Application of arthroscopic surgery combined with direct anterior approach in hip diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DENG Xiangtian ¹ , LIU Juncai ¹ , YANG Shuncheng ¹ , WANG Xinyuan ² ,  LI Zhong ¹

1. Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Oncology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LI Zhong, Email: 545890312@qq.com

Keywords：

Hip arthroscopy; direct anterior approach; femoral head fracture; femoral neck fracture; osteonecrosis of femoral head

DOI：

10.7507/1002-1892.201803115

Video：

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ObjectiveTo evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases.MethodsA retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively.ResultsAll the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores (t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score (t=21.314, P=0.000).ConclusionArthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.

Citation： DENG Xiangtian, LIU Juncai, YANG Shuncheng, WANG Xinyuan, LI Zhong. Application of arthroscopic surgery combined with direct anterior approach in hip diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1167-1171. doi: 10.7507/1002-1892.201803115 Copy

1.	Minkara AA, Westermann RW, Rosneck J, et al. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med, 2018: 989020445.
2.	Flores SE, Borak KR, Zhang AL. Hip arthroscopic surgery for femoroacetabular impingement: A prospective analysis of the relationship between surgeon experience and patient outcomes. Orthop J Sports Med, 2018, 6(2): 1809802472.
3.	Domb BG, Yuen LC, Ortiz-Declet V, et al. Arthroscopic labral base repair in the hip: 5-year minimum clinical outcomes. Am J Sports Med, 2017, 45(12): 2882-2890.
4.	Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am, 2009, 40(3): 311-320.
5.	Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
6.	D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
7.	Casp A, Gwathmey FW. Hip arthroscopy: Common problems and solutions. Clin Sports Med, 2018, 37(2): 245-263.
8.	Hari KB, Joshi GR, Pushkar A. Arthroscopic removal of intraarticular fracture fragment after fracture dislocation of hip. Med J Armed Forces India, 2015, 71(Suppl 1): S208-S210.
9.	Cvetanovich GL, Weber AE, Kuhns BD, et al. Hip arthroscopic surgery for femoroacetabular impingement with capsular management: factors associated with achieving clinically significant outcomes. Am J Sports Med, 2018, 46(2): 288-296.
10.	Sochacki KR, Jack RA, Safran MR, et al. There is a significant discrepancy between " Big Data” database and original research publications on hip arthroscopy outcomes: A systematic review. Arthroscopy, 2018, 34(6): 1998-2004.
11.	Kierkegaard S, Langeskov-Christensen M, Lund B, et al. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med, 2017, 51(7): 572-579.
12.	Park MS, Her IS, Cho HM, et al. Internal fixation of femoral head fractures (Pipkin Ⅰ) using hip arthroscopy. Knee Surg Sports Traumatol Arthrosc, 2014, 22(4): 898-901.
13.	Chen Y, Nan Y, Jirong S, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade IIIA-IIIB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
14.	陈志文, 林斌, 丁真奇, 等. Pipkin Ⅰ 型股骨头骨折伴髋关节后脱位的治疗. 中国修复重建外科杂志, 2011, 25(5): 521-525.
15.	Agarwal A, Vaishya R, Gulati D. Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws. Int Orthop, 2010, 34(6): 897-901.
16.	Sultan A, Khursheed O, Bhat MR, et al. Management of capitellar fractures with open reduction and internal fixation using Herbert screws. Ulus Travma Acil Cerrahi Derg, 2017, 23(6): 507-514.
17.	Grosso MJ, Danoff JR, Thacher R, et al. Risk factors for conversion surgery to total hip arthroplasty of a hemiarthroplasty performed for a femoral neck fracture. Hip Int, 2018, 28(2): 168-172.
18.	Bhargava T, Goytia RN, Jones LC, et al. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedic, 2010, 33(7): 472.
19.	Macheras GA, Christofilopoulos P, Lepetsos P, et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int, 2016, 26(4): 338-343.
20.	Connolly KP, Kamath AF. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique. World J Orthop, 2016, 7(1): 38-43.

1. Minkara AA, Westermann RW, Rosneck J, et al. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med, 2018: 989020445.
2. Flores SE, Borak KR, Zhang AL. Hip arthroscopic surgery for femoroacetabular impingement: A prospective analysis of the relationship between surgeon experience and patient outcomes. Orthop J Sports Med, 2018, 6(2): 1809802472.
3. Domb BG, Yuen LC, Ortiz-Declet V, et al. Arthroscopic labral base repair in the hip: 5-year minimum clinical outcomes. Am J Sports Med, 2017, 45(12): 2882-2890.
4. Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am, 2009, 40(3): 311-320.
5. Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
6. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
7. Casp A, Gwathmey FW. Hip arthroscopy: Common problems and solutions. Clin Sports Med, 2018, 37(2): 245-263.
8. Hari KB, Joshi GR, Pushkar A. Arthroscopic removal of intraarticular fracture fragment after fracture dislocation of hip. Med J Armed Forces India, 2015, 71(Suppl 1): S208-S210.
9. Cvetanovich GL, Weber AE, Kuhns BD, et al. Hip arthroscopic surgery for femoroacetabular impingement with capsular management: factors associated with achieving clinically significant outcomes. Am J Sports Med, 2018, 46(2): 288-296.
10. Sochacki KR, Jack RA, Safran MR, et al. There is a significant discrepancy between " Big Data” database and original research publications on hip arthroscopy outcomes: A systematic review. Arthroscopy, 2018, 34(6): 1998-2004.
11. Kierkegaard S, Langeskov-Christensen M, Lund B, et al. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med, 2017, 51(7): 572-579.
12. Park MS, Her IS, Cho HM, et al. Internal fixation of femoral head fractures (Pipkin Ⅰ) using hip arthroscopy. Knee Surg Sports Traumatol Arthrosc, 2014, 22(4): 898-901.
13. Chen Y, Nan Y, Jirong S, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade IIIA-IIIB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
14. 陈志文, 林斌, 丁真奇, 等. Pipkin Ⅰ 型股骨头骨折伴髋关节后脱位的治疗. 中国修复重建外科杂志, 2011, 25(5): 521-525.
15. Agarwal A, Vaishya R, Gulati D. Fractures of capitellum: a review of 14 cases treated by open reduction and internal fixation with Herbert screws. Int Orthop, 2010, 34(6): 897-901.
16. Sultan A, Khursheed O, Bhat MR, et al. Management of capitellar fractures with open reduction and internal fixation using Herbert screws. Ulus Travma Acil Cerrahi Derg, 2017, 23(6): 507-514.
17. Grosso MJ, Danoff JR, Thacher R, et al. Risk factors for conversion surgery to total hip arthroplasty of a hemiarthroplasty performed for a femoral neck fracture. Hip Int, 2018, 28(2): 168-172.
18. Bhargava T, Goytia RN, Jones LC, et al. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedic, 2010, 33(7): 472.
19. Macheras GA, Christofilopoulos P, Lepetsos P, et al. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach. Hip Int, 2016, 26(4): 338-343.
20. Connolly KP, Kamath AF. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique. World J Orthop, 2016, 7(1): 38-43.

Chinese Journal of Reparative and Reconstructive Surgery

Application of arthroscopic surgery combined with direct anterior approach in hip diseases

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