Outcomes after arthroscopic surgery for femoroacetabular impingement with global pincer: a systematic review

The purpose of this systematic review was to evaluate the clinical and radiological outcomes, and complications for arthroscopic management of global pincer-type femoroacetabular impingement (FAI). Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 21, 2017 by two independent reviewers. The inclusion criteria were English language studies that investigated arthroscopic management of global pincer-type FAI, and reported clinical and radiographic outcomes. The Methodologic quality of the studies was assessed using the MINORS (Methodological Index for Non-Randomized Studies) tool. The results are presented in a narrative summary. The search identified 3,176 studies, of which 5 studies (101 patients; mean age, 35.0 years) were included for assessment. We found 1 case report, 2 case series, and 2 retrospective comparative studies, each having level of evidence of IV, IV, and III, respectively. The most commonly reported outcomes were the Modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS), which showed mean improvements in pre-operative scores from 53.9 to 80.7, and 50.5 to 79.1, respectively. In studies reporting radiographic correction of lateral center-edge angle (LCEA), the mean improvement from pre- to post-surgery was 48.9° to 37.9°, respectively. There was a 9.3% conversion rate to total hip arthroplasty (THA) at a mean time of 13.1 months post-operatively (mean age of 40.9 years). In conclusion, short-term data suggests that patients with global pincer-type FAI managed with arthroscopic surgery may expect significant improvement in pain and function. Rapid conversion to THA was seen in a notable proportion of patients. While the degree of clinical improvement appears to be of lower magnitude compared to patients with focal overcoverage, this type of osseous deformity is still correctable with arthroscopic treatment by the experienced surgeon.