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Treatment of Severe Pincer-Type Femoroacetabular Impingement With Arthroscopic Significant Acetabular Rim Correction and Circumferential Labral Reconstruction Improves Patient-Reported Outcome Measures. Arthroscopy 2023; 39:41-50. [PMID: 35724802 DOI: 10.1016/j.arthro.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To validate an arthroscopic approach for performing significant acetabular rim correction and circumferential labral reconstruction required to treat severe pincer-type femoroacetabular impingement. METHODS Using a minimum of 2-year follow-up, data from 48 hips, including 47 patients (11 male, 36 female; mean age of 42 years) having undergone significant arthroscopic acetabuloplasty for severe pincer impingement (center edge angle >45°) with concomitant circumferential allograft labral reconstruction were analyzed to determine improvements in patient-reported outcomes and degree of radiographic correction. RESULTS Findings demonstrated a 98% success rate, including substantial improvements on all radiographic measurements and patient-reported outcomes. Minimal clinically important differences were met with extremely strong measures of effect. The mean center edge angle improved from 49° to 36° (MΔ = 13.96, P ≤ .001, standard deviation [SD] = 55.97, confidence interval [CI] 12.17- 15.62, d = 2.33) and the mean Tönnis angle improved from -6° to 0° (MΔ = 6.2, P ≤ .001, SD = 2.76 CI -7.1 to -5.39, d = 2.29). Modified Hip Harris Scores improved by a mean of 34.45 points (P ≤ .001, SD = 20.64, 95% CI 28.45-40.44, d = 1.66). Lower extremity functional scale scores improved by a mean of 27.35 points (P ≤ .001, SD = 18.37, 95% CI 22.02-32.69, d =1.48). No complications were reported. One case converted to a total hip arthroplasty (2%). CONCLUSIONS Findings validated that the significant acetabular rim correction required to treat severe pincer morphology is safe and feasible via an arthroscopic approach. This, in addition to concomitant circumferential allograft labral reconstruction, resulted in improvement in patient-reported outcomes and radiographic measurements. LEVEL OF EVIDENCE Level IV, therapeutic case-series.
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Klosterman EL, Zacharias AJ, Dooley MS, Wilson NM, Turner EH, Goodspeed DC, Spiker AM. Treatment of Coxa Profunda With Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction. Arthrosc Tech 2022; 11:e1499-e1508. [PMID: 36061463 PMCID: PMC9437615 DOI: 10.1016/j.eats.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/31/2022] [Indexed: 02/03/2023] Open
Abstract
Coxa profunda presents a unique challenge in surgical treatment approach given global acetabular overcoverage. Arthroscopic treatment can be fraught with difficulty obtaining hip distraction for safe arthroscopic instrumentation, and limited arthroscopic access may prevent sufficient osseous resection of the excess acetabular rim. Although hip arthroscopy use has increased markedly over the past decades for all types of hip pathology, coxa profunda may represent one unique indication for surgical hip dislocation. This technique describes open surgical hip dislocation, rim resection, femoral osteoplasty, and labral reconstruction using anterior tibialis allograft for coxa profunda with combined-type femoroacetabular impingement syndrome and labral ossification.
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Affiliation(s)
- Emma L. Klosterman
- Address correspondence to Emma L. Klosterman, M.D., Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, 6th Floor, Madison, WI 53705.
