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Lin HY, Chiang ER, Wu SL, Wu CL, Chiou HJ, Wu HT. The correlation between hip alpha angle and acetabular labral tear location and size: A cross-sectional study. J Chin Med Assoc 2024; 87:119-125. [PMID: 37962357 DOI: 10.1097/jcma.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Explore the correlation between hip morphology and labral tear location/size. METHODS This retrospective study analyzed patients with hip pain who received magnetic resonance (MR) arthrography at our institution, between January 2017 and December 2020. Imaging analysis includes labral tear location and size, and hip morphology measurement with alpha angle, lateral center-edge (CE) angle, anterior CE angle, and femoral neck version. The correlation between hip morphology angles and labral tear location/size was evaluated using multiple regression, followed by stratification analysis with Chi-square test to investigate interactions between the variables. RESULTS A total of 103 patients (105 hips) with hip pain who received MR arthrography (mean age, 50 years ± 15 [SD]) were included, with mean alpha angle of 57.7° ± 9.9° [SD], mean lateral CE angle of 32.6° ± 6.8° [SD], mean anterior CE angle of 58.2° ± 8.1° [SD], mean femoral neck version of 17.1° ± 8.2° [SD]. Large alpha angle (>57°) and older age were both correlated with superior and posterosuperior labral tear incidence ( p < 0.05) and larger tear size ( p < 0.05). Furthermore, alpha angle is significantly correlated with superior labral tear incidence in young-age subgroup (age <45 years) ( p < 0.05), also significantly correlated with posterosuperior labral tear incidence and larger tear size in middle-age subgroup (45 ≤ age ≤ 60 years) ( p < 0.05). CONCLUSION A large alpha angle (>57°) is significantly correlated with increased incidence of superior and posterosuperior labral tear, and larger tear size in patients with hip pain, and the relationships depend on age.
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Affiliation(s)
- Han-Ying Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - En-Rung Chiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shang-Liang Wu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Ta Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Owens JS, Saks BR, Fox JD, Jimenez AE, Lall AC, Domb BG. The Circumferential Femoroplasty: An All-Arthroscopic Technique for Addressing a Challenging Hip Deformity. Arthrosc Tech 2022; 11:e1737-e1745. [PMID: 36311314 PMCID: PMC9596604 DOI: 10.1016/j.eats.2022.06.009] [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: 04/04/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement is recognized as a common cause of hip pain. Cam-type femoroacetabular impingement results from abnormal contact between an aspherical femoral head and the acetabular rim during hip range of motion, leading to labral tearing, cartilage damage, and, eventually, osteoarthritis. Arthroscopic correction of this bony deformity has been well described, particularly in the anterolateral quadrant of the femoral neck. Some deformities extend well beyond this quadrant, involving most or all of the circumference of the femoral neck, making arthroscopic decompression a challenge. We present a post-less, all-arthroscopic technique for performing a circumferential cam decompression using 3-dimensional preoperative planning software and interactive fluoroscopy-integrated computer vision interface.
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Affiliation(s)
- Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - James D. Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA,Address correspondence to Dr. Benjamin G. Domb, M.D., 999 E Touhy Ave., Suite 450, Des Plaines, IL 60018
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Yuan D, Wu Z, Luo S, Zou Q, Zou Z, Ye C. Impact of Femoral Neck Cortical Bone Defect Induced by Core Decompression on Postoperative Stability: A Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3667891. [PMID: 35647189 PMCID: PMC9142285 DOI: 10.1155/2022/3667891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/24/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the impact of femoral neck cortical bone defect induced by core decompression on postoperative biomechanical stability using the finite element method. Methods Five finite element models (FEMs) were established, including the standard operating model and four models of cortical bone defects at different portions of the femoral neck (anterior, posterior, superior, and inferior). The maximum stress of the proximal femur was evaluated during normal walking and walking downstairs. Results Under both weight-bearing conditions, the maximum stress values of the five models were as follows: femoral neck (inferior) > femoral neck (superior) > femoral neck (posterior) > femoral neck (anterior) > standard operation. Stress concentration occurred in the areas of femoral neck cortical bone defect. Under normal walking, the maximum stress of four bone defect models and its increased percentage comparing the standard operation were as follows: anterior (17.17%), posterior (39.02%), superior (57.48%), and inferior (76.42%). The maximum stress was less than the cortical bone yield strength under normal walking conditions. Under walking downstairs, the maximum stress of four bone defect models and its increased percentage comparing the standard operation under normal walking were as follows: anterior (36.75%), posterior (67.82%), superior (83.31%), and inferior (103.65%). Under walking downstairs conditions, the maximum stress of bone defect models (anterior, posterior, and superior) was less than the yield strength of cortical bone, while the maximum stress of bone defect model (inferior) excessed yield strength value. Conclusions The femoral neck cortical bone defect induced by core decompression can carry out normal walking after surgery. To avoid an increased risk of fracture after surgery, walking downstairs should be avoided when the cortical bone defect is inferior to the femoral neck except for the other three positions (anterior, posterior, and superior).
