Evaluation of clinical and radiological results of patients with femoroacetabular impingement who were treated surgically

The aim of this study was to clarify the effects of resection depth, width and resection arc on the frequency of reaching significant clinical benefit (SCB) and patient acceptable status (PASS) at the end of the 2nd year after arthroscopic surgery in patients with femoroacetabular impingement. A total of 26 patients (one patient operated bilaterally) who underwent arthroscopic surgery by a single orthopedic surgeon between 2018 and 2020 and had follow-ups of 2 years were included in the study. 10 (38.46%) of the patients were female, 16 (61.54%) were male, and the age distribution was 18-56 (mean 33.57). Patient-reported outcome measures (PROM), the Hip Outcome Scores Activities of Daily Living (HOSADL), modified Harries Hip Score (mHHS) and Visual Analog Scale for Pain (Pain VAS) were recorded one day before the surgery and at the second year follow-up assessment. Preoperatively pelvis xrays were taken Lateral center-edge angle (LCEA), femur head diameter, using the Dunn 450 x ray the alpha angletraditional (αT) was measured. Postoperatively anteriorposterior pelvis x rays were taken Lateral center-edge angle (LCEA), using the Dunn 450 x ray the alpha angletraditional (αT), alpha anglecartilage, (αC), resection arc angle0 (RA0: % alpha anglecartilage - alpha angletraditional / 3600 ), resection height (H 'mm'), resection depth (''D''mm) and depth ratio ''D%'' (D/diameter %) were measured. The SCB values determined by Ueland et al were accepted as 23 points for mHHS, 16 points for HOSADL, as well as 85 points for PASS mHHS and 86 points for HOSADL. Student-t test, Mann Whitney U test, Chi-square tests were used according to whether demographic characteristics, preoperative, peroperative and postoperative information, clinical scoring and radiographic data of the cases were parametrically distributed; correlation tests were done with the Spearman test. SPSS 24.0 statistical analysis software was used in all analyzes and the statistical significance value was accepted as p<0.05. There was no satitistically significant correlation between clinical results age, preoperative symptom duration and sex. 2nd year mHHS, HOSADL were higher (94+/-6 vs 64+/-18, 83+/-17 vs 42+/-20 p: <0.001) and VAS scores lower (3+/-1 vs 7+/-1, p: <0.001) than preoperative scores. Mean 450 Dunn view alpha angle and antero-posterior LCEA0 decreased from 680+/-150, 320+/-50 to 490+/-70 and 290+/-60 postoperatively (p<0.001). 16 hips (%59) passed the threshold of 23 points for mHHS SCB and 22 hips (%81) passed 85 points for mHHS PASS. For HOSADL 25 hips (%92) passed the threshold of 16 points increase for SCB and 12 hips (%44) passed the threshold of 86 points for PASS. Higher frequency of catching SCB threshold for mHHS was related to labrum repair (labrum repair %73 vs debridement %25 p: 0.03), preoperative lower alpha angle (640 vs 760, p:0.04), lower preoperative mHHS (54 vs 81, p<0.001) and higher preoperative VAS score (8 vs 7, p: 0.02). mHHS threshold score of 85 for PASS, lower alpha cartilage angle (820 vs 920 p:0.02), resection arc angle (80 vs 110, p:0.03), resection depth (2.8 vs 4.5 p:0.03), resection depth percentage (4.7 vs 8.4 p:0.04) and higher postoperative mHHS (97 vs 82 p<0.001) were associated with higher frequency of passing that value. Higher frequency of catching SCB threshold for HOSADL was related to lower resection depth percentage (5 vs 10 p:0.04). Lower resection depth amount approached statistical significance (2.9mm vs 5.5mm, p:0.054). Conclusion: Cam resection depth has an effect on the frequency of clinically meaningful scores and resection depth less than %6 of the femoral head diameter seems to be appropriate for optimal results. Starting point of the resection on the cartilage of the femoral head needs to be less than 900 when alpha angle is used for reference. Keywords: Femoroacetabular impingement, cam, pincer, resection depth