Arthroscopic treatment of femoroacetabular pincer impingement.
OBJECTIVE
Arthroscopic resection of the bony overhang of the acetabular rim with concurrent treatment of associated chondrolabral injury in order to improve femoroacetabular clearance, provide symptomatic relief and in theory, delay the onset or progression of osteoarthritis of the hip.


METHODS
Clinical and radiographic evidence of femoroacetabular pincer or combined impingement, with minimal to moderate degenerative change in the hip joint.


METHODS
Advanced osteoarthritis of the hip joint. Femoroacetabular pincer impingement arising from generalised overcoverage, e.g. coxa profunda. Acetabular retroversion in a dysplastic hip.


METHODS
Arthroscopy of the peripheral compartment, using a proximal anterolateral viewing portal and anterior and anterolateral working portals. Labral assessment, release from its capsular reflection, limited bony resection of the acetabular rim or labral ossification. Central compartment arthroscopy under traction, using the anterolateral and anterior portals alternately as viewing and working portals, and a distal anterolateral accessory portal. The labrum is detached to expose the bony overhang in the acetabular rim, which is resected with a burr. The labrum is refixed if it is of sufficient quality and debrided or resected otherwise.


METHODS
Labral resection: partial weight bearing, with pain-controlled progression to full weight bearing over 1-2 weeks. Labral refixation: Protected (20 kg) weight bearing for the first 4 weeks. Continuous passive motion therapy and the use of a stationary bicycle for 4 weeks, and early proprioceptive training are part of the rehabilitation regimen.


RESULTS
Arthroscopic treatment of femoroacetabular impingement has been shown to provide symptomatic relief, improve hip outcome scores and is postulated to delay progression of osteoarthritis. Better clinical outcomes can be obtained with labral refixation if the labrum is of sufficient quality.
Orthopädische Chirurgie München (OCM), Steinerstraße 6, 81369, Munich, Germany.
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Orthopädische Chirurgie München (OCM), Steinerstraße 6, 81369, Munich, Germany.
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Orthopädische Chirurgie München (OCM), Steinerstraße 6, 81369, Munich, Germany. michael.dienst@ocm-muenchen.de.
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D001182:Arthroscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D057925:Femoracetabular Impingement / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
Arthroscopy; Complications; Femoroacetabular impingement; Operative technique; Results