One stage total hip arthroplasty and contralateral hip arthroscopy for bilateral femoroacetabular impingement and osteoarthritis: A clinical trial.

Abstract

The management of cam morphology of FAI associated with osteoarthritis (OA) is debated. However, current surgical indications are becoming obsolete, and hip arthroscopy spreads in different settings. The present clinical trial evaluated the outcome of one-stage unilateral hip arthroscopy and contralateral total hip arthroplasty (THA) in patients with bilateral cam deformity associated with labral tears and early and advanced OA stages, respectively. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of complications. All patients who underwent one-stage THA and contralateral hip arthroscopic for symptomatic cam deformity were prospectively invited to participate in the present study. Arthroscopies were performed first with patients in a supine position on a traction bed under fluoroscopic control. Three standard portals were used. The intraarticular joint space was inspected, and the peripheral acetabular labral lesions were selectively debrided. Cam bunectomy was performed, and labral tears were debrided and repaired using bio-resorbable anchors. After arthroscopy, patients were positioned in a lateral position, and THA was performed using a minimally invasive posterolateral approach. All patients received uncemented short stems with ceramic heads and vitamin-E augmented polyethylene (GTS, Zimmer Biomet, United States or 3C, Link, Germany). All 16 patients were men, with a mean age of 41 years ±7.9. The mean length of the follow-up was 4.2 ± 1.3 years (range, 2 to 6). All patients returned to their normal daily activities within one month. PROMs were statistically significantly increased from baseline to the last follow-up in all patients. No patient experienced minor or major complications. One patient required THA five years after arthroscopy for symptomatic and radiographic progression of osteoarthritis. No other patients progressed to THA. No patient underwent revision surgery for failed arthroscopy. One-stage arthroscopy and contralateral arthroplasty are effective in managing FAI combined with early and mild to severe OA, respectively.