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Affiliation(s)
- Daizhu Yuan
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
- Sports Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Zhanyu Wu
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Siwei Luo
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Qiang Zou
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Zihao Zou
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Chuan Ye
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
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Alter TD, Knapik DM, Guidetti M, Espinoza A, Chahla J, Nho SJ, Malloy P. Three-Dimensional Quantification of Cam Resection Using MRI Bone Models: A Comparison of 2 Techniques. Orthop J Sports Med 2022; 10:23259671221095417. [PMID: 35547617 PMCID: PMC9083056 DOI: 10.1177/23259671221095417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The current clinical standard for the evaluation of cam deformity in femoroacetabular impingement syndrome is based on radiographic measurements, which limit the ability to quantify the complex 3-dimensional (3D) morphology of the proximal femur. Purpose: To compare magnetic resonance imaging (MRI)–based metrics for the quantification of cam resection as derived using a best-fit sphere alpha angle (BFS-AA) method and using 3D preoperative-postoperative surface model subtraction (PP-SMS). Study Design: Descriptive laboratory study. Methods: Seven cadaveric hemipelvises underwent 1.5-T MRI before and after arthroscopic femoral osteochondroplasty, and 3D bone models of the proximal femur were reconstructed from the MRI scans. The alpha angles were measured radially along clockfaces using a BFS-AA method from the literature and plotted as continuous curves for the pre- and postoperative models. The difference between the areas under the curve for the pre- and postoperative models was then introduced in the current study as the BFS-AA–based metric to quantify the cam resection. The cam resection was also quantified using a 3D PP-SMS method, previously described in the literature using the metrics of surface area (FSA), volume (FV), and height (maximum [FHmax] and mean [FHmean]). Bivariate correlation analyses were performed to compare the metrics quantifying the cam resection as derived from the BFS-AA and PP-SMS methods. Results: The mean ± standard deviation maximum pre- and postoperative alpha angle measurements were 59.73° ± 15.38° and 48.02° ± 13.14°, respectively. The mean for each metric quantifying the cam resection with the PP-SMS method was as follows: FSA, 540.9 ± 150.7 mm2; FV, 1019.2 ± 486.2 mm3; FHmax, 3.6 ± 1.0 mm; and FHmean, 1.8 ± 0.5 mm. Bivariate correlations between the BFS-AA–based and PP-SMS–based metrics were strong: FSA (r = 0.817, P = .012), FV (r = 0.888, P = .004), FHmax (r = 0.786, P = .018), and FHmean (r = 0.679, P = .047). Conclusion: Strong positive correlations were appreciated between the BFS-AA and PP-SMS methods quantifying the cam resection. Clinical Relevance: The utility of the BFS-AA technique is primarily during preoperative planning. The utility of the PP-SMS technique is in the postoperative setting when evaluating the adequacy of resection or in patients with persistent hip pain with suspected residual impingement. In combination, the techniques allow surgeons to develop a planned resection while providing a means to evaluate the depth of resection postoperatively.
