Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.27
Peer-review started: March 8, 2019
First decision: April 16, 2019
Revised: May 16, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 18, 2020
Femoroacetabular impingement (FAI) is a predisposing factor for secondary osteoarthritis of the hip joint. The two extensively described impingement mechanisms of FAI are CAM and Pincer-type. Initially managed conservatively, operative intervention should be offered to the persistently symptomatic patient. The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs. The radiological correction of the alpha angle has not been previously compared between different surgical approaches. We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.
To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.
This is a retrospective study assessing seventy-nine patients identified in a 5-year period. These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution, a tertiary care center. Patients with missing radiographic documentation, radiographs with insufficient quality which then precluded accurate measurement of the angle α, a diagnosed congenital condition, isolated type II pathology (Pincer), and history of prior surgery were excluded from the study. Either the Ganz surgical hip dislocation or the anterior mini open approach was used. Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.
A total of 79 patients met the inclusion and exclusion criteria. Forty-seven males (mean age of 35.3, range 16-53) and 32 females (mean age 36.7, range 16-60) were enrolled. Forty-seven patients underwent the anterior mini-open approach, and 32 underwent the Ganz surgical hip dislocation. There were no significant differences in age between the two surgical groups or in pre- and post-operative alpha angles based on patient gender. The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees (SD 12.3) and 99.4 degrees (SD 7.2) for the anterior mini-open group. Mean post-operative angles were 49.9 degrees (SD 4.3) for the Ganz surgical hip dislocation and 43.8 (SD 4.3) degrees for the anterior mini-open group. There was a statistically significant difference in patient’s pre-operative and post-operative angles (P = 0.000) with both surgical approaches.
Statistically significant decreases in alpha angle were noted for both surgical techniques, with larger decreases seen in the anterior mini-open group.
Core tip: It is well understood that femoroacetabular impingement (FAI) is a predisposing factor for secondary osteoarthritis of the hip joint. The two extensively described impingement mechanisms of FAI are CAM and Pincer-type. If conservative management fails, a surgical approach can be chosen. The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs. The radiological correction of the alpha angle, as measured on a lateral view radiograph, has not been previously compared between different surgical approaches. This article compares the magnitude of alpha angle correction achieved by using two different operative techniques: the Ganz surgical hip dislocation and the anterior mini-open approach. Seventy-nine patients were identified in a 5-year period who underwent surgery at our institution. Statistically significant decreases in alpha angle were noted for both surgical techniques, with larger decreases seen in the anterior mini-open group.