ABSTRACT
BACKGROUND: The iliopsoas tendon is a recognized cause of extra-articular hip pain, and tenotomy has been described as an effective treatment in patients who do not respond to conservative treatments. Endoscopic release showed higher success rate, lower recurrence, fewer complications compared to open surgery. The aim of the study is to report the results at a mean of 4 years follow-up of a series of patients affected by femoroacetabular impingement (FAI) and an associated iliopsoas tendinopathy, treated with hip arthroscopy and transcapsular tendon release. METHODS: Fifteen patients were retrospectively reviewed. Assessment of radiographic signs of FAI was performed, the alpha angle, the femoral head-neck offset and the lateral center edge angle (LCEA) were collected. Osteoarthritis was assessed from the AP pelvic and graded according to the Tönnis classification. Modified Harris Hip Score (mHHS), VAIL score and VAS score were administered to all patients before surgery, at follow-up at 1 year (T1) and final follow-up (T2). RESULTS: We found a statistical significant improvement in functional scores (mHHS and VAIL score) from the baseline to T2. According to VAS score, a statistical significant improvement was also found from T0 to T2, from a median of 5.5 (range 3-7) to 0 (range 0-5) (P<0.001). Two patients referred a recurrence of pain one year after surgery who were treated conservatively. No other complications have been reported. CONCLUSION: Iliopsoas tendinopathy can be associated to FAI in some patients, and failure in diagnosing and treating may be the reason of poor results and a revision surgery. Arthroscopic iliopsoas tendon release seems to produce good clinical outcome, reducing pain and the rate of a revision surgeries. Level of evidence: IV case series.
ABSTRACT
BACKGROUND: The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. MATERIALS AND METHODS: Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). RESULTS: The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2-9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. CONCLUSION: Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series.
