Operative Orthopadie und Traumatologie · 2021
[Arthroscopic assisted mini-open arthrotomy for the treatment of the femoroacetabular impingement].
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Floerkemeier T, Ezechieli M, Wirries N, Windhagen H, Ribas M, Budde S
Аннотация
OBJECTIVES: Treatment of pathologies of the central and peripheral compartment of the hip using arthroscopic assisted mini-open arthrotomy via the Smith-Petersen approach.
INDICATIONS: Cam- and pincer-type femoroacetabular impingement (FAI), labral tear, loose bodies.
(RELATIVE) CONTRAINDICATIONS: Osteoarthritis of the hip with Tönnis classification grade ≥ 2.
SURGICAL TECHNIQUE: After mini-open approach to the hip joint via direct anterior muscular gap, the anterior capsule is split with protection of the labrum. Decompression allows the joint to be inspected using an arthroscope. Depending on the intra-articular findings, additional procedures can be performed (e.g., curettage of the cartilage, microfracturing, matrix-induced autologous chondrocyte implantation [MACI]). Cases with pincer-type FAI or labral tear can also be addressed. After partial release, the cam-type FAI can be resected using a surgical burr.
POSTOPERATIVE MANAGEMENT: Partial weightbearing for 2-6 weeks with 10-20 kg or half body weight using crutches depending on the intraoperative treatment.
RESULTS: Radiological analysis of the pre- and postoperative X‑rays (n = 69) prove that this surgical technique is suitable to address pathologies especially FAI syndromes. The α‑angle according to Nötzli could be reduced from a mean preoperative value of 72.8° to 49.4° postoperative. In combined cam-type and Pincer-type FAI syndrome (n = 16), the lateral center-edge angle could be reduced from a mean preoperative value of 50.2° to 37.6° postoperatively. The clinical follow-up (n = 29) revealed good midterm outcomes after arthroscopic assisted mini-open arthrotomy (modified Harris Hip Score [mHHS] 84.8 points after 4.9 years [range 4.2-5.7; ±0.43]).
INDICATIONS: Cam- and pincer-type femoroacetabular impingement (FAI), labral tear, loose bodies.
(RELATIVE) CONTRAINDICATIONS: Osteoarthritis of the hip with Tönnis classification grade ≥ 2.
SURGICAL TECHNIQUE: After mini-open approach to the hip joint via direct anterior muscular gap, the anterior capsule is split with protection of the labrum. Decompression allows the joint to be inspected using an arthroscope. Depending on the intra-articular findings, additional procedures can be performed (e.g., curettage of the cartilage, microfracturing, matrix-induced autologous chondrocyte implantation [MACI]). Cases with pincer-type FAI or labral tear can also be addressed. After partial release, the cam-type FAI can be resected using a surgical burr.
POSTOPERATIVE MANAGEMENT: Partial weightbearing for 2-6 weeks with 10-20 kg or half body weight using crutches depending on the intraoperative treatment.
RESULTS: Radiological analysis of the pre- and postoperative X‑rays (n = 69) prove that this surgical technique is suitable to address pathologies especially FAI syndromes. The α‑angle according to Nötzli could be reduced from a mean preoperative value of 72.8° to 49.4° postoperative. In combined cam-type and Pincer-type FAI syndrome (n = 16), the lateral center-edge angle could be reduced from a mean preoperative value of 50.2° to 37.6° postoperatively. The clinical follow-up (n = 29) revealed good midterm outcomes after arthroscopic assisted mini-open arthrotomy (modified Harris Hip Score [mHHS] 84.8 points after 4.9 years [range 4.2-5.7; ±0.43]).