteristics undergoing a hip arthroscopy suffered a labral tear as a result of portal placement.
Conclusion: The incidence of iatrogenic labral injury during hip arthroscopy can be as low as 0.67% when using the described technique.
Background
Hip arthroscopy represents a new and minimally invasive method of treating patients with femoroacetabular impingement (FAI). However, participation in popular sports after this procedure has not yet been analyzed.
Hypotheses
Arthroscopic treatment of FAI increases the level of popular sports activities, and this level of activity correlates with the clinical outcome in terms of pain and function.
Study Design
Case series; Level of evidence, 4.
Methods
Fifty-three patients (41 male, 12 female) were evaluated preoperatively and after a mean follow-up of 2.4 years (range, 2–3.2 years) after arthroscopic osteoplasty for cam and mixed FAI. Evaluation included the type and level of sports activities (sports frequency score [SFS]) as well as clinical outcome in terms of pain (VAS) and function (nonarthritic hip score [NAHS]).
Results
Forty-five of the 53 patients had regularly participated in popular sports until the first occurrence of FAI symptoms. Preoperatively, only 4 of these 45 patients had maintained their accustomed level of activity. At the final follow-up, 31 patients had returned to their full accustomed level of activity. None of the patients who had not been active in sports before the first occurrence of symptoms of FAI (n = 
had begun participation in sports after arthroscopic osteoplasty. The SFS significantly increased from 0.78 to 1.84 (P < .001), and the mean VAS pain score significantly improved from 5.7 (range, 1–9) to 1.5 (range, 0–6) points (P < .001). The NAHS improved from 54.4 (range, 28.75–92.5) to 85.7 (range, 47.5–100) (P < .001). There was no significant correlation between SFS and NAHS (r = .051, P = .35), as well as between SFS and VAS pain score (r = .159, P = .140) preoperatively, but a significant correlation was seen at the time of the last postoperative follow-up (SFS/NAHS: r = .392, P = .003; SFS/VAS: r = .242, P = .049). The 3 most frequent sports activities postoperatively were biking, hiking, and fitness.
Conclusion
Arthroscopic osteoplasty can significantly improve the rate and level of popular sports activities in patients with FAI. The level of postoperative sports activity directly correlates with the clinical outcome in terms of pain and function.
