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Outcomes of arthroscopic hip surgery in patients with Femoro-acetabular Impingement

Doctoral thesis
Authors Mikael Sansone
Date of public defense 2016-04-15
ISBN 978-91-628-9704-8
Publisher University of Gothenburg
Place of publication Göteborg
Publication year 2016
Published at Institute of Clinical Sciences, Department of Orthopaedics
Language en
Links hdl.handle.net/2077/41551
Keywords hip joint, hip arthroscopy, register, PROM, femoro-acetabular impingement, athlete, cam, outcome
Subject categories Orthopedics

Abstract

Hip and groin problems are common, especially among athletes. The treatment of hip and groin problems has undergone rapid change during the latest 15 years, mainly due to our understanding of femoro-acetabular impingement (FAI). FAI consists of skeletal changes of the hip, which lead to a mismatch between the femoral head and pelvic socket, leading to collision and impingement. These changes are called cam when placed on the femoral side and pincer on the pelvic side. Technical advances have led to arthroscopic treatment as a standard procedure for treating FAI. The results after this treatment have, however, not been well investigated. This thesis aims to investigate the results after arthroscopic treatment for FAI. A clinical register was created in order to evaluate and follow this patient category over time. A long-term follow-up was made of patients who had undergone tenotomy in the groin region. This study showed that three out of four patients experienced good results after surgery. The patients with a poorer outcome had a significantly higher prevalence of FAI. A database was created with the aim of evaluating patients treated arthroscopically for FAI. In an assessment of the first 606 patients in the database, it was seen that, when measured with modern and validated outcome measures, these patients reported substantial clinical symptoms. A one-year follow-up of 85 elite athletes after arthroscopic treatment revealed good results, including less pain, improved function, quality of life and return to sports. A two-year follow-up of 289 patients with FAI treated arthroscopically showed significant improvements in terms of pain, function and quality of life. A two-year follow-up of 75 patients with FAI and concomitant mild to moderate osteoarthritis of the hip showed significant improvements in terms of pain, function and quality of life. In a case report of two cases of total hip dislocation after hip arthroscopy and psoas tenotomy referred to us, the importance of dynamic and static stabilisers of the hip was highlighted. A study of different outcomes used to evaluate patients with FAI reported on the use of composite outcomes to better evaluate this patient category.

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