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Thomas D. Alter, MS, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA ()
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Espinoza
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Arcadia University, Glenside, Pennsylvania, USA
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Varshneya K, Abrams GD, Sherman SL, Safran MR. Patient-Specific Risk Factors Exist for Hip Fractures After Arthroscopic Femoroacetabular Impingement Surgery, But Not for Dislocation—An Analysis of More Than 25,000 Hip Arthroscopies. Arthrosc Sports Med Rehabil 2022; 4:e519-e525. [PMID: 35494300 PMCID: PMC9042775 DOI: 10.1016/j.asmr.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome. Methods MarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: acetabuloplasty only or femoroplasty only. A subanalysis of combined acetabuloplasty and femoroplasty also was undertaken. Surgical outcomes were followed postoperatively for 180 days. Multivariate logistic regression was used to control for with an alpha value of 0.05 set as significant. Results This study identified 13,809 patients (mean age, 36.3 years) who underwent primary acetabuloplasty or femoroplasty. We also identified 10,026 patients who underwent both procedures. Postoperative complication rates were similar between the cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, P = .0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, P = .0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, P < .0001) were greater in the femoroplasty-only cohort. Combined acetabuloplasty and femoroplasty was associated with the greatest complication burden of 21.6% (P < .0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (P > .05). Patients who were aged younger than 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (odds ratio 0.3, 95% confidence interval 0.1-0.8). Hypertension was independently associated with increased odds of hip fracture (odds ratio 1.7, 95% confidence interval 1.2-3.5). Conclusions Older age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient- and procedure-specific factors that could be assessed with this database did not influence risk for hip dislocation. Level of Evidence Level III; retrospective comparative observation trial.
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Zeman P, Rafi M, Kautzner J. Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. INTERNATIONAL ORTHOPAEDICS 2021; 45:2525-2529. [PMID: 34223924 DOI: 10.1007/s00264-021-05114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. MATERIALS AND METHODS The study cohort consisted of 908 patients mean age of 37 years (14-67 years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36 months. Results were statistically evaluated and risk factors for complications were identified. RESULTS The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). CONCLUSION Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.
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Affiliation(s)
- Petr Zeman
- Orthopaedics and Traumatology Department, University Hospital Pilsen, Pilsen, Czech Republic
| | - Moheb Rafi
- Orthopaedic Department, Kromeriz Hospital, Kromeriz, Czech Republic
| | - Jakub Kautzner
- Department of Childrens and Adults Orthopaedics and Traumatology 2Nd Medical Faculty, Charles University and Motol Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
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Horbach AJ, Staat M, Pérez-Viana D, Simmen HP, Neuhaus V, Pape HC, Prescher A, Ciritsis B. Biomechanical in vitro examination of a standardized low-volume tubular femoroplasty. Clin Biomech (Bristol, Avon) 2020; 80:105104. [PMID: 32712527 DOI: 10.1016/j.clinbiomech.2020.105104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoporosis is associated with the risk of fractures near the hip. Age and comorbidities increase the perioperative risk. Due to the ageing population, fracture of the proximal femur also proves to be a socio-economic problem. Preventive surgical measures have hardly been used so far. METHODS 10 pairs of human femora from fresh cadavers were divided into control and low-volume femoroplasty groups and subjected to a Hayes fall-loading fracture test. The results of the respective localization and classification of the fracture site, the Singh index determined by computed tomography (CT) examination and the parameters in terms of fracture force, work to fracture and stiffness were evaluated statistically and with the finite element method. In addition, a finite element parametric study with different position angles and variants of the tubular geometry of the femoroplasty was performed. FINDINGS Compared to the control group, the work to fracture could be increased by 33.2%. The fracture force increased by 19.9%. The used technique and instrumentation proved to be standardized and reproducible with an average poly(methyl methacrylate) volume of 10.5 ml. The parametric study showed the best results for the selected angle and geometry. INTERPRETATION The cadaver studies demonstrated the biomechanical efficacy of the low-volume tubular femoroplasty. The numerical calculations confirmed the optimal choice of positioning as well as the inner and outer diameter of the tube in this setting. The standardized minimally invasive technique with the instruments developed for it could be used in further comparative studies to confirm the measured biomechanical results.
