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Hatem MA, Helal A, Khoury AN, Martin HD. Anteroinferior Hip Instability in Flexion During Dynamic Arthroscopic Examination Is Associated With Abnormal Anterior Acetabular Horn. Orthop J Sports Med 2020; 8:2325967120965564. [PMID: 33415172 PMCID: PMC7750772 DOI: 10.1177/2325967120965564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The stabilization of the femoral head is provided by the distal acetabulum
when the hip is in a flexed position. However, the osseous parameters for
the diagnosis of hip instability in flexion are not defined. Purpose/Hypothesis: To determine whether the osseous parameters of the distal acetabulum are
different in hips demonstrating anteroinferior subluxation in flexion under
dynamic arthroscopic examination, compared with individuals without hip
symptoms. The hypothesis was that the morphometric parameters of the
anterior acetabular horn are distinct in hips with anteroinferior
instability compared with asymptomatic hips. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 30 hips with anteroinferior instability in flexion under dynamic
arthroscopic examination were identified. A control group of 60 hips (30
patients), matched by age and sex, was formed from individuals who had
undergone pelvis magnetic resonance imaging (MRI) for nonorthopaedic
reasons. Unstable and control hips were compared according to the following
parameters assessed on axial MRI scans of the pelvis: anterior sector angle
(ASA), anterior horn angle (AHA), posterior sector angle (PSA), posterior
horn angle (PHA), acetabular version, lateral center-edge angle, acetabular
inclination (Tönnis angle), and femoral head diameter. Results: The coverage of the femoral head by the anterior acetabular horn was
decreased in unstable hips compared with the control group (mean ASA, 54.8°
vs 61°, respectively; P < .001). Unstable hips also had
a steeper anterior acetabular horn, with an increased mean AHA compared with
controls (52.5° vs 46.8°, respectively; P < .001). An
ASA <58° had a sensitivity of 0.8, a specificity of 0.68, a negative
predictive value of 0.87, and a positive predictive value of 0.56 for
anteroinferior hip instability. An AHA >50° had a sensitivity of 0.77, a
specificity of 0.72, a negative predictive value of 0.86, and a positive
predictive value of 0.57 for anteroinferior hip instability. There was no
statistically significant difference in the mean PSA, PHA, acetabular
version, lateral center-edge angle, acetabular inclination, or femoral head
diameter between unstable hips and controls. Conclusion: Abnormal morphology of the anterior acetabular horn is associated with
anteroinferior instability in hip flexion. The ASA and AHA can aid in the
diagnosis of hip instability.
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Affiliation(s)
- Munif A Hatem
- Hip Preservation Center at Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Asadullah Helal
- Hip Preservation Center at Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Anthony N Khoury
- Hip Preservation Center at Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Hal David Martin
- Hip Preservation Center at Baylor University Medical Center at Dallas, Dallas, Texas, USA
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Westermann RW, Day MA, Duchman KR, Glass NA, Lynch TS, Rosneck JT. Trends in Hip Arthroscopic Labral Repair: An American Board of Orthopaedic Surgery Database Study. Arthroscopy 2019; 35:1413-1419. [PMID: 30979629 DOI: 10.1016/j.arthro.2018.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the trends in labral repair in American Board of Orthopaedic Surgery Part II candidates performing hip arthroscopy. METHODS Candidates who performed arthroscopic hip surgery between 2011 and 2015 during their American Board of Orthopaedic Surgery Part II board collection period were identified using Current Procedural Terminology codes (29860, 29861, 29862, 29863, 29914, 29915, 29916). The proportion of hip arthroscopy cases including labral repair (Current Procedural Terminology code 29916) were calculated for each year and analyzed by fellowship training experience. Trends in labral repair utilization were calculated using univariate and regression analyses, with significance set at P < .05. RESULTS During the study period, 1,606 hip labral repair cases were performed, with a 35% increase in utilization between 2011 and 2015. Overall, labral repair was performed in 64.8% (1,606/2,480) of hip arthroscopy cases, with a significant increase between 2011 and 2015 (47.4% vs 79.2%; P < .001). Of the hip arthroscopy cases including labral repair, 80.4% (1,291/1,606) were performed by candidates with sports medicine fellowship training. The proportion of hip arthroscopy cases including labral repair was highest for surgeons with sports medicine fellowship training compared with those without sports medicine fellowship training (66.1% vs 59.8%; P = .007). Candidates with sports medicine training performing at least 1 labral repair each year increased from 68% to 89% over the study period (P = .0007). The average number of labral repairs per candidate increased significantly over the duration of the study period (P = .0072). CONCLUSIONS Labral repair utilization during hip arthroscopy procedures nearly doubled from 2011 to 2015 for American Board of Orthopaedic Surgery Part II candidates, reflecting a significant change in practice. Current data suggest that nearly 80% of hip arthroscopy procedures include labral repair. These trends may reflect the current practice patterns at academic institutions with sports medicine fellowships.
