Systematic Review With Video Illustration
Comparative Systematic Review of the Open Dislocation, Mini-Open, and Arthroscopic Surgeries for Femoroacetabular Impingement

https://doi.org/10.1016/j.arthro.2010.09.011Get rights and content

Purpose

To analyze the current approaches to the surgical management of symptomatic femoroacetabular impingement (FAI).

Methods

Thirteen relevant queries were used in four search engines (PubMed, EMBASE, Ovid, and the Cochrane Review) with a resultant 5,856 articles. Eighteen peer-reviewed treatment outcome studies met the inclusion criteria with minimum 1-year follow-up of the surgical treatment of skeletal pathoanatomy and associated chondrolabral pathology in skeletally mature patients with FAI.

Results

There were 6 open surgical dislocation, 4 mini-open, and 8 arthroscopic studies, all with Levels of Evidence III or IV. The only prospective studies were in the arthroscopic category. Outcome data were extracted and analyzed with respect to surgical efficacy, failure rates, and complications.

Conclusions

The open dislocation, mini-open, and arthroscopic methods for treating symptomatic FAI are effective in improving pain and function in short-term to midterm studies and are relatively safe procedures. The historical gold standard of open dislocation surgery had a comparatively high major complication rate primarily because of trochanteric osteotomy–related issues. The mini-open method showed comparable efficacy but a significant incidence of iatrogenic injury to the lateral femoral cutaneous nerve in some studies. The arthroscopic method had surgical outcomes equal to or better than the other methods with a lower rate of major complications when performed by experienced surgeons.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

Section snippets

Methods

Four databases were selected to ensure a comprehensive review of the literature: PubMed, EMBASE, Ovid, and the Cochrane Review. On January 25, 2010, a total of 13 different queries were used for each engine: (1) “femoroacetabular impingement OR FAI,” (2) “hip impingement,” (3) “cam impingement,” (4) “pincer impingement,” (5) “surgical dislocation AND impingement,” (6) “osteotomy AND impingement,” (7) “hip AND treatment AND impingement,” (8) “hip arthroscopy,” (9) “mini-open,” (10) “Hueter AND

Results

Use of the previously mentioned terms resulted in a total of 5,856 articles for further review, with 3,278 of those from PubMed, 1,281 from EMBASE, 1,295 from Ovid, and 2 from the Cochrane Review. An additional 53 articles resulted from the aforementioned hand search. A total of 950 articles were selected for further abstract review. The resulting 55 articles were then obtained in full-text format for further analysis. Of the 55 articles that met inclusion criteria, 22 met the inclusion

Discussion

Clohisy et al.15 performed a systematic review of FAI surgical outcome studies. They reviewed 11 studies, of which 1 used the mini-open technique. They found an overall clinical success rate varying from 65% to 96% over a mean follow-up period of 3.2 years, an improvement in pain and function in all studies, a total hip conversion rate between 0% and 26%, and a complication rate of 0% to 18%. No comparisons were made between surgical methods.

A systematic review by Bedi et al.16 looked at the

Conclusions

The open dislocation, mini-open, and arthroscopic methods for treating symptomatic FAI are effective in improving pain and function in short-term to midterm studies and are relatively safe procedures (Table 6). The historical gold standard of open dislocation surgery had a comparatively high major complication rate primarily because of trochanteric osteotomy–related issues. The mini-open method showed comparable efficacy but a significant incidence of iatrogenic injury to the LFCN in some

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    The authors report no conflict of interest.

    Note: To access the video accompanying this report, visit the February issue of Arthroscopy at www.arthroscopyjournal.org.

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