Treatment of Femoroacetabular Impingement in Athletes Using a Mini–Direct Anterior Approach
Notice bibliographique
Résumé
BACKGROUND: Femoroacetabular impingement (FAI) is an increasingly common diagnosis in active patients with hip pain. Surgical options for FAI include arthroscopy, open surgical dislocation, or mini-direct anterior approaches. Arthroscopic and open treatments of FAI have been commonly performed and have had promising results in athletes. Hypothesis/ PURPOSE: We hypothesized that the mini-direct anterior approach would provide the advantages of a minimally invasive procedure and still allow adequate exposure of the hip joint to successfully treat FAI in an athletic population. The purpose of this study was to determine if a mini-open approach for the treatment of FAI in athletic patients would allow a return to preoperative activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 234 patients (257 hips) with FAI were treated by a mini-open approach; 59 were athletic patients (66 hips) with a preoperative University of California, Los Angeles (UCLA) activity score of 7 or higher or Super Simple Hip (SUSHI) activity score of 70 or greater. Forty-four of the 59 athletic patients (47 hips) have reached 1-year minimum follow-up. No patients were lost to follow-up. The mini-open approach was performed through a 4-cm incision and modified Smith-Peterson approach with no muscle detachment. All patients were prospectively evaluated using the following outcome measures: preoperative and postoperative UCLA activity, Short-Form 36 Health Survey (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), modified Harris Hip Score (HHS), and SUSHI scores. RESULTS: The average age at the time of surgery was 32 years (range, 17-60 years), with an average follow-up of 22 months. Labral changes-whether tear, detachment, or ossification-were present in all patients, and 84% had chondral lesions. The mean HHS improved from 55 preoperatively to 79 postoperatively (P < .001). The WOMAC scores also improved from 47.9 to 8.3 (P < .001). Mean SF-36 scores improved from 65 to 85 postoperatively (P < .001). The mean preoperative SUSHI general score was 31.1, pain score was 26.6, and limitation score was 28.9. The mean postoperative SUSHI general score was 53.6, pain score was 47.5, and limitation score was 51.6 (P < .001). There was minimal change from preinjury to postoperative UCLA (8.0 to 8.7, respectively; P = .07) or SUSHI activity scores (76.3 to 67.7, respectively; P = .048), indicating a reliable return to preinjury activity levels. Twenty-four of 44 patients (55%) reported a return to their specific preoperative sports. Nine patients (20%) developed meralgia paresthetica postoperatively, which resolved within 1 year. CONCLUSION: The mini-open approach for the treatment of FAI is a safe and effective procedure that allows surgical treatment of FAI in athletic patients and a successful return to high activity levels. The outcome of the mini-open approach for athletes may be comparable with open and arthroscopic treatment of FAI.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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