J Korean Orthop Assoc.  2018 Aug;53(4):307-315. 10.4055/jkoa.2018.53.4.307.

Morphologic Changes of Femoral Cam Lesion after Osteoplasty for Femoroacetabular Impingement

• Hwang JM
• Hwang DS
• Noh CK
• Zheng L
• Yoo CH

• KMID: 2419466
• DOI: http://doi.org/10.4055/jkoa.2018.53.4.307

Abstract

PURPOSE
We evaluated the morphologic change of cam lesion of femoroacetabular impingement (FAI) using 3-dimensional computed tomography (3D-CT) at the minimum 2-year follow-up and estimated its relationship with clinical outcomes.
MATERIALS AND METHODS
Between February 2007 and March 2014, all patients who underwent hip arthroscopic femoroplasty under the impression of FAI were retrospectively evaluated. We selected patients who received 3D-CT and were followed-up for more than 2 years. We estimated the quantitative volume of femoroplasty, alpha angle and femoral head-neck offset using 3D-CT.
RESULTS
Thirty-two patients (37 cases) were selected in our study. The mean age was 31.2 years (16-69 years) and the mean follow-up duration was 47.3 months (26-119 months). The mean resection volume measured after femoroplasty using 3D-CT was 48.9 mm2 (13.2-106.4 mm2), and follow-up mean resection volume was 37.9 mm2 (7.83-90.37 mm2). A little bit of the mean volumatic overgrowth of the resection area between immediate postoperative and last follow-up was shown; however, there was no statistically significant difference in the mean values (p>0.05). The clinical outcomes showed a significant improvement during the perioperative and follow-up periods in all categories (p < 0.05).
CONCLUSION
There was no significant regrowth of cam lesion after femoroplasty for FAI at maximum 9 years. Moreover, in most cases, clinical outcomes were improved. This suggests that we were able to achieve good clinical outcomes without harmful anatomical regrowth of cam deformity using arthroscopic femoroplasty.

Keyword

hip arthroscopy; femoroacetabular impingement; cam lesion; femoroplasty

MeSH Terms

Congenital Abnormalities
Femoracetabular Impingement*
Follow-Up Studies
Hip
Humans
Retrospective Studies

Figure

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  Figure 1 Computed tomography (CT) of pre- and postoperative and follow-up. Section of axial image was selected to measure the same level of resection area. (A) Preoperative alpha angle. (B) Postoperative alpha angle. (C) Follow-up alpha angle. (D) Preoperative femoral head-neck offset. (E) Postoperative femoral head-neck offset. (F) Follow-up femoral head-neck offset. (G) Resection area measurement of immediate postoperative CT. (H) Resection area measurement of follow CT.

• 

  Figure 2 Clinical outcome score and pain score: preoperative (Preop.) and 2-month follow-up, and 2-year follow-up. POD, postoperative day; mHHS, modified Harris hip score; NAHS, non-arthritic hip score; HOS-ADL, hip outcome score-activities of daily living; HOS-SSS, hip outcome score-sport specific subscale; VAS, visual analogue scale.

• 

  Figure 3 A 21-year-old male patient presented with right side anterior groin pain with positive anterior impingement test. Radiologic evaluation before the operation showed abnormal findings. Radiologic evaluation at 119 months, showed no regrowth at the previous resection area. (A) Preoperative alpha angle ('06. Aug.). (B) Preoperative femoral head-neck offset ('06. Aug.). (C, D) Intraoperative arthroscopic finding ('06. Aug.). (E) Postoperative computed tomography (CT) scan ('06. Aug.). (F) Following CT scan at 119 months after surgery ('16. Jul.).

• 

  Figure 4 A 29-year-old female patient underwent the operation after the diagnosis of femoroacetabular impingement. (A) Arthroscopic femoral bumpectomy was performed. (B, C) During the follow-up period, she felt hip pain. Axial oblique computed tomography (CT) scan of hip at the follow-up revealed regrowth at the previous resection area. She underwent revision hip arthroscopy (D) and has had no further episodes of hip pain after revision surgery (E). (A) First operation: postoperative CT scan ('09 Sep.). (B) First operation: first follow-up (F/U) (postoperative day [POD] 11 months from first operation, '11 Sep.). (C) First operation: second F/U (POD 41 months from first operation, '12 Jul.). (D) Second operation: postoperative CT scan ('12 Jul.). (E) Second operation: third F/U (POD 49 months from second operation, '16 Aug.).

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