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Affiliation(s)
- Robert W Westermann
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, IA, U.S.A
| | - Molly A Day
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, IA, U.S.A..
| | - Kyle R Duchman
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, IA, U.S.A
| | - Natalie A Glass
- University of Iowa Hospitals and Clinics, Department of Orthopedics and Rehabilitation, Iowa City, IA, U.S.A
| | - T Sean Lynch
- Columbia University Medical Center, Department of Orthopedic Surgery, New York, NY, U.S.A
| | - James T Rosneck
- Cleveland Clinic, Department of Orthopedic Surgery, Garfield Heights, OH, U.S.A
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Kalhor M, Gharanizadeh K, Rego P, Leunig M, Ganz R. Valgus Slipped Capital Femoral Epiphysis: Pathophysiology of Motion and Results of Intracapsular Realignment. J Orthop Trauma 2018; 32 Suppl 1:S5-S11. [PMID: 29373445 DOI: 10.1097/bot.0000000000001085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques. DESIGN Case series. SETTING Multiple academic centers. PATIENTS Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE). INTERVENTION Intracapsular realignment osteotomy combined with periacetabular osteotomy if needed. MAIN OUTCOME MEASUREMENT The clinical and radiographical results and pathophysiology of motion. RESULTS Eight hips in 6 patients were treated with subcapital (5 hips) or femoral neck (3 hips) osteotomy for realignment. The medially prominent metaphysis created an inclusive impingement at the anterior acetabular wall, whereas the high coxa valga favored impacting impingement at the posterior head-neck junction. The mean preoperative epiphyseal-shaft angle of 110.5 (range 90-125 degrees) was reduced to 62 degrees (range 55-70 degrees) postoperatively. At the last follow-up, all but 1 hip were pain-free and impingement-free, with normal range of motion. One hip was replaced after repeated attempts of correction. The overall hip functional result using modified Merle d'Aubigne scoring system was excellent in 5 hips (18-16 points), good in 2 hips (16-15 points), and poor in 1 hip (6 points). CONCLUSIONS Impingement in valgus SCFE deformity is specific and complex. Anatomical realignment can lead to favorable results by the restoration of normal morphology and impingement-free range of motion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Morteza Kalhor
- Department of Orthopaedic Surgery, Firoozgar Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Gharanizadeh
- Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Reinhold Ganz
- Faculty of Medicine, University of Bern, Bern, Switzerland
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Abstract
Femoroacetabular impingement (FAI) describes the repetitive painful contact between the acetabulum, the pelvis and the proximal femur. This bony abutment can lead to a characteristic pattern of chondrolabral damage and is one of the main etiological factors in the development of juvenile osteoarthritis of the hip joint. This article describes the current treatment concepts of FAI and the radiological assessment including an overview of standard measurement methods, coxometric parameters and cut-off values. Furthermore, the authors stress the importance of a profound understanding of the entire configuration of the pelvis and the dynamic interplay of its components.
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5
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Oduwole KO, de Sa D, Kay J, Findakli F, Duong A, Simunovic N, Yi-Meng Y, Ayeni OR. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017; 6:472-480. [PMID: 28790036 PMCID: PMC5579313 DOI: 10.1302/2046-3758.68.bjr-2017-0018.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/04/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies. Results Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively. Conclusion In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety. Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1.
