AOSSM/AANA Specialty Day 2020-Mid-Term Outcomes with FAIS_ What Have We Learned Over the Past Decade

Mid-Term Outcomes with FAIS_ What Have We Learned Over the Past Decade

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This presentation by J.W. Thomas Byrd, MD, reviews mid-term outcomes of femoroacetabular impingement syndrome (FAIS) treatments over the past decade, highlighting evolution in surgical approaches and understanding.<br /><br />Initially, simple debridement procedures yielded reasonable outcomes, especially in young patients without arthritis. However, evolving patient profiles showing early joint degeneration revealed that debridement merely delays disease progression rather than halting it. Historically, labral repair was rare due to uncertain healing and primitive techniques.<br /><br />Now, labral repair is routinely favored due to excellent healing capacity, improved surgical techniques, and streamlined rehabilitation. Multiple studies, despite methodological flaws, show better outcomes with repair over debridement. Addressing cam lesions aggressively while preserving labrum integrity is crucial. Even in challenging scenarios like borderline dysplasia and older patients, labral repair is often pursued; poor results in the elderly relate mostly to arthritis, not age itself.<br /><br />Femoral version abnormalities significantly influence outcomes: excessive version risks instability, whereas reduced version can exacerbate cam lesion effects and cause labral failure. Subspine impingement is recognized but remains a debated factor; it can be evaluated via special imaging and treated with capsule-sparing approaches.<br /><br />Capsular management has evolved from neglect to more tailored strategies. Capsule closure is indicated in cases prone to instability, extreme laxity, high-motion activities, or after large cam decompression but is not universally required. Some evidence suggests better outcomes with closure.<br /><br />Lastly, the concept that precautionary femoroplasty protects labral repairs is challenged; since the femoral head’s normal sphericity cannot be enhanced, decompression at the head-neck junction may not safeguard the repair.<br /><br />In summary, improved understanding of hip morphology, labral healing, and individualized surgical techniques have refined FAIS management. Repair-focused treatment, attention to femoral version, and selective capsular closure have emerged as key lessons to optimize mid-term patient outcomes.

Keywords

Femoroacetabular Impingement Syndrome

FAIS treatment outcomes

Labral repair

Debridement vs repair

Cam lesion management

Femoral version abnormalities

Subspine impingement

Capsular management

Hip morphology

Femoroplasty