EP3.27 Improved Clinical outcomes and Low Conversion Rate to THA, 5-14 Years After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement in 110 patients

Abstract

Abstract Background The benefits of hip arthroscopic surgery for Femoroacetabular impingement (FAI) are well-established, with promising mid-term results. The goal of hip preserving surgery is to achieve a lasting improvement in hip function and to prevent the development of osteoarthritis. Purpose The purpose of our study is to evaluate the clinical outcomes and complications after hip arthroscopy for the treatment of FAI in young patients in a follow-up of 5 to 14 years and to mention the low conversion rate to THA and try to understand the reason of continuous pain after hip arthroscopy. Materials and Methods From January 2012 to January 2023, 110 patients (41 males, 69 females) of mean age 31.4 years old (range; 17 to 55) with FAI were operated arthroscopically by the same team (DN,GS) in a Rotex Table. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. Surgery involved removal of the impingement lesion (femoral and/or acetabular) and labral preservation or removal with repair of chondral lesions (where appropriate). Femoral osteochondroplasty alone was performed in 81 hips, combined femoral osteochondroplasty with acetabular recession was performed in 24 hips and acetabular recession alone in 5 hips. Chondral and labral lesions were treated using thermal treatment with radiofrequency probe, labral reattachment, or chondrolabral repair using sutures. X-rays of the hip and MRI were performed in all cases pre-operatively (72.7% MRI arthrogram). All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 3,6,12 months after surgery and at the final evaluation (5-14 years). Interviews were conducted by the senior surgeons (DN, PS, SB). The mean follow-up period was 9,2 years (minimum 5y. and maximum 14y.). Results The mean mHHS was 65.1 preoperatively, 88.6 at 3 months postoperatively and 95.8 at final evaluation. The mean VAS score was 7.4 preoperatively, 2.3 at 3 months postoperatively and 0.9 at final evaluation. A statistically significant difference existed among these scores (p<0.001). There were 5 cases (5.5%) with traction-related nerve injuries (perineum paresthesia) for 1 to 3 months, 3 cases (3.3%) of ankle pain for 3 to 5 weeks, 12 cases (13.3%) of fluid extravasation, no infection, no osteonecrosis, 17 cases (18.9%) of trochanteric bursitis and 14 cases (15.6%) of heterotopic ossification. Nine patients of Tonnis 1 and 2 patients of Tonnis 0 needed THA from 5-14 years post-arthroscopy, whereas 11 patients presented with residual painful hip in the follow-up period. Conclusion In this series, 90% of patients retained their native hips and reported good patient-reported outcome scores at least 5 to 14 years after arthroscopic treatment of symptomatic FAI. Younger patients fared better in this series, as did hips without signs of osteoarthritis.