Remplissage of the Femoral Head-Neck Junction in Revision Hip Arthroscopy: A Technique to Correct Excessive Cam Resection

Femoroacetabular impingement (FAI) is an increasingly recognized cause of hip pain. This pathology often involves abnormal femoral neck shape (cam-type FAI), acetabular over coverage (pincer-type FAI), or mixed pathology. Surgical treatment of this entity includes labral repair and femoral head-neck osteochondroplasty. A mindful arthroscopic technique is of paramount importance, because maintaining the integrity of the labrum and a corresponding neck volume has been reported to be vital in maintaining the hip suction seal. Arthroscopic resection of the cam deformity must be performed with care to ensure appropriate femoral offset and maintenance of appropriate femoroacetabular contact. Although the most common cause of failure after hip arthroscopy is incomplete resection of a cam lesion, a previously unrecognized complication is excessive cam resection that can also lead to excessive femoral offset and loss of the suction seal. The purpose of this technical note is to describe the technique for arthroscopic recognition of excessive cam decompression leading to loss of the suction seal and a surgical treatment approach using the "remplissage" technique.