The Clinical Outcome of a Fluoroscopy‐Free “4‐Step Cam Resection” Technique Compared With the Traditional Technique for Arthroscopic Treatment of Cam‐Type Femoroacetabular Impingement

PURPOSE: To compare the clinical outcomes of the novel fluoroscopy-free "4-step cam resection" technique with the traditional cam resection method for treating cam-type FAI during hip arthroscopy. No established consensus exists on a standardized, reproducible technique that ensures complete cam resection without intraoperative fluoroscopy, and residual anterolateral cam deformity remains a leading cause of persistent impingement and revision surgery. The present study was therefore performed to determine whether the 4-step technique improves the completeness of cam resection compared with the conventional single-position technique. METHODS: Patients with symptomatic femoroacetabular impingement (FAI) who underwent the "4-step cam resection" technique between January 2021 and January 2022 were included. The 4-step intervention consisted of femoral head-neck osteoplasty performed sequentially with the hip placed in four positions: (i) 10° of flexion in maximal internal rotation; (ii) 10° of flexion in neutral rotation; (iii) 30° of flexion with rotation from internal to external; and (iv) 45° of flexion with rotation from internal to external. In the traditional technique, the cam lesion was resected with the hip in a single position of approximately 45° of flexion. No intraoperative fluoroscopy was used in either group. A historical control group extracted from our database was matched in a 1:1 ratio based on demographic and preoperative clinical variables. Outcomes were assessed using the Harris Hip Score (HHS), Hip Outcome Score (HOS), and Visual Analog Scale (VAS) for pain. Radiographic measurements, including the lateral center-edge angle (LCEA) and alpha angle and gamma angle, were evaluated pre- and postoperatively. RESULTS: A total of 36 patients (36/40, 90.0%) in the study group (Group A, "4-step cam resection" technique) completed the final follow-up and 36 patients were matched as the control group (Group B, traditional technique). At a mean follow-up of 29 months, both groups demonstrated significant improvements in HOS, HHS, and VAS scores postoperatively (p < 0.05). Radiographic parameters including alpha angle, gamma angle, and LCEA were significantly reduced compared to preoperative values, with Group A showing significantly lower gamma angles and VAS for pain and a higher HOS-Sports score compared to Group B. The correlation analysis revealed that VAS (correlation coefficient = 0.281, p = 0.017) was correlated with gamma angle at the final follow-up. CONCLUSION: The "4-step cam resection" technique achieves comparable subjective outcomes compared with the traditional technique and is associated with a greater decrease of gamma angle, lower VAS score, and better HOS-Sports outcome.