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Affiliation(s)
- K O Oduwole
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - D de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J Kay
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - F Findakli
- Centre for Evidence Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - A Duong
- Centre for Evidence Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - N Simunovic
- Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Y Yi-Meng
- Division of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - O R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Hatem MA, da Cunha LAM, Abdo JCM, Martin HD. Parameters for assessment of the inferior acetabulum morphology in 300 adult hips. J Hip Preserv Surg 2017. [PMID: 28630728 PMCID: PMC5467419 DOI: 10.1093/jhps/hnw040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The inferior acetabulum (IA) has been studied as a stabilizer of the hip in flexed positions with potential implications in femoroacetabular impingement and hip instability. However, there is a paucity of studies considering the normal morphology and parameters for assessment of the IA. The purpose of this study was to define parameters to assess the IA morphology and their normal range. Specifically, the objectives were to assess: (i) the width of the anterior horn (AH) and posterior horn (PH) of the acetabulum; (ii) the inclination of the articular surface of the AH angle (AHA) and PH angle (PHA) in the axial plane; (iii) the anterior opening angle of the IA and differences between genders. One hundred and fifty adult skeletons were utilized in this study. Measurements were taken directly from acetabula in 300 innominate bones utilizing digital calipers. In sequence, the innominate bones were assembled to sacrum and 150 pelvises were digitally photographed in standardized positions. Angular parameters of the acetabulum were then measured utilizing the Adobe Photoshop software. The mean width of the AH was 14.80 ± 2.35 mm (range 9.44–20.88). The mean width of the PH was 19.72 ± 2.61 mm (range 13.16–25.86). The AHA was on average 43.58 ± 7.10° (range 24.70–64) and the PHA was on average 36.07 ± 7.54° (16.10–53.20). The mean anterior opening angle of the IA was 25.33 ± 5.40° (10.90–43.10). The IA morphology can be evaluated in all anatomical planes through quantitative parameters. The assessment of the osseous morphology of the IA is the first step to elucidate abnormalities of the IA as potential source of hip pain.
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Affiliation(s)
- Munif A Hatem
- Hip Preservation Center at Baylor Scott &White Health, Dallas, TX 75246, USA.,Department of Orthopaedic Surgery, Universidade Federal do Paraná and Hospital Pequeno Príncipe, Curitiba, PR 80.060-900, Brazil
| | - Luiz A M da Cunha
- Department of Orthopaedic Surgery, Universidade Federal do Paraná and Hospital Pequeno Príncipe, Curitiba, PR 80.060-900, Brazil
| | - João C M Abdo
- Department of Orthopaedic Surgery, Universidade Federal do Paraná and Hospital Pequeno Príncipe, Curitiba, PR 80.060-900, Brazil
| | - Hal David Martin
- Hip Preservation Center at Baylor Scott &White Health, Dallas, TX 75246, USA
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Bretschneider H, Stiehler M, Hartmann A, Boger E, Osswald C, Mollenhauer J, Gaissmaier C, Günther KP. Characterization of primary chondrocytes harvested from hips with femoroacetabular impingement. Osteoarthritis Cartilage 2016; 24:1622-8. [PMID: 27084349 DOI: 10.1016/j.joca.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acetabular chondral lesions are common in patients with femoroacetabular impingement (FAI) syndrome. The aim of this study was (1) to evaluate the proliferation potential of primary human chondrocytes (hC) derived from both acetabular and femoral site and (2) to validate cellular differentiation during three-dimensional (3D) cultivation as a prerequisite for autologous matrix-assisted cartilage regeneration of the hip joint. METHODS hC were isolated from cartilage samples obtained from N = 6 patients during offset reconstruction. Proteoglycan content was assessed by Safranin-O staining. Proliferation and cell viability were quantified by microscopic cell counting and Trypan Blue exclusion. Messenger ribonucleic acid (mRNA) expression levels of collagen type 1 and 2, aggrecan (ACAN), and interleukin-1β (IL-1β) genes were assessed upon monolayer cultivation, after 48 h/4-10°C - transport simulation and after 14 days of 3D hydrogel cultivation. RESULTS Primary hC from acetabular and femoral damaged sites were viable. No significant intergroup differences were observed concerning cell viability (>95%) after monolayer cultivation and transport simulation. Harvest yields from acetabular and femoral cartilage samples were comparable to that known from knee joints (mean ± standard deviation (SD), 13.4 × 10(6) ± 5 × 10(6) cells per culture vs 20 × 10(6) cells). Redifferentiation was induced during 3D hydrogel cultivation as observed by increased levels of collagen II (1000-fold) and ACAN (10-fold) gene vs monolayer cultivation (P < 0.001). CONCLUSION hC derived from damaged acetabular and femoral site are qualified for autologous matrix-assisted cartilage transplantation paving the way for cell-based cartilage regeneration in FAI patients.
