Femoroacetabuläres Impingement-Syndrom - Over-the-Top-Technik ohne Anker versus Over-the-Top-Technik mit Anker - eine prospektive randomisiert-kontrollierte Nichtunterlegenheitsstudie
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Philipps-Universität Marburg
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Abstract
Femoroacetabular impingement (FAI) particularly affects young, athletically active people and the prevalence of FAI syndrome in the general population ranges from 10 - 25 %. FAI carries a high risk of pain and irreversible damage of the hip joint, cartilage and labrum, meaning that people suffering from FAI may develop coxarthrosis at an earlier stage.
The aim of this prospective, randomized controlled study was to investigate whether labrum-sparing hip arthroscopy without insertion of a labral anchor is non-inferior to the same surgical method with insertion of a labral anchor in terms of postoperative outcome. The study included 82 cases of 81 patients who underwent randomized arthroscopic treatment, were prospectively interviewed and underwent radiographic and clinical examination. Patients with isolated Pincer or combined FAI were included. Cases with isolated Cam FAI, labral injuries, signs of coxarthrosis and previous hip joint surgery were excluded.
Of the 82 included hip joints, 46 cases were randomized to the group with anchors and 36 cases to the group without anchors. In the group with anchors, anchor implantation was not performed in 14 cases due to intraoperative anatomical conditions, which was considered in the intention-to-treat and per-protocol analysis. The 82 cases included 46 women (53.1 %) and 36 men (43.9 %) as well as 4 cases (4.9 %) with Pincer-FAI and 78 cases (85.1 %) with combined-FAI. The average age in the group without an anchor was 42 ± 13.5 years (18 - 65 years) and in the group with an anchor 39.8 ± 13.7 years (18 - 64 years) (p > 0.05).
The data collection included subjective parameters, which were measured using five questionnaires (Hip Outcome Score, International Hip Outcome Score 33, Modified Harris Hip Score, Visual Analog Scale, Short Item 36 score) preoperatively and at defined time points postoperatively. On the other hand, objective parameters in the form of radiological measurements (lateral center edge angle, medial center edge angle, femoral extrusion index, alpha angle, head-neck offset, crossover sign, posterior wall sign) were collected preoperatively and postoperatively.
The data of the objective parameters were comparable between the group without and with anchors (p > 0.05). The preoperatively pathologically altered radiological measurements showed a significant improvement and in some cases normalization after surgery.
The data of the subjective parameters of all of the used questionnaires showed an improvement in the values one year after the hip arthroscopy, which among other things represent a reduction in pain and an improvement in physical activity, social and mental health. In the statistical evaluation, the intention-to-treat and per-protocol analysis did not prove non-inferiority of the treatment effect in the group without a labral anchor compared to the group of FAI patients with a labral anchor (p > 0.025). However, the very similar results between the groups suggest that the number of cases may have been too small to prove non-inferiority with such small differences between the groups. In addition, a higher preoperative status showed a significantly better postoperative outcome after one year for many of the subjective parameters collected, whereas the subtype of FAI had no influence on the outcome in most cases.
Future studies should include standardized follow-up over a longer observation period to include endpoints such as the development of coxarthrosis and the need for further surgery or even implantation of a total hip joint endoprosthesis. To be able to answer the research question of the study presented, studies with larger numbers of cases and preferably with a multicenter study design are necessary.
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Created: 2025Issued: 2025-02-26Updated: 2025-02-26
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Koxarthrose
DFG-subjects
SportlerleisteHüftgelenkCam-FAILeistenschmerzFAIPincer-FAIFemoroacetabuläres ImpingementHüftarthroskopieNichtunterlegenheit
DDC-Numbers
610
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Wawer Matos Reimer, Philomena Alice (0000-0001-8443-4858): Femoroacetabuläres Impingement-Syndrom - Over-the-Top-Technik ohne Anker versus Over-the-Top-Technik mit Anker - eine prospektive randomisiert-kontrollierte Nichtunterlegenheitsstudie. : Philipps-Universität Marburg 2025-02-26. DOI: https://doi.org/10.17192/z2025.0139.
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This item has been published with the following license: In Copyright