Tenosuspension of the Reflected Head of the Rectus Femoris in Hip Arthroscopy: Description of a Portal and a Surgical Maneuver

Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger

Objective  To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger.

Methods  This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed.

Results  Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up ( p  > 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1 ^st postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage.

Conclusion  In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.

Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Purpose

To describe the functional results of arthroscopic treatment in patients with femoroacetabular impingement (FAI) and subspine impingement (SSI) evaluated with a 3-dimensional (3D) dynamic study.

Methods

This was a retrospective observational study of patients with a diagnosis of FAI and SSI, evaluated with a 3D dynamic computed tomography scan with Move Forward software, who underwent hip arthroscopy between February 2015 and December 2017. Measurements of the alpha angle, femoral anteversion, acetabular anteversion, lateral center-edge angle, and Tönnis angle were extracted from the 3D dynamic study. Functionality was evaluated using the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after surgery.

Results

We analyzed 22 hips in 17 patients (9 female and 8 male patients) with an average age of 34.6 ± 14.3 years. Of the 22 hips, 15 had cam morphology, 6 had mixed morphology, and 1 had pincer morphology. Of the hips, 11 had a type I spine, 10 had type II, and 1 had type III. The average alpha angle, Tönnis angle, femoral anteversion, and acetabular anteversion were 61.9° ± 11.1°, 2.5° ± 6.4°, 8.8° ± 6.8°, and 15.1° ± 7.1°, respectively. The median lateral center-edge angle was 38.1° (interquartile range, 32.6°-43.5°). At 1-year follow-up, a decrease in the Western Ontario McMaster Universities Osteoarthritis Index score (P = .001) and an increase in the flexion angle (P < .001) were observed. No cases needed posterior surgical revision because of persistent pain.

Conclusions

Arthroscopic treatment provides symptom relief and good functional results in patients with FAI and SSI.

Level of Evidence

Level IV, therapeutic case series.