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Affiliation(s)
- H Bretschneider
- University Centre for Orthopaedics & Trauma Surgery and Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at Technische Universität Dresden, Germany
| | - M Stiehler
- University Centre for Orthopaedics & Trauma Surgery and Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at Technische Universität Dresden, Germany.
| | - A Hartmann
- University Centre for Orthopaedics & Trauma Surgery and Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at Technische Universität Dresden, Germany
| | - E Boger
- TETEC Tissue Engineering Technologies AG, Reutlingen, Germany
| | - C Osswald
- TETEC Tissue Engineering Technologies AG, Reutlingen, Germany
| | - J Mollenhauer
- TETEC Tissue Engineering Technologies AG, Reutlingen, Germany
| | - C Gaissmaier
- TETEC Tissue Engineering Technologies AG, Reutlingen, Germany
| | - K-P Günther
- University Centre for Orthopaedics & Trauma Surgery and Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at Technische Universität Dresden, Germany
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Ganz R, Aprato A, Mazziotta G, Pignatti G. Joint Instability After Anatomic Reconstruction of Severe, Chronic Slipped Capital Femoral Epiphysis: A Report of 3 Cases, with High Femoral Anteversion in 1 and Adaptive Acetabular Roof Deformation in 3. JBJS Case Connect 2016; 6:e50. [PMID: 29252682 DOI: 10.2106/jbjs.cc.15.00149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASES Joint instability after slipped capital femoral epiphysis (SCFE) reorientation through the physis has been attributed to a combination of capsulotomy and chondrolabral rim damage. We report on 3 hips with severe SCFE with closed physes, in which anatomic correction with femoral neck osteotomy led to joint instability. All 3 had acetabular roof flattening; 1 showed slight additional acetabular retroversion but also increased femoral anteversion. CONCLUSION We speculate that the slight roof flattening in all 3 cases and/or the high femoral anteversion in 1 case had contributed to joint instability. Femoral derotation osteotomy was performed in 1 and periacetabular osteotomy was performed in 2 for joint restabilization.
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MacDonald AE, Bedi A, Horner NS, de Sa D, Simunovic N, Philippon MJ, Ayeni OR. Indications and Outcomes for Microfracture as an Adjunct to Hip Arthroscopy for Treatment of Chondral Defects in Patients With Femoroacetabular Impingement: A Systematic Review. Arthroscopy 2016; 32:190-200.e2. [PMID: 26385287 DOI: 10.1016/j.arthro.2015.06.041] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/12/2015] [Accepted: 06/25/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the indications, preoperative workup outcomes, and postoperative rehabilitation of patients with femoroacetabular impingement (FAI) receiving microfracture as an adjunct to hip arthroscopy for chondral defects. METHODS The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving patients with FAI treated arthroscopically with microfracture of the hip for chondral defects either solely or as an adjunct to hip arthroscopy. Data regarding indications, investigations, outcomes, and postoperative rehabilitation were abstracted from eligible studies. The references of included studies were additionally searched, and descriptive statistics are provided. RESULTS There were 12 studies included in this review, involving 267 patients. With the exception of a single, one-patient case report, 11 of the 12 studies reported positive outcomes after hip arthroscopy with microfracture. Only 0.7% of the total patients experienced a complication, and 1.1% required further surgery on the basis of outcomes evaluated at a mean follow-up of 29.5 (range, 4 to 60) months across the studies. Eight of 12 studies discussed the preoperative workup of these patients, with X-rays and magnetic resonance imaging being the most common preoperative imaging used. There was little reported on weight-bearing status during postoperative rehabilitation. CONCLUSIONS The outcomes reported in the literature after hip arthroscopy with microfracture for chondral defects are, in general, positive, with a very low percentage of patients requiring further surgery or experiencing complications. The most common indication used in the literature for microfracture is a full-thickness, focal chondral defect (Outerbridge grade IV). The vast majority of literature recommends limited weight bearing after microfracture; however, there was significant variation among the specific rehabilitation protocols used. More research is needed to explore what indications and postoperative rehabilitation result in the best outcomes for patients. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Austin E MacDonald
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Asheesh Bedi
- Department of Surgery, Division of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Nolan S Horner
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, Centre for Evidence-Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Abstract
In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known 'impingement' syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms.
