Orthopaedic surgeons at Brigham and Women’s Hospital (BWH) are utilizing an innovative arthroscopic technique to treat femoral acetabular impingement (FAI) while preserving the chondrolabral junction.
“Patients with untreated FAI and concomitant labral tears are at risk for chondral lesions and arthritis with damage that may lead to total hip replacement in many patients,” said orthopaedic surgeon Scott D. Martin, MD.
While labral repair and acetabuloplasty are beneficial, previously described arthroscopic treatment techniques have required surgical detachment of the labrum to access acetabular rim pincer lesions with subsequent repair. These techniques may compromise labral blood flow, which can lead to incomplete labral healing and further damage to the chondrolabral junction. An arthroscopic technique pioneered by Dr. Martin preserves the labral vascularity and chondrolabral junction during labral repair and acetabular osteoplasty (Arthrosc Tech. 2013 Jun 14;2(3):e213-6.).
During this procedure, the capsulolabral complex is elevated off of the acetabulular rim above the chondrolabral junction, all the way down to the edge of the acetabular rim. Osteoplasty with burring is performed on the reverse mode to avoid damage to the labrum and surrounding capsule. Using this technique, the capsulolabral blood vessels are preserved (Figures 4A and 4B). The acetabular shelf is then contoured under fluoroscopic guidance, and the labrum is repaired and reconstituted to a newly recessed anatomic footprint.
A retrospective assessment of cases performed at BWH using this technique is currently underway. Every patient is scored before surgery and follow-up information is tracked. In a review of 551 cases, there are 341 cases with two-year follow up. Eighty-three percent of these patients have reported satisfactory results, with less than five percent progressing to a total hip replacement. Over 95 percent of the patients who went on to hip replacement had progressive osteoarthritis with Outerbridge scores of three or four at the time of hip arthroscopy. In the 76 patients who returned for extensive review, 65 percent had good-to-excellent outcomes at follow-up as determined by a modified Harris Hip Score of 80 or higher. Full-thickness cartilage loss was associated with poorer outcomes. Prospective tracking of ongoing cases is being conducted; patients are only considered for repair using this technique if their osteoarthritis is not too far progressed. Dr. Martin also has trained residents and fellows on the technique with much success.
“This technique has been shown to relieve symptoms in the majority of patients,” said Dr. Martin. “It also is instrumental in helping to prevent or delay the need for total hip replacement, particularly in younger patients.”
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