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Affiliation(s)
- Andreas J Horbach
- FH Aachen University of Applied Sciences, Institute of Bioengineering, Biomechanics Lab., Heinrich-Mußmann-Straße 1, 52428 Jülich, Germany.
| | - Manfred Staat
- FH Aachen University of Applied Sciences, Institute of Bioengineering, Biomechanics Lab., Heinrich-Mußmann-Straße 1, 52428 Jülich, Germany.
| | - Daniel Pérez-Viana
- FH Aachen University of Applied Sciences, Institute of Bioengineering, Biomechanics Lab., Heinrich-Mußmann-Straße 1, 52428 Jülich, Germany.
| | - Hans-Peter Simmen
- Universitätsspital Zürich, Trauma Unit, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Valentin Neuhaus
- Universitätsspital Zürich, Trauma Unit, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Hans-Christoph Pape
- Universitätsspital Zürich, Trauma Unit, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Andreas Prescher
- Institute of Anatomy and Cell Biology, Rheinisch-Westfälische Technische Hochschule Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
| | - Bernhard Ciritsis
- Ente Ospedaliero Cantonale Ospedale di Bellinzona e Valli, Trauma Unit, Via Ospedale 12, 6500 Bellinzona, Switzerland; Centro Ortopedico di Quadrante, Lungolago Buozzi 25, 28887 Omegna (VB), Italy.
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Bonano JC, Johannsen A, Mardones RM, Fithian A, Storaci H, Tam K, Safran MR. The Effect of Resection Size in the Treatment of Cam-Type Femoroacetabular Impingement in the Typical Patient With Hip Arthroscopy: A Biomechanical Analysis. Am J Sports Med 2020; 48:2897-2902. [PMID: 32881582 DOI: 10.1177/0363546520952774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic osteochondroplasty may improve range of motion and relieve pain in patients with symptomatic hip impingement. Femoral neck fracture is a risk of this procedure because of the weakening of the proximal femur. To our knowledge, there are no biomechanical studies in young human cadaveric bone evaluating the effect of osteochondroplasty on femoral neck strength. PURPOSE/HYPOTHESIS The purpose was to evaluate loads to fracture in young human cadavers after resection depths of 25% and 40% at the head-neck junction. We hypothesized that both depths will maintain ultimate loads to failure above previously published loads, as well as above physiologic weightbearing loads. STUDY DESIGN Descriptive laboratory study. METHODS Cadaveric proximal femoral specimens (6 matched pairs, under the age of 47 years) were divided into 2 groups: 25% or 40% of the diameter at the head-neck junction was resected. The length of the resection was 2 cm and the width of the resection was determined by the length of the anterolateral quadrant at the head-neck junction in all cases. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared between groups. RESULTS The average peak load to fracture after 25% resection (7347 N) was significantly higher than after the 40% resection (5892 N) (P = .010). The average energy to fracture was also significantly higher in the 25% resection group (30.2 J vs 19.2 J; P = .007). The average stiffness was higher in the 25% group, although not statistically significant (P = .737). CONCLUSION Resection depths of 25% and 40% at the anterolateral quadrant of the femoral head-neck junction may be safe at previously described functional loads such as standing and walking in the age range more typically seen in patients undergoing hip arthroscopy. Loads to fracture were significantly higher than previously reported using older cadaveric specimens. CLINICAL RELEVANCE Currently, most surgeons limit weightbearing after femoral osteochondroplasty in part because of risk of femoral neck fracture. Given the higher observed loads to fracture, young patients could possibly bear weight sooner after surgery, although postoperative protocols should be individualized based on patient age, weight, bone density, amount of bone resected, concomitant procedures, and potential compliance with activity restrictions.