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11
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Kamath AF, Ganz R, Zhang H, Grappiolo G, Leunig M. Subtrochanteric osteotomy for femoral mal-torsion through a surgical dislocation approach. J Hip Preserv Surg 2015; 2:65-79. [PMID: 27011816 PMCID: PMC4718471 DOI: 10.1093/jhps/hnv011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/27/2014] [Accepted: 12/11/2014] [Indexed: 01/15/2023] Open
Abstract
Missed torsional femur deformities may contribute to reasons for failure after open and more likely arthroscopic hip preservation surgery. A number of surgical approaches have been described for addressing torsion abnormalities. This report describes a subtrochanteric osteotomy technique in a consecutive series of patients with complex hip pathologies, for which intertrochanteric osteotomy is not suitable and precise derotation is required. Subtrochanteric derotation was performed, always in combination with a surgical hip dislocation, in accordance with the authors’ preferred technique. Before osteotomy, a localized decortication was executed. Application of a 4.5-mm broad or narrow plate was undertaken with dynamic compression of the osteotomy. Twenty-eight consecutive subtrochanteric derotational osteotomies were performed in 26 patients. Twenty-one females and five males were treated at an average age of 21.4 years (range, 12–43). Underlying diagnoses included dysplasia, arthrogryposis, cerebral palsy, Down’s syndrome, instability and impingement. The decision to perform derotation was for antetorsion over 20° or less than 0° (retrotorsion). Patients were followed clinically and radiographically till final follow-up. All patients went on to successful osteotomy union. There were two initial failures: one delayed union prompting revision fixation in a chronic smoker and one plate failure due to self-accelerated weight-bearing in a patient status post successful contralateral derotational osteotomy. Rotational deformity of the femur must be considered in the patient undergoing hip preservation surgery. This technique of subtrochanteric derotational osteotomy, with adjunctive surgical hip dislocation, is applicable and reproducible in the setting of complex hip pathologies. Level of evidence: IV, case series.
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Affiliation(s)
- Atul F Kamath
- 1. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hong Zhang
- 3. Department of Orthopaedic Surgery, The 1st Affiliated Hospital of PLA General Hospital of CPLA, Beijing, China
| | - Guido Grappiolo
- 4. Santa Corona Hospital, Livio Sciutto Onlus Foundation for Orthopedic Biomedical Research, Via XXV Aprile, 38 17027, Pietra Ligure SV, Italy
| | - Michael Leunig
- 5. Department of Orthopaedic Surgery, Schulthess Klinik, Zürich, Switzerland
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12
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Surgical treatment of femoroacetabular impingement: what are the limits of hip arthroscopy? Arthroscopy 2014; 30:99-110. [PMID: 24384276 DOI: 10.1016/j.arthro.2013.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 02/02/2023]
Abstract
The variety of hip pathology that can be addressed in a minimally invasive fashion in the young, pre-arthritic patient has rapidly grown in parallel with technical advances in hip arthroscopy. However, the indications and limits of arthroscopy must be carefully defined and indications must evolve correspondingly to avoid an increase in failure rates and unsatisfactory clinical outcomes. Some diagnoses may be better and more comprehensively addressed with open procedures or combined surgical approaches. The purpose of this article is to provide an unbiased and evidence-based review of conditions of the pre-arthritic hip to define our current understanding of the advantages, disadvantages, and limitations of an arthroscopic approach.
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13
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Abstract
The use of joint-preserving surgery of the hip has been largely abandoned since the introduction of total hip replacement. However, with the modification of such techniques as pelvic osteotomy, and the introduction of intracapsular procedures such as surgical hip dislocation and arthroscopy, previously unexpected options for the surgical treatment of sequelae of childhood conditions, including developmental dysplasia of the hip, slipped upper femoral epiphysis and Perthes’ disease, have become available. Moreover, femoroacetabular impingement has been identified as a significant aetiological factor in the development of osteoarthritis in many hips previously considered to suffer from primary osteoarthritis. As mechanical causes of degenerative joint disease are now recognised earlier in the disease process, these techniques may be used to decelerate or even prevent progression to osteoarthritis. We review the recent development of these concepts and the associated surgical techniques. Cite this article: Bone Joint J 2014;96-B:5–18.
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Affiliation(s)
- M. Leunig
- Schulthess Clinic, Department
of Orthopaedics, Lengghalde 2, 8008
Zürich, Switzerland
| | - R. Ganz
- University of Berne, Faculty
of Medicine, Berne, Switzerland
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Leunig M, Ganz R. Symposium: 2012 International Hip Society Proceedings. Clin Orthop Relat Res 2013; 471:3760-1. [PMID: 24081668 PMCID: PMC3825908 DOI: 10.1007/s11999-013-3310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Michael Leunig
- />Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, CH-8008 Zürich, Switzerland
| | - Reinhold Ganz
- />Department of Orthopaedic Surgery, University of Berne, Berne, Switzerland
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