Open dislocation of the hip versus arthroscopy in the treatment of femoroacetabular impingement: a comparison of the clinical results.

Over the past decade the surgical treatment of femoroacetabular impingement (FAI) has developed as a surgical technique through arthroscopy, open dislocation of the hip and combined techniques. The aim of this systematic review was to assess and compare the clinical results of the surgical techniques available for femoroacetabular impingement.
A systematic review was carried out of the PubMed database, and the selection criteria were (1) patients operated on for femoroacetabular impingement, (2) level I, II, III or IV studies, (3) studies written in the English language. Case reports and studies with patients with acetabular dysplasia were excluded.
A total of 1299 papers met our criteria. Of these, 26 papers reported clinical results, using 3 surgical methods: open dislocation of the hip, hip arthroscopy and the combined methods. In the collection of the data, the results of a total of 1462 hips in 1409 patients were analysed. The most widely published surgical technique was hip arthroscopy, which accounted for 62% of the patients. Repair of the labrum was performed more often with the open technique and with the combined techniques than with hip arthroscopy. The mean improvement in the modified Harris Hip Score after surgery was 26.4 for arthroscopy, 20.5 for open dislocation and 12.3 for the combined techniques. A higher rate of return to sporting activity was observed in the professional athletes treated arthroscopically than in those who underwent open surgery. Overall the complication rates were 1.7% for the arthroscopic group, 9.2% for the open surgery group and 16% for the group with the combined techniques.
The authors concluded that all 3 methods led to an improvement in patients' symptoms. Because of the variety of subjective hip questionnaires, it was not possible to make a direct comparison of the results. However, it appears that overall the arthroscopic method has the lowest complication rate and the fastest postoperative recovery.