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Affiliation(s)
- John C Bonano
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Adam Johannsen
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Rodrigo M Mardones
- Department of Orthopaedic Surgery, Hospital Militar de Santiago, Santiago, Chile.,Department of Orthopaedic Surgery, Clínica Las Condes, Santiago, Chile
| | - Andrew Fithian
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Hunter Storaci
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Kaysie Tam
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Computer assistance in hip preservation surgery-current status and introduction of our system. INTERNATIONAL ORTHOPAEDICS 2020; 45:897-905. [PMID: 32914216 DOI: 10.1007/s00264-020-04788-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Preservation surgery of the hip with open or arthroscopic approach has always been challenging as complex 3-D anatomy and limited surgical access make intraoperative evaluation difficult. Recent advances in computer technology offer a wide range of innovative solutions with a goal to improve accuracy and safety of corrective procedures on human joints. METHOD The author critically reviews currently available literature in the field of computer assistance in hip preservation surgery. Basic features of unique planning software and navigation surgical system used in treatment of femoroacetabular impingement and hip dysplasia are introduced. RESULTS Currently available software provides preoperative identification of hip deformity on CT-based 3-D model and planning of the surgical correction using kinematic protocols. Real-time intraoperative 3-D orientation is possible, and execution of surgical correction can be performed either with navigation of surgical tools or with printed templates. Computer assistance in hip preservation surgery is in the developing phase. First clinical experiences of its use in treatment of femoroacetabular impingement, hip dysplasia, hip tumors, and avascular necrosis of the femoral head are promising. CONCLUSION Computer assistance has been applied for treatment of several hip disorders. Technical advances are suggested and quality basic studies and clinical trials are encouraged for the novel technology to become more user friendly and widely accepted.
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Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique. Arthrosc Tech 2020; 9:e303-e313. [PMID: 32226736 PMCID: PMC7093702 DOI: 10.1016/j.eats.2019.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/23/2019] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement describes a pathologic interaction between the bony femoral head/neck junction and acetabulum. Cam-type femoroacetabular impingement results from an aspherical femoral head architecture, which increases early contact along the acetabular surface during hip range of motion. Errant arthroscopic femoroplasty recently has been discussed within the literature to describe a preventable etiology of failed hip arthroscopy, most notably cam over- and under-resection. We present an arthroscopic surgical technique for achieving the perfectly spherical femoroplasty, meant to minimize complications and improve postoperative outcomes.
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McCrum CL, Ben-David B, Shin JJ, Wright VJ. Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy. J Hip Preserv Surg 2018; 5:233-239. [PMID: 30393550 PMCID: PMC6206687 DOI: 10.1093/jhps/hny024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/18/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022] Open
Abstract
The purpose of our study was to evaluate the effect on immediate patient outcomes following hip arthroscopy with use of a preoperative, single shot quadratus lumborum (QL) block. We retrospectively reviewed patients who underwent hip arthroscopy following a preoperative QL block. These patients were matched by age and gender to patients who had not received a block. Visual analogue scale (VAS) pain scores immediately postoperatively and at the time of discharge were recorded. Hourly and overall opioid intake in the postanesthesia care unit (PACU) was also recorded. Continuous data was analysed with paired t-test, with significance being defined as P < 0.05. Complications in the immediate postoperative period were recorded, as was time from admission to PACU to discharge. Fifty-six patients were included. Twenty-eight patients underwent QL block and 28 did not undergo a block. QL block patients required significantly less hydromorphone (P = 0.010) and oxycodone (P = 0.001) during their time in the PACU, and significantly fewer morphine equivalents overall and per hour in the PACU (P < 0.001). Despite receiving less opioid analgesia, QL block patients had significantly less pain immediately postoperatively (P = 0.026) and at the time of discharge (P = 0.015). The mean time to PACU discharge was 155 ± 49 min, and there was no difference in time to discharge between groups (P = 0.295). One patient in the QL block group experienced persistent flank numbness. Hip arthroscopy patients who received a preoperative QL block had less pain and a lower opioid requirement in PACU than those who did not receive a block. Level of Evidence: Level III (Retrospective matched cohort study).
