ePoster #714 - ISHA Annual Scientific Meeting 2016

Does The Femoral Cam Lesion Regrow After Arthroscopic Femoroplasty In The Skeletally Immature Patient With An Open Femoral Head Physis? Radiographic Review And Clinical Outcomes With Minimum Two-Year Follow-Up

Itay Perets, MD, Westmont, IL UNITED STATES
Asheesh Gupta, MD, Woodridge, VA UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Lyall Ashberg, MD, Westmont, IL UNITED STATES
David E. Hartigan, MD, Westmont, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: In skeletally immature females, hip arthroscopic treatment of FAI and/or labral tears is a safe and favorable intervention due to its high patient satisfaction and outcome scores, and absence of postoperative complications.

Abstract:
Background: Femoroacetabular impingement (FAI) due to femoral cam lesions may occur in skeletally immature adolescents, which is often treated through an arthroscopic osteoplasty of the femoral neck. However, the possibility of cam lesion regrowth in an adolescent population has not yet been examined.
Purpose: The purpose of this study was to determine whether or not the femoral cam lesion regrows in patients with open femoral head physes undergoing femoral osteoplasty during hip arthroscopy for the treatment of FAI and concomitant labral pathology.
Methods: We analyzed n = 11 hips (10 patients) with open femoral head physes that underwent femoroplasty for the treatment of a cam lesion between October 2008 and November 2013. We included patients with minimum follow-up time of two years, who completed patient-reported outcome (PRO) questionnaires and x-rays preoperatively, two-weeks postoperatively, and at a minimum of two-years postoperatively. The exclusion criteria were preoperative Tönnis grade > 1 and previous hip conditions. The alpha angle was measured preoperatively, two weeks postoperatively, and at a minimum of two years postoperatively. PRO scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), Visual Analog Scale (VAS), were measured preoperatively and at latest follow-up. Satisfaction was also recorded at follow-up.
Results: The cohort consisted of 10 female patients with a mean age of 14.7 years at the time of surgery. Mean follow-up time was 35.7 months. All hips tested positive for anterior impingement preoperatively. All hips (n = 11) underwent a femoroplasty concomitantly with labral repair (n = 10) or debridement (n = 1). The mean alpha angle measured on the preoperative Dunn view was 61.8°. The mean two-week postoperative alpha angle was 41.5° (p < 0.0001). The mean alpha angle was 40.7° at a minimum of two years postoperatively, which was not significantly different than those measured 2 weeks postoperatively. No patient had regrowth of the cam lesion on radiographs. Mean mHHS increased from 58.5 preoperatively to 79.8 at latest follow-up (p < 0.0001). Mean NAHS increased from 56.8 preoperatively to 87.1 at latest follow-up (p < 0.008). Mean HOS-SSS increased from 34.3 preoperatively to 78.3 at latest follow-up (p < 0.004). Mean VAS decreased from 7.5 preoperatively to 1.3 at latest follow-up (p < 0.0001). Mean satisfaction at latest follow-up was 8.7 ± 1.7. Two hips (18.2%) underwent an additional revision arthroscopy procedure at a mean of 24.8 months. No postoperative complications were reported.
Conclusions: Cam regrowth is unlikely to occur in skeletally immature females who underwent arthroscopic femoroplasty. In this group of patients, hip arthroscopic treatment of FAI and/or labral tears is a safe and favorable intervention due to its high patient satisfaction and outcome scores, and absence of postoperative complications.