Computer Navigation-Assisted Osteochondroplasty May Improve Accuracy of Resection Planning With Limited Outcome Differences Compared With Freehand Hip Arthroscopic Technique in Patients With Femoroacetabular Impingement Syndrome

PURPOSE: To evaluate the achievement of the preoperative plan and clinical outcomes in patients with cam- or combined-type femoroacetabular impingement syndrome undergoing computer navigation-assisted arthroscopic osteochondroplasty compared with freehand techniques. METHODS: This retrospective study included patients treated between 2020 and 2024 who met the following criteria: (1) primary hip arthroscopic surgery for cam- or combined-type femoroacetabular impingement syndrome, (2) availability of pre- and postoperative computed tomography imaging, and (3) minimum 12-month follow-up. Patients were divided into a navigation-assisted group and a freehand group. In the navigation group, a computed tomography-based system was used, enabling real-time tracking of the abrader burr during resection. Achievement of the preoperative plan was assessed by comparing postoperative 3-dimensional range of motion simulations to preoperative targets at 90°, 70°, and 45° of hip flexion. Clinical outcomes included the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). RESULTS: Fifty-five hips were included (25 in the navigation-assisted group and 30 in the freehand group). Mean follow-up was 14.7 ± 4.4 months (range, 12-25 months) in the navigation group and 31.3 ± 11.2 months (range, 12-58 months) in the freehand group. The navigation group had greater achievement rates of the preoperative range of motion plan at 90° (92.0% vs 46.7%, P < .001) and 70° (80.0% vs 50.0%, P = .027). At 1 year, NAHS was greater in the navigation group (88.6 ± 9.2 vs 79.8 ± 18.9, P = .037), with more patients achieving the minimal clinically important difference (76.0% vs 46.7%, P = .032). There were no significant differences in mHHS, revision arthroscopy, or conversion to total hip arthroplasty. CONCLUSIONS: Computer navigation-assisted osteochondroplasty may improve the accuracy of cam resection and contribute to better short-term outcomes such as the NAHS at 1 year. However, clinical benefits over freehand technique were limited in other measures such as mHHS, revision, or conversion rates. LEVEL OF EVIDENCE: Level Ⅲ, retrospective comparative study.