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Affiliation(s)
- Christopher L McCrum
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bruce Ben-David
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jason J Shin
- Department of Orthopaedics and Sports Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Vonda J Wright
- Northside Hospital Sports Medicine Network, Atlanta, GA, USA
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Mechanical Strength of the Proximal Femur After Arthroscopic Osteochondroplasty for Femoroacetabular Impingement: Finite Element Analysis and 3-Dimensional Image Analysis. Arthroscopy 2018; 34:2377-2386. [PMID: 29937343 DOI: 10.1016/j.arthro.2018.03.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the influence of femoral neck resection on the mechanical strength of the proximal femur in actual surgery. METHODS Eighteen subjects who received arthroscopic cam resection for cam-type femoroacetabular impingement (FAI) were included. Finite element analyses (FEAs) were performed to calculate changes in simulative fracture load between pre- and postoperative femur models. The finite element femur models were constructed from computed tomographic images; thus, the models represented the shape of the original femur, including the bone resection site. Three-dimensional image analysis of the bone resection site was performed to identify morphometric factors that affect strength in the postoperative femur model. Four oblique sagittal planes running perpendicular to the femoral neck axis were used as reference planes to measure the bone resection site. RESULTS At the transcervical reference plane, both the bone resection depth and the cross-sectional area at the resection site correlated strongly with postoperative changes in the simulated fracture load (R2 = 0.6, P = .0001). However, only resection depth was significantly correlated with the simulated fracture load at the reference plane for the head-neck junction. The resected bone volume did not correlate with the postoperative changes in the simulated fracture load. CONCLUSIONS The results of our FEA suggest that the bone resection depth measured at the head-neck junction and transcervical reference plane correlates with fracture risk after osteochondroplasty. By contrast, bone resection at more proximal areas did not have a significant effect on the postoperative femur model strength in our FEA. The total volume of resected bone was also not significantly correlated with postoperative changes in femur model strength. CLINICAL RELEVANCE This biomechanical study using FEA suggest that there is a risk of femoral neck fracture after arthroscopic cam resection, particularly when the resected lesion is located distally.
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Mansor Y, Perets I, Close MR, Mu BH, Domb BG. In Search of the Spherical Femoroplasty: Cam Overresection Leads to Inferior Functional Scores Before and After Revision Hip Arthroscopic Surgery. Am J Sports Med 2018; 46:2061-2071. [PMID: 29924630 DOI: 10.1177/0363546518779064] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroplasty performed for the treatment of cam-type femoroacetabular impingement (FAI) has become a common procedure. Underresection may result in residual FAI. Conversely, overresection may disrupt the labral seal, which is responsible for chondroprotective fluid dynamics of the hip. Hypothesis/Purpose: It was hypothesized that cam overresection negatively affects hip function. The purpose was to examine the effect of the accuracy of previous femoroplasty on hips presenting for revision hip arthroscopic surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected for patients presenting for revision hip arthroscopic surgery between June 2010 and August 2014. On the basis of measurements on Dunn view radiographs, cases were divided into 3 groups: overresection (OR group) in which overresection measured over 5% of the diameter of the femoral head, underresection (UR group) in which there was a residual cam lesion (alpha angle >60°), and neutral resection (neutral group). Data collection included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale, and visual analog scale at presentation and at a minimum 2-year follow-up after revision hip arthroscopic surgery and rates of conversion to total hip arthroplasty (THA). RESULTS One hundred thirty hips (120 patients) were included. Twenty hips (15.4%) were classified as the OR group, 16 (12.3%) as the UR group, and 94 (72.3%) as the neutral group. The mean follow-up was 39.6 ± 15.9 months. The mHHS and NAHS values at presentation were lower in the OR group compared with the UR group (50.2 ± 15.5 vs 64.7 ± 19.4 [ P = .033] and 48.5 ± 18.6 vs 63.0 ± 19.1 [ P = .044], respectively). The mHHS value at a minimum 2-year follow-up after revision was lower for the OR group (66.7 ± 19.8) than for the UR group (81.0 ± 14.5) ( P = .031). Conversion to THA was more common in the OR group than in the UR group (30% vs 0%, respectively; P = .024). Fifty percent of cases in the OR group, 69.9% in the neutral group, and 75% in the UR group met the minimal clinically important difference for the mHHS (Δ). The latest mHHS value reached the patient acceptable symptomatic state (PASS) in 35% of the cases in the OR group, 53.2% in the neutral group, and 75% in the UR group. Hips in the OR group had a significantly lower chance of reaching the PASS than the UR group (odds ratio, 0.1795 [95% CI, 0.0418-0.7711]; P = .0209). CONCLUSION Cam overresection of more than 5% of the diameter of the femoral head on the Dunn view predicts inferior clinical outcomes compared with cam underresection in this population. Furthermore, overresection predicts inferior outcomes after revision hip arthroscopic surgery and higher rates of conversion to THA.