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Kriechling P, Leoty L, Fürnstahl P, Rahbani D, Zingg PO, Vlachopoulos L. A Statistical Shape Model-Based Analysis of Periacetabular Osteotomies: Technical Considerations to Achieve the Targeted Correction. J Bone Joint Surg Am 2022; 104:1107-1115. [PMID: 35363641 DOI: 10.2106/jbjs.21.00454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Classic and reverse Bernese periacetabular osteotomy (PAO) have been shown to be effective for the treatment of developmental dysplasia of the hip (by classic PAO), severe acetabular retroversion (by reverse PAO), and some protrusio acetabuli (by reverse PAO). Especially in severe cases with higher degrees of correction, a relevant overlap between the osteotomized fragment and the pelvis might occur, leading to necessary fragment translation. The aim of the present study was to analyze the necessary translation as a function of the degree of correction using a statistical mean model of the pelvis according to the technique (classic PAO or reverse PAO). METHODS A mean statistical shape model of the pelvis and 2 extreme models were used to simulate rotation of the osteotomized fragment during a classic or reverse PAO and to calculate rotations from -20° to 20° in the frontal, sagittal, and transverse planes and a combination thereof. The depth and volume of the intersection between the mobilized fragment and the pelvis were calculated, and the minimum translation of the fragment necessary to avoid segment overlap was determined. RESULTS The maximum intersection distances between the pelvis and the 20° rotated fragment were 6.7 and 15.3 mm for adduction and abduction (frontal plane), 6.4 and 4.5 mm for internal and external rotation (transverse plane), and 27.8 and 9.2 mm for extension and flexion (sagittal plane). The necessary translations for 20° of fragment rotation were 7.0 and 12.8 mm for adduction and abduction (frontal plane), 4.8 and 5.0 mm for internal and external rotation (transverse plane), and 18.5 mm and 8.8 mm for extension and flexion (sagittal plane). CONCLUSIONS Acetabular reorientation with the classic or reverse PAO results in translation of the fragment and in a consequent change in the rotational center. This finding is more pronounced with higher degrees of fragment reorientation in abduction and extension; it becomes especially pronounced in reverse PAO for acetabular retroversion or protrusio acetabuli, and might limit the ability to achieve the intended improvement in overall hip biomechanics.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Laura Leoty
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dana Rahbani
- Graphics and Vision Research Group (GraVis), University of Basel, Basel, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Meek WM, Abraham PF, Kucharik MP, Martin SD. Limitations of Postless Hip Arthroscopy for a Patient with Coxa Profunda: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00037. [PMID: 33657025 PMCID: PMC9071033 DOI: 10.2106/jbjs.cc.20.00347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
CASE A 27-year-old man with coxa profunda and a right acetabular labral tear presented for surgical re-evaluation after a postless arthroscopic labral repair was attempted at an outside institution and aborted because of inadequate distraction during portal placement. Arthroscopic labral repair with a perineal post was subsequently performed without complications. CONCLUSION Indications and limitations of postless hip distraction are seldom discussed in the literature. This report examines possible limitations of postless hip distraction for a patient with coxa profunda. Careful radiographic evaluation of hip anatomy may be essential for patients with deep hip sockets to determine the best-suited distraction technique.
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Affiliation(s)
- Wendy M. Meek
- Massachusetts General Hospital Department of Orthopaedic Surgery, Sports Medicine Center, Boston, Massachusetts
| | - Paul F. Abraham
- Massachusetts General Hospital Department of Orthopaedic Surgery, Sports Medicine Center, Boston, Massachusetts
| | - Michael P. Kucharik
- Massachusetts General Hospital Department of Orthopaedic Surgery, Sports Medicine Center, Boston, Massachusetts
| | - Scott D. Martin
- Massachusetts General Hospital Department of Orthopaedic Surgery, Sports Medicine Center, Boston, Massachusetts
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Disegni E, Martinot P, Dartus J, Migaud H, Putman S, May O, Girard J, Chazard E. Hip arthroscopy in France: An epidemiological study of postoperative care and outcomes involving 3699 patients. Orthop Traumatol Surg Res 2021; 107:102767. [PMID: 33333273 DOI: 10.1016/j.otsr.2020.102767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications. HYPOTHESIS Hip arthroscopy in France produced similar results to those observed in other countries. MATERIALS AND METHODS We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis. RESULTS A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p<0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3%, revision rate was 8.2%, and readmission rate for a postoperative complication was 5%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)]. CONCLUSION Unlike the international literature, our study population was largely male. The rates of revision (8.2% after five years) and conversion to arthroplasty (16.3% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted. LEVEL OF EVIDENCE IV; descriptive epidemiological study.
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Affiliation(s)
- Elio Disegni
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France.
| | - Pierre Martinot
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France
| | - Julien Dartus
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France
| | - Henri Migaud
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France
| | - Sophie Putman
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France
| | - Olivier May
- Clinique Médipôle Garonne, 31036 Toulouse, France
| | - Julien Girard
- University Lille, MABLab-Unité Labellisée de Recherche, ULR4490, 59000 Lille, France; CHU Lille, Service d'Orthopédie, Hôpital Salengro, Place de Verdun, 59000 Lille, France
| | - Emmanuel Chazard
- University Lille, ULR 2694 Metrics, CERIM, 59000 Lille, France; CHU Lille, Pôle de santé publique, 59000 Lille, France
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