 |
For more information call
The Wellington Hospital: 020 7483 5589
Fortius Clinic: 0845 853 1000 The Yorkshire Clinic: 01274 621600  |
|
For more information call
The Wellington Hospital: 020 7483 5589
Fortius Clinic: 0845 853 1000 The Yorkshire Clinic: 01274 621600 |
Results following hip arthroscopy: what to expect in a realistic way…
To assess the results in our practice we ask patients to fill in assessment forms before and after surgery. Hip arthroscopy is not a procedure with a 100% success rate and the outcomes depend on a number of factors:
The majority of patients with hip impingement rate their pain between 7 and 10 out of 10 (10 being the worst pain; 0 being no pain) before the operation and go to a pain score of 0-1/10 after 2 years. What usually does not happen is that patients wake up after their surgery with no pain: indeed, for the majority of patients it takes around 6 months for the pain to be more or less disappear, but the biggest reduction in pain is observed between 0-2 months postoperatively. Overall, patience is needed and patients should allow for 6 months before they can properly assess the success of their hip operation.
Professor Schilders has treated over 200 athletes with hip impingement and in professional athletes the average return to sports is around 14 weeks, whilst for recreational athletes the average return to sports is 20 weeks. 94% of our professional athletes return to sports, whilst the recreational athletes return to sports in 89% of the cases.
It is important to understand that many other issues can cause pain other than the condition for which you had surgery and revisiting your surgeon or therapist might be required.
Please find below some of our outcome studies:
Schilders E, Dimitrakopoulou A, Bismil Q, Marchant P, Cooke C. J Bone Joint Surg Br. 2011 Aug; 93(8):1027-32.
Abstract:
Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.
Schilders E., Dimitrakopoulou A., Bismil Q., Talbot C. Knee Surgery Sports Traumatol 1 Arthroscopy 2010 (18) Supp 1. S65
Abstract:
Aim:
Treatment of athletes with femoroacetabular impingement (FAI) is challenging. With our study we demonstrate that arthroscopic treatment of athletes with FAI can be successful with the correct patient selection.
Methods:
Retrospective study of 45 consecutive athletes with FAI treated with hip arthroscopy. Inclusion criteria were a positive impingement test, radiographic features of FAI, Tonnis grade ≤2, and a lateral sourcil distance ≥2 mm. The FABER distance was recorded. The type of impingement and operative findings were recorded. Patients were assessed using a 100 point Modified Harris Hip Score (MHHS) pre-op and at 2, 6 and 12 months and 2 years post-op.
Results:
45 patients (mean age 30 years, range 15-54) were followed between 1 and 2 years. Clinically 34 patients had an increased FABER distance. 34% of patients had a Tonnis Grade 0, 52% Grade 1 and 14% Grade 2. The average lateral sourcil distance was 3.6mm (range 2-5mm, mode 4mm).
44% patients were treated by a combination of acetabular rim trimming and cam decompression; 24 % with isolated acetabular rim trimming; and 27% with isolated cam decompression. 84% had associated labral tears (73% underwent repair, 13% resection). Micro-fracture was also performed in 18% of patients.
Overall the average pre-op MHHS was 62.1 (95% CI 57.8-66.4) and the average post-op MHHS, between 6 months and 2years, had statistically significantly increased to 94.8 (95% CI 92.8-96.9) (p<0.001). Average return to sport was 2.4 months.
There was no statistical difference in outcome score when correlated with age. However, outcome was statistically worse if Grade 4 acetabular chondral lesions were noted compared to patients with normal cartilage (p<0.001).
Conclusions:
Our short term results of therapeutic hip arthroscopy can provide good or excellent improvement of symptomatic FAI in selected athletes. Chondral lesions appear to be a predictor for a less favourable outcome.