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Systematic Review With Video Illustration
Open Surgical Dislocation Versus Arthroscopy for Femoroacetabular
Impingement: A Comparison of Clinical Outcomes
Itamar B. Botser, M.D., Thomas W. Smith Jr., B.S., Rima Nasser, M.D., and Benjamin G. Domb, M.D.
Purpose:
Over the last decade, the surgical treatment of femoroacetabular impingement (FAI) has
evolved as surgical techniques through arthroscopy, open surgical dislocation, and combined ap-
proaches have been developed. The purpose of this systematic review was to evaluate and compare
the clinical results of available surgical approaches for FAI.
Methods:
A review of the literature was
performed through the PubMed database and related articles’ reference lists. Inclusion criteria were
(1) all patients treated for FAI, (2) Level I, II, III, or IV study design, and (3) written in the English
language. Case reports and studies involving patients with acetabular dysplasia were excluded.
Results:
Overall, 1,299 articles fit our keyword search criteria. Of these, 26 articles reported clinical
outcomes, using 3 surgical modalities: open surgical dislocation, arthroscopic, and combined ap-
proaches. In compiling the data in these articles, we analyzed the outcomes of a total 1,462 hips in
1,409 patients. The most published surgical method was arthroscopy, which included 62% of the
patients. Labral repair was performed more frequently in open surgical dislocation (45%) and
combined approach (41%) procedures than in arthroscopies (23%). Mean improvement in the
modified Harris hip score after surgery was 26.4 for arthroscopy, 20.5 for open surgical dislocation,
and 12.3 for the combined approach. A higher rate of return to sport was reported for arthroscopy in
professional athletes than for open surgical dislocation. Overall complication rates were 1.7% for the
arthroscopic group, 9.2% for the open surgical dislocation group, and 16% in the combined approach
group.
Conclusions:
All 3 surgical approaches led to consistent improvements in patient outcomes.
Because a wide variety of subjective hip questionnaires were used, direct comparisons could not be
made in many cases, and none of the approaches could be clearly shown to be superior to the others.
However, it seems that, overall, the arthroscopic method had the lowest complication and fastest
rehabilitation rate.
Level of Evidence:
Level III, systematic review.
T
he term “femoroacetabular impingement
(FAI)” was first coined in the English-language
literature in 1999.
1
A major advance in the under-
standing of FAI came with the development of the
open surgical dislocation technique, as described by
Ganz et al.
2
in 2001. Open surgical dislocation was
previously considered the gold standard of surgical
treatment for this condition. Subsequently, techno-
logic advancements in arthroscopic technique made
an arthroscopic approach to FAI possible.
3-6
More
recently, some authors have suggested a combined
arthroscopic and mini-open approach.
7-9
Today, ar-
throscopic surgery is an increasingly common prac-
tice for correction of bony pathologies and labral
tears in FAI.
From Hinsdale Orthopaedics Associates (I.B.B., T.W.S., R.N.,
B.G.D.), Hinsdale, Illinois; and the Loyola University Stritch
School of Medicine (I.B.B., B.G.D.), Chicago, Illinois, U.S.A.
B.G.D. is a consultant of Arthrex. The other authors report no
conflict of interest.
Received October 25, 2010; accepted November 5, 2010.
Address correspondence and reprint requests to Benjamin G.
Domb, M.D., Orthopaedics Associates, 1010 Executive Ct, Ste 250,
Westmont, IL 60559, U.S.A. E-mail:
bendomb@yahoo.com
© 2011 by the Arthroscopy Association of North America
0749-8063/10623/$36.00
doi:10.1016/j.arthro.2010.11.008
Note: To access the video accompanying this report, visit the
February issue of
Arthroscopy
at
www.arthroscopyjournal.org
.
270
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 27, No 2 (February), 2011: pp 270-278