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Affiliation(s)
- Yosif Mansor
- American Hip Institute, Westmont, Illinois, USA.,Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Itay Perets
- American Hip Institute, Westmont, Illinois, USA.,Hadassah Medical Center, Jerusalem, Israel
| | | | - Brian H Mu
- American Hip Institute, Westmont, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, USA.,Hinsdale Orthopaedics, Hinsdale, Illinois, USA
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Schmaranzer F, Arendt L, Lerch TD, Steppacher SD, Nuss K, Wolfer N, Dawson HE, von Rechenberg B, Kircher PR, Tannast M. Femoral osteochondroplasty can be performed effectively without the risk of avascular necrosis or femoral neck fractures in an experimental ovine FAI model. Osteoarthritis Cartilage 2018; 26:128-137. [PMID: 29061495 DOI: 10.1016/j.joca.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The experimental induction of cam-type femoroacetabular impingement (FAI) in sheep is established. To tap the full potential of this ovine model, one should be able to perform a femoral osteochondroplasty safely. This study was based on previous cadaver experiments on the blood supply to the ovine femoral head and on the biomechanical strength of the proximal femur following offset creation. We hypothesized that offset creation in this ovine FAI model does not lead to (1) avascular necrosis (AVN) of the ovine femoral head or (2) iatrogenic femoral neck fractures and (3) can be performed effectively. DESIGN In this experimental, controlled, prospective study nine sheep underwent unilateral FAI induction through an intertrochanteric, varus osteotomy. Seventy days following FAI induction, femoral osteochondroplasty was performed. Sheep were sacrificed after another 140 days. Radiographs, computed tomography (CT) scans and MRI were acquired. Histologic samples were stained with hematoxylin-eosin. (1) The multimodal Association Research Circulation Osseous (ARCO) classification was used for assessment of AVN. (2) Femoral neck fractures were assessed with the multimodal imaging approach. (3) Pre- and postoperative (=after sacrifice) alpha angles and femoral neck diameters were compared. RESULTS (1) No signs for AVN according to the ARCO classification or (2) for femoral neck fractures were detected. (3) Mean alpha angles and femoral neck diameters decreased significantly (p < 0.001) superiorly by at least 30° respectively 4 mm after the offset creation. CONCLUSIONS Femoral osteochondroplasty can be performed effectively and without the risk of AVN or femoral neck fractures in this ovine FAI model.
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Affiliation(s)
- F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - L Arendt
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - T D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - K Nuss
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - N Wolfer
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - H E Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - B von Rechenberg
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - P R Kircher
- Department of Small Animals, Division of Diagnostic Imaging, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
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Zimmerer A, Sobau C, Ries C, Miehlke W. Femoral neck fracture is a rare complication after arthroscopic femoroplasty for femoroacetabular impingement with no known prognostic factors and few reported risk factors: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Marin-Peña O, Tey-Pons M, Perez-Carro L, Said HG, Sierra P, Dantas P, Villar RN. The current situation in hip arthroscopy. EFORT Open Rev 2017; 2:58-65. [PMID: 28507776 PMCID: PMC5420826 DOI: 10.1302/2058-5241.2.150041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hip arthroscopy is an evolving surgical technique that has recently increased in popularity. Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy. Good clinical results in the medium term will allow improvements in this technique and increase its indications.
Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041
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Affiliation(s)
- Oliver Marin-Peña
- Orthopedic Surgery and Traumatology, University Hospital Infanta Leonor, Madrid, Spain
| | | | | | | | - Pablo Sierra
- Madrid. University Hospital Torrejon, Madrid, Spain
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Santana Artiles ME, Venetsanos DT. A new evolutionary optimization method for osteoporotic bone augmentation. Comput Methods Biomech Biomed Engin 2017; 20:691-700. [DOI: 10.1080/10255842.2017.1291805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rath E, Sharfman ZT, Paret M, Amar E, Drexler M, Bonin N. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines. J Hip Preserv Surg 2017. [PMID: 28630722 PMCID: PMC5467404 DOI: 10.1093/jhps/hnw045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3–8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.
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Affiliation(s)
- Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Matan Paret
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Nicolas Bonin
- Lyon Ortho Clinic, Clinique de la sauvegarde, 25 B avenue des sources, Lyon 69009, France
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Horner NS, Vikas K, MacDonald AE, Naendrup JH, Simunovic N, Ayeni OR. Femoral neck fractures as a complication of hip arthroscopy: a systematic review. J Hip Preserv Surg 2017. [PMID: 28630716 PMCID: PMC5467412 DOI: 10.1093/jhps/hnw048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to identify the causes and risk factors for hip fractures, a rare but devastating complication, following hip arthroscopy. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant clinical and basic sciences studies and pertinent data was abstracted and analysed in Microsoft Excel. Nineteen studies (12 clinical studies and seven biomechanical studies) with a total of 31 392 patients experiencing 43 hip fractures (0.1% of patients) met the inclusion criteria for this systematic review. Femoral osteochondroplasty was performed in 100% of patients who sustained a hip fracture. Six of the 12 (50%) studies identified early weight bearing (prior to 6 weeks post-operatively) as the cause for the hip fracture. Other causes of this complication included over resection during femoral osteochondroplasty, minor trauma and intensive exercise. The results suggest that early weight bearing is the largest modifiable risk factor for hip fracture after femoral osteochondroplasty. For this reason, an extended period of non-weight bearing or restricted weight bearing should be considered in select patients. Studies report a correlation between risk for post-operative hip fracture and increased age. Increased resection during osteochondroplasty has been correlated with increased risk of fracture in various basic science studies. Resection depth has significantly higher impact on risk of fracture than resection length or width. The reported amounts of resection that depth that can be performed before there is a significantly increased risk of fracture of the femoral neck varies from 10 to 30%.
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Affiliation(s)
- Nolan S Horner
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 4E15, Hamilton, ON L8S 4K1, Canada
| | - Khanduja Vikas
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Austin E MacDonald
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 4E15, Hamilton, ON L8S 4K1, Canada
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Nicole Simunovic
- Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E15, ON L8N 3Z5, Canada
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Crim J. Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement. Skeletal Radiol 2017; 46:1315-1326. [PMID: 28466104 PMCID: PMC5559574 DOI: 10.1007/s00256-017-2665-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
Arthroscopic surgery for femoroacetabular impingement (FAI) is increasingly frequently performed. Initial reports were that complications were very low, but as experience has increased, a number of long-term complications, in addition to factors related to poor clinical outcomes, have been identified. This review describes the normal and abnormal postoperative imaging appearance of the hip after arthroscopy for FAI. Abnormalities discussed include incomplete resection or over-resection of the impingement lesion, heterotopic ossification, cartilage damage, chondrolysis, instability and dislocation, recurrent labral tear, adhesions, psoas atrophy, infection, and avascular necrosis.
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Affiliation(s)
- Julia Crim
- University of Missouri at Columbia, Columbia, MO USA
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22
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CORR Insights ®: Head-Neck Osteoplasty has Minor Effect on the Strength of an Ovine Cam-FAI Model: In Vitro and Finite Element Analyses. Clin Orthop Relat Res 2016; 474:2641-2644. [PMID: 27590643 PMCID: PMC5085947 DOI: 10.1007/s11999-016-5067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/29/2016] [Indexed: 01/31/2023]
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23
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Larson CM, Clohisy JC, Beaulé PE, Kelly BT, Giveans MR, Stone RM, Samuelson KM. Intraoperative and Early Postoperative Complications After Hip Arthroscopic Surgery: A Prospective Multicenter Trial Utilizing a Validated Grading Scheme. Am J Sports Med 2016; 44:2292-8. [PMID: 27311412 DOI: 10.1177/0363546516650885] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited literature looking at comprehensive complication rates after arthroscopic hip procedures. PURPOSE To prospectively report complication rates for a consecutive series of hips undergoing arthroscopic procedures. STUDY DESIGN Case series; Level of evidence, 4. METHODS Over a 29-month period, 1615 consecutive hips in patients with a mean age of 30.5 years underwent arthroscopic hip procedures at 4 institutions. The diagnosis, demographic information, and procedures were recorded, and a validated grading classification for complications of hip joint surgery was utilized prospectively. The cohort with complications was observed postoperatively for a mean of 36.7 months (range, 24-54 months). RESULTS There were 1487 primary hip arthroscopic procedures and 128 revision hip arthroscopic procedures. Arthroscopic femoroacetabular impingement