Paper #5 - ISHA Annual Scientific Meeting 2016

Is Fluoroscopy Still Necessary to Perform Arthroscopic Femoroplasty?

Idriss Tourabaly, MD, MSc, Paris FRANCE
Thierry Boyer, MD, Neuilly Sur Seine FRANCE
Elodie Baraduc
Alexis Nogier, MD, Paris FRANCE

Institut de l'Appareil Locomoteur NOLLET, Paris, FRANCE

FDA Status Not Applicable

Summary: We presented our radiological results of femoroplasty performed with no fluoroscopy.

Abstract:
Background

Femoro-acetabular impingement represents over 50% of hip arthroscopy indications. The treatment has evolved still fifteen years. From open technique described by Ganz to arthroscopic or mini-open procedure. Until today, the use of fluoroscopy is considered as necessary to perform a complete peripheral/central hip arthroscopy and to assess the femoroplasty resection. We present our hip arthroscopy procedure without fluoroscopy with a peripheral first access to hip and a visual controlled access to central compartment. The purpose of this study was to report our experience and to determine the radiological result of FAI treatment without fluoroscopy.

Method

A retrospective study of hip arthroscopies was performed until Mai 2014 to Mai 2016 with prospective collection of data. All procedure were performed by one senior hip surgeon (AN) at the same institution. Inclusion criteria were a femoro-acetabular impingement diagnosis with femoral cam. Preoperative radiological evaluation included AP pelvic view and lateral Dunn profile . to explore the femoral cam. MRI and/or arthro-CT were performed to assess associated cartilage/labrum lesions. During surgery, femoroplasty was extended under visual control and with dynamic test in flexion, FADIR and FABER. All patient were evaluated preoperatively and post-operatively by an independent practitioner. For all patient alpha angle were measured on lateral Dunn x-ray profile. We compared preoperative and post operative alpha angle results.

Result

A total of 67 patients underwent 67 hip arthroscopies. 7 patients were lost of follow up. The mean age at time of surgery was 36 years (14 years old to 42 years old). There were 51 males (76%). The surgical treatment consisted to femoroplasty for the femoral cam performed without fluoroscopy and labral resection in most of cases. The mean preoperative alpha angle was 70.7° (8.2) and the mean postoperative alpha angle was 44.8° (+- 6.0°). No excessive correction were noticed and 2 insufficient correction were described with alpha angle over 60°.

Conclusion

Continuous visual control during hip arthroscopy is possible with our fluoroscopy less peripheral first technic. The main advantage of this technic is to avoid Xray exposure and to simplify OR set up. In addition, our study shows that dynamic preoperative control of the femoroplasty provides good radiological results with complete removal of the femoral cam and no over correction of the femoroplasty. We so believe that the use use of Xray during hip arthroscopy should be reconsidered.