Hip Arthroscopic Management for Patients With Subchondral Stress Fractures of the Femoral Head: A Case-Control Study.

Abstract

Background: A subchondral stress fracture of the femoral head (SSFFH) is managed with nonoperative treatment. There is a lack of knowledge regarding whether hip arthroscopic management is effective for active patients with SSFFHs.

Purpose: To elucidate whether arthroscopic management of SSFFHs enables active patients to return to sports activity.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 22 patients undergoing hip arthroscopic management (labral repair/reconstruction and fragment fixation with hydroxyapatite and poly-L-lactic acid [HA/PLLA]-threaded pins) were enrolled and divided into 2 groups. The active group was defined as patients who participated in any kind of sports, regardless of the level of competition. The inactive group was defined as patients who did not participate in sports or any activity. Patient-reported outcome measure (PROM) scores, including the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively and at 6 months, 12 months, and the final follow-up (mean, 70.0 ± 36.6 months [range, 24-144 months]) after surgery. The authors performed chi-square and Mann-Whitney U tests to compare the PROM scores between the 2 groups.

Results: There were 10 patients in the active group and 12 patients in the inactive group in the final analysis. Overall, 14 SSFFHs underwent internal fixation with HA/PLLA-threaded pins. The PROM scores significantly improved from preoperatively to the final follow-up. The active group had significantly better PROM scores than the inactive group at 6 months (mHHS: 96.6 ± 5.0 vs 85.3 ± 13.6, respectively [P = .033]; NAHS: 74.3 ± 6.4 vs 57.0 ± 15.6, respectively [P = .008]) and 1 year (mHHS: 98.8 ± 1.8 vs 92.7 ± 8.6, respectively [P = .040]; NAHS: 78.0 ± 2.1 vs 65.9 ± 11.7, respectively [P = .007]). Additionally, 9 of 10 patients in the active group returned to their sports activity.

Conclusion: The study showed that arthroscopic management (femoroacetabular impingement correction, labral preservation, and stabilization with HA/PLLA-threaded pins) provided favorable clinical outcomes and a high rate of return to sports activity in active patients with SSFFHs. Active patients with SSFFHs had better postoperative results than inactive patients.