Hip arthroscopy after previous surgical hip dislocation for femoroacetabular impingement.
OBJECTIVE
The purpose of this study was to examine whether arthroscopic adhesiolysis can relieve symptoms of patients with persistent pain after open surgical hip dislocation for femoroacetabular impingement syndrome without osseous or cartilaginous alterations.


METHODS
This study comprised 16 consecutive patients (6 men and 10 women; mean age, 33.5 years [range, 19 to 60 years]) with persistent pain without osseous or cartilaginous alterations after surgical hip dislocation for the treatment of femoroacetabular impingement. At index surgery, all patients had osteochondroplasty of the head-neck junction and resection of the acetabular rim with reattachment of the labrum in 9 cases. All patients had preoperative magnetic resonance imaging-arthrogram and were treated with arthroscopy of the hip.


RESULTS
At arthroscopy, all reattached labra were stable. In the cases without preservation of the labrum at the index operation, the joint capsule was attached at the level of the acetabular rim and synovitis was noticed. All patients had adhesions between the neck of the femur and joint capsule or between the labrum and capsule. In 3 patients the arthroscopic procedure was technically limited by massive thickening of the capsule. Overall, 81% of patients (13/16) showed less pain or were pain-free. The Merle d'Aubigné score improved from 13 points preoperatively to 16 points at the last follow-up.


CONCLUSIONS
Persistent pain after surgical dislocation of the hip without evidence of cartilaginous and osseous alterations could result from intra-articular adhesions. Hip arthroscopy after previous surgery can be demanding because of scarring. If the adhesions can be released, good results can be achieved.


METHODS
Level IV, therapeutic case series.
Krueger
Andreas
A
Department of Orthopaedic Surgery, Inselspital, University of Berne, Berne, Switzerland. andreas.krueger@insel.ch
Leunig
Michael
M
Siebenrock
Klaus A
KA
Beck
Martin
M
D000077:Acetabulum / Q000473:pathology / Q000601:surgery*; D000328:Adult; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005272:Femur Neck / Q000473:pathology / Q000601:surgery*; D006621:Hip Joint / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods; D000267:Tissue Adhesions / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome