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Hip arthroscopy enables classification and treatment of precollapse subchondral insufficiency fracture of the femoral head associated intra-articular pathology. Knee Surg Sports Traumatol Arthrosc 2018; 26:2527-2535. [PMID: 28942460 PMCID: PMC6061709 DOI: 10.1007/s00167-017-4722-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/14/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purposes of this study were to investigate (1) the clinical, radiographic and arthroscopic presentation of patients with subchondral insufficiency fracture of the femoral head (SIFFH) and (2) the outcomes following arthroscopic treatment with internal fixation using hydroxyapatite poly-lactate acid (HA/PLLA) threaded pins and concomitant arthroscopic treatment of associated findings. METHODS Nine patients (median age 49.0 years, range 43-65, five female and four male patients) with SIFFH who underwent arthroscopic treatment with labral repair, capsular closure and internal fixation of SIFFH using HA/PLLA pins were retrospectively reviewed. Inclusion criteria were adult patients with precollapse SIFFH with minimum 1-year follow-up (median follow-up 30.0 months, range 12-56). RESULTS Acetabular labral tears were observed in all patients. The median BMI was 24.3 kg/m2 (range 20.1-31.8). Clinical presentations and radiographic measurements demonstrated mixed type FAI in six patients, borderline developmental dysplasia in two patients and pincer type FAI in one patient. The median MHHS significantly improved from preoperatively (67.1, range 36.3-78.0) to post-operatively (96.8, range 82.5-100; p = 0.001). The median NAHS significantly improved from preoperatively (34.0, range 17-63) to post-operatively (78.0 range 61-80; p = 0.001). CONCLUSION SIFFH is associated with bony deformities and labral tears. Precollapse SIFFH can be treated with bioabsorbable pin stabilization of unstable lesions and treatment of associated intra-capsular pathology in those with stable lesions as determined by a new arthroscopic classification system with promising early outcomes. LEVEL OF EVIDENCE IV.
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Joukainen A, Virén T, Penttilä P, Liukkonen J, Puhakka PH, Kröger H, Töyräs J. Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans. Arthrosc Tech 2017; 6:e1063-e1068. [PMID: 28970993 PMCID: PMC5621660 DOI: 10.1016/j.eats.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
An ultrasound arthroscopy (UA) technique is a promising tool for the evaluation of the articular cartilage during arthroscopic examination. However, the applicability of UA for the evaluation of the hip joint is unknown. We describe a UA assessment of a patient with osteochondritis dissecans at the femoral head. An ultrasound catheter designed for intravascular imaging was inserted into the hip joint by use of conventional arthroscopic portals, and the cartilage surfaces of the femoral head and acetabulum were investigated with ultrasound. UA provided essential quantitative information on the integrity of the articular cartilage and the condition of the subchondral plate not assessable with conventional arthroscopy. Furthermore, the UA technique provided the possibility to monitor arthroscopy-assisted retrograde drilling and bone transplantation in the hip joint.
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Affiliation(s)
- Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland,Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Address correspondence to Tuomas Virén, Ph.D., Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland.Department of Applied PhysicsUniversity of Eastern FinlandPOB 1627FI-70211 KuopioFinland
| | - Pekko Penttilä
- Department of Children and Adolescents, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Liukkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pia Henriikka Puhakka
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland,Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Uchida S, Utsunomiya H, Honda E, Kanezaki S, Nakamura E, Pascual-Garrido C, Sakai A. Arthroscopic osteochondral autologous transplantation for the treatment of osteochondritis dissecans of the femoral head. SICOT J 2017; 3:18. [PMID: 29792398 PMCID: PMC5966838 DOI: 10.1051/sicotj/2016044] [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] [Received: 10/19/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
Osteochondritis dissecans (OCD) of the femoral head is an unusual cause of hip pain. It can be associated with other intra-articular pathologies including: acetabular labral tears or bone deformities such as Legg-Calve-Perthes Disease (LCPD). In this article, we propose a modern surgical technique using an arthroscopic antegrade and retrograde osteochondral autologous transplantation (OAT) procedure for assessing and treating OCD lesions of the femoral head.
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Affiliation(s)
- Soshi Uchida
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hajime Utsunomiya
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Eisaburo Honda
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shiho Kanezaki
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Eiichiro Nakamura
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Cecilia Pascual-Garrido
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Akinori Sakai
- Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Xu M, Stattin EL, Shaw G, Heinegård D, Sullivan G, Wilmut I, Colman A, Önnerfjord P, Khabut A, Aspberg A, Dockery P, Hardingham T, Murphy M, Barry F. Chondrocytes Derived From Mesenchymal Stromal Cells and Induced Pluripotent Cells of Patients With Familial Osteochondritis Dissecans Exhibit an Endoplasmic Reticulum Stress Response and Defective Matrix Assembly. Stem Cells Transl Med 2016; 5:1171-81. [PMID: 27388238 DOI: 10.5966/sctm.2015-0384] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED : Familial osteochondritis dissecans (FOCD) is an inherited skeletal defect characterized by the development of large cartilage lesions in multiple joints, short stature, and early onset of severe osteoarthritis. It is associated with a heterozygous mutation in the ACAN gene, resulting in a Val-Met replacement in the C-type lectin domain of aggrecan. To understand the cellular pathogenesis of this condition, we studied the chondrogenic differentiation of patient bone marrow mesenchymal stromal cells (BM-MSCs). We also looked at cartilage derived from induced pluripotent stem cells (iPSCs) generated from patient fibroblasts. Our results revealed several characteristics of the differentiated chondrocytes that help to explain the disease phenotype and susceptibility to cartilage injury. First, patient chondrogenic pellets had poor structural integrity but were rich in glycosaminoglycan. Second, it was evident that large amounts of aggrecan accumulated within the endoplasmic reticulum of chondrocytes differentiated from both BM-MSCs and iPSCs. In turn, there was a marked absence of aggrecan in the extracellular matrix. Third, it was evident that matrix synthesis and assembly were globally dysregulated. These results highlight some of the abnormal aspects of chondrogenesis in these patient cells and help to explain the underlying cellular pathology. The results suggest that FOCD is a chondrocyte aggrecanosis with associated matrix dysregulation. The work provides a new in vitro model of osteoarthritis and cartilage degeneration based on the use of iPSCs and highlights how insights into disease phenotype and pathogenesis can be uncovered by studying differentiation of patient stem cells. SIGNIFICANCE The isolation and study of patient stem cells and the development of methods for the generation of iPSCs have opened up exciting opportunities in understanding causes and exploring new treatments for major diseases. This technology was used to unravel the cellular phenotype in a severe form of inherited osteoarthritis, termed familial osteochondritis dissecans. The phenotypic abnormalities that give rise to cartilage lesions in these patients were able to be described via the generation of chondrocytes from bone marrow-derived mesenchymal stromal cells and iPSCs, illustrating the extraordinary value of these approaches in disease modeling.
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Affiliation(s)
- Maojia Xu
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
| | - Eva-Lena Stattin
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Georgina Shaw
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
| | - Dick Heinegård
- Department of Clinical Sciences, Rheumatology, and Molecular Skeletal Biology, Lund University, Lund, Sweden
| | | | - Ian Wilmut
- Medical Research Council Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan Colman
- A*STAR Institute of Medical Biology, Singapore
| | - Patrik Önnerfjord
- Department of Clinical Sciences, Rheumatology, and Molecular Skeletal Biology, Lund University, Lund, Sweden
| | - Areej Khabut
- Department of Clinical Sciences, Rheumatology, and Molecular Skeletal Biology, Lund University, Lund, Sweden
| | - Anders Aspberg
- Department of Clinical Sciences, Rheumatology, and Molecular Skeletal Biology, Lund University, Lund, Sweden
| | - Peter Dockery
- Anatomy, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Timothy Hardingham
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences University of Manchester, Manchester, United Kingdom
| | - Mary Murphy
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
| | - Frank Barry
- Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland
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Abstract
Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.
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de Sa D, Stephens K, Parmar D, Simunovic N, Philippon MJ, Karlsson J, Ayeni OR. A Comparison of Supine and Lateral Decubitus Positions for Hip Arthroscopy: A Systematic Review of Outcomes and Complications. Arthroscopy 2016; 32:716-25.e8. [PMID: 26947742 DOI: 10.1016/j.arthro.2015.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one approach over the other. METHODS Three databases (Embase, PubMed, and Medline) were searched for studies that addressed hip arthroscopy performed in either position, and were subsequently screened by two reviewers with data abstracted in duplicate. RESULTS Similar outcomes were observed. Supine studies showed a greater mean postoperative improvement for modified Harris hip score (33.74), visual analog scale (-3.99), nonarthritic hip score (29.61), Harris hip score (35.73), and hip outcome score (31.4). Lateral decubitus studies showed greater improvement using the Western Ontario and McMaster University Osteoarthritis (14.76) score. Supine studies reported more neuropraxic injuries (2.06% v 0.47%), labral penetration (0.65% v 0%), and heterotopic ossification (0.21% v 0%). Lateral decubitus studies reported more fluid extravasation (0.21% v 0.05%) and missed loose bodies (0.08% v 0.01%). Similar rates of revision (1.8% lateral, 1.4% supine) and conversion to open procedures (2.6% in lateral, 2.0% in supine) were also identified. CONCLUSIONS Because of quality of evidence, direct comparisons are currently limited; however, the supine position is associated with more neuropraxic injuries, labral penetration, and heterotopic ossification, whereas lateral decubitus has increased risk of fluid extravasation and missed loose bodies. At this time, no evidence exists to establish superiority of one position. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Kellee Stephens
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Parmar
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
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Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head. Arthrosc Tech 2015; 4:e675-80. [PMID: 26870645 PMCID: PMC4738504 DOI: 10.1016/j.eats.2015.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time. Case series and outcomes after this technique are not currently reported in the literature; however, it could be a less invasive method and provide favorable clinical outcomes for patients with OCD lesions of the femoral head.
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de Amorim Cabrita HAB, de Castro Trindade CA, de Campos Gurgel HM, Leal RD, de Souza Marques RDF. Hip arthroscopy. Rev Bras Ortop 2015; 50:245-53. [PMID: 26229924 PMCID: PMC4519569 DOI: 10.1016/j.rboe.2014.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 12/27/2022] Open
Abstract
Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.
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Affiliation(s)
| | | | - Henrique Melo de Campos Gurgel
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil ; Instituto Vita, São Paulo, SP, Brazil
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Durur-Subasi I, Durur-Karakaya A, Yildirim OS. Osteochondral Lesions of Major Joints. Eurasian J Med 2015; 47:138-44. [PMID: 26180500 DOI: 10.5152/eurasianjmed.2015.50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/17/2014] [Indexed: 11/22/2022] Open
Abstract
This paper provides information about osteochondral lesions (OCL) and example cases of OCL occurring in major joints, some of which are rarely seen. This simple tutorial is presented in question and answer format.
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Affiliation(s)
- Irmak Durur-Subasi
- Department of Radiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Afak Durur-Karakaya
- Clinic of Radiology, Regional Research and Training Hospital, Erzurum, Turkey
| | - Omer Selim Yildirim
- Department of Orthopedics and Traumatology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Matsuda DK, Villamor A. The modified mid-anterior portal for hip arthroscopy. Arthrosc Tech 2014; 3:e469-74. [PMID: 25276606 PMCID: PMC4175545 DOI: 10.1016/j.eats.2014.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/08/2014] [Indexed: 02/03/2023] Open
Abstract
The modified mid-anterior portal is a utilitarian hip arthroscopy working portal that permits dual-portal comprehensive surgery for femoroacetabular impingement and related chondrolabral procedures without the need for interportal exchange. Its distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. The relatively lateral location permits instrument navigation not only along the anterosuperior acetabular rim and anterolateral proximal femur typically required for acetabuloplasty and femoroplasty but even to the posterior regions of the hip in cases of global pincer femoroacetabular impingement and posterior extensions of cam morphology and the anteromedial proximal femur while avoiding direct injury to the lateral femoral cutaneous nerve.
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Affiliation(s)
- Dean K. Matsuda
- Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A.,Address correspondence to Dean K. Matsuda, M.D., Kaiser West Los Angeles Medical Center, 6041 Cadillac Ave, Los Angeles, CA 90034, U.S.A.
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Glick JM, Valone F, Safran MR. Hip arthroscopy: from the beginning to the future--an innovator's perspective. Knee Surg Sports Traumatol Arthrosc 2014; 22:714-21. [PMID: 24482213 DOI: 10.1007/s00167-014-2859-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
Hip arthroscopy is one of the fastest-growing areas of orthopaedic surgery. There are many reasons for this, including a better understanding of the pathophysiology of damage to the hip joint, improvements in imaging and technology advancements in arthroscopic instrumentation. This manuscript documents the historical development of hip arthroscopy, in general, as well as advances and ideas that have led to common techniques with regard to portal placement, traction and instrumentation. These advances have led to expanding indications for hip arthroscopy. This manuscript ends with some thoughts about the future of hip arthroscopy from the perspective of one of the leaders who helped shape hip arthroscopy, as it is performed today.
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Affiliation(s)
- James M Glick
- Department of Orthopaedic Surgery, University of California, San Francisco, 2705 Ralston Ave., Hillsborough, San Francisco, CA, 94010, USA,
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