The efficacy of hip arthroscopy for concurrent femoroacetabular and subspine impingement / 中华骨科杂志

ABSTRACT

Objective:To assess the clinical outcomes of hip arthroscopy in patients with concurrent femoroacetabular impingement (FAI) and subspine impingement (SSI).Methods:Data were retrospectively reviewed for patients with both FAI and SSI who underwent hip arthroscopy surgery from August 2021 to May 2022. A total of 23 patients (23 hips) followed up for more than 1 year, including 10 males and 13 females, 9 left hips and 14 right hips, with an average age of 31.3±4.6 years (range, 25-45 years). Subspine decompression by anterior inferior spine (AIIS) shaping for SSI was performed during hip arthroscopy in addition to labral repair and bony correction for FAI in the patients with concurrent FAI and SSI. Clinical outcomes were evaluated using preoperative and 1-year postoperative measures: lateral center-edge (LCE) angle, α angle on 45° Dunn view X-rays, maximum hip flexion angle, hip flexion and knee extension strength, visual analogue scale (VAS) for pain, modified Harris Hip Scores (mHHS), and International Hip Outcome Tool-12 (iHOT-12).Results:Of the 23 patients, 20 had type 2 AIIS and 3 had type 3 AIIS. At 1-year follow-up after surgery, there were significant improvements: LCE angle decreased (33.3°±6.1° to 31.7°±4.1°, t=1.076, P=0.288), α angle reduced (63.7°±8.5° to 50.0°±6.6°, t=6.116, P<0.001), hip flexion angle increased (107.4°±6.0° to 120.2°±4.4°, t=8.269, P<0.001), VAS scores decreased (4.0±1.1 to 1.0±1.1, t=9.591, P<0.001), mHHS improved (62.6±4.9 to 87.5±8.1, t=12.700, P<0.001), and iHOT-12 scores rose (51.4±4.9 to 75.7±7.7, t=12.593, P<0.001). There was no significant difference in the strength of hip flexion and knee extension between preoperative and follow-up ( t=0.930, P=0.357 and t=0.050, P=0.960, respectively). There were no reports of traction-related complications (such as skin necrosis and nerve paralysis), severe adverse events (such as femoral neck fractures, deep vein thrombosis in the lower limbs, intra-articular infections, ectopic ossification and hip instability), or the need for revision surgery. Conclusion:Subspine decompression by anterior inferior spine (AIIS) shaping for SSI during conventional hip arthroscopy is safe and effective, enhancing hip function and alleviating pain at 1-year follow-up without significant complications.