A novel concept of cam-type femoroacetabular impingement treatment with patient-specific template guided osteochondral d
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ORIGINAL PAPER
A novel concept of cam-type femoroacetabular impingement treatment with patient-specific template guided osteochondral deformity ablation Rene Mihalič 1
&
Peter Brumat 1
&
Rihard Trebše 1,2
Received: 2 November 2020 / Accepted: 17 November 2020 # SICOT aisbl 2020
Abstract Purpose To present a novel surgical concept for the cam-type femoroacetabular impingement (FAI) treatment and to assess and report the clinical outcomes. Methods We performed a retrospective study of a single-surgeon case series of six hips in five consecutive male patients with symptomatic cam-type FAI, treated with the mini-open anterior hip approach with a patient-specific template (PST)-guided deformity ablation between 2015 and 2018. We assessed the hip range of motion, iHOT-33, Tegner, and EQ-5D before surgery and after a minimum follow-up of 30 months. Results The average age was 37 ± 13.3 years, average BMI was 31.1 ± 3.3 kg/m2, and average pre-surgery Tönnis hip osteoarthritis (OA) grade was 1 ± 1. The average surgery duration was 71 ± eight minutes. The average estimated blood loss was 83 ± 26 ml. After a mean follow-up of 50 ± 12 months, we observed no OA progression with no change in Tönnis hip OA grades. Hip flexion and internal rotation significantly improved (p = 0.007; p = 0.048) from mean 98° ± 9° and 14° ± 11° to mean 113° ± 8° and 23° ± 8°, respectively. iHOT-33, Tegner, and EQ-5D improved significantly (p = < 0.001; p = 0.004; p = < 0.001) from mean 44.7 ± 12.2, 3 ± 1, and 0.513420 ± 0.101389 to mean 94 ± 2.7, 5 ± 1, and 1.000000 ± 0, respectively. One patient needed revision surgery for heterotopic ossification removal, with no sequelae at the last follow-up. Conclusion Mini-open anterior hip approach with the PST-guided cam-type FAI deformity ablation presents an accurate and reproducible solution for cam-type FAI surgical treatment, with promising clinical outcomes. Using a PST in the cam-type FAI surgery may present a powerful additional tool in the existing open techniques armamentarium. Keywords Patient-specific template . PST . Femoroacetabular impingement . FAI . Cam impingement
Introduction Femoroacetabular impingement (FAI) should be suspected in 47 to 74% of patients with hip pain and
* Rene Mihalič [email protected] Peter Brumat [email protected] Rihard Trebše [email protected] 1
Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia
2
Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
without arthritis [1]. Cam-type FAI, particularly, is now well accepted as a risk factor in the development of hip osteoarthritis (OA) [2]. Moreover, it is recognized as one of the two most common causes of hip OA, as well as pain in the pre-arthritic state secondary to labral and cartilage pathology [2]. OA ranks globally among the 50 most common sequelae of diseases and injuries, affecting over 4% of the world’s population [3]. When nonsurgical treatment methods fail, surgical options are indicated [4]. The goal of
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