Hip arthroscopy with initial access to the peripheral compartment for femoroacetabular impingement: midterm results from a large-scale patient cohort.

BACKGROUND: Hip arthroscopy with initial access to the peripheral compartment could reduce the risk of iatrogenic injury to the labrum and cartilage; furthermore, it avoids the need for large capsulotomies with separate portals for peripheral and central (intra-articular) arthroscopy. Clinical results of the peripheral-compartment-first technique remain sparse, in contrast to those of conventional hip arthroscopy starting in the intra-articular central compartment. The purpose of this study was to assess outcome of hip arthroscopy with the peripheral-compartment-first technique, including complication rates, revision rates and patient-reported outcome scores. MATERIALS AND METHODS: This outcome study included 704 hips with femoroacetabular impingement. All arthroscopies were performed using the peripheral-compartment-first technique. A joint replacement registry and the institutional database were used to assess the revision and complication rates, while patient-reported outcome measures were used to assess functional outcomes and patient satisfaction. RESULTS: In total, 704 hips (615 patients) were followed up for a mean of 6.2 years (range 1 to 9 years). The mean age of the patients was 32.1 ± 9.2 years. During the follow-up period, 26 of 704 (3.7%) hips underwent total hip arthroplasty (THA) after a mean of 1.8 ± 1.2 years, and 18 of the 704 (2.6%) hips required revision hip arthroscopy after a mean of 1.2 ± 2.1 years. 9.8% of the hips had an unsatisfactory patient-reported outcome at final follow-up. CONCLUSIONS: The results for the peripheral-compartment-first technique were promising. We recommend a well-conducted randomized controlled clinical trial to guide future therapeutic recommendations regarding the most favorable hip arthroscopy technique. LEVEL OF EVIDENCE: Level IV, therapeutic study. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (U.S. National Library of Medicine; ID: NCT05310240).

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

Aims: Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods: A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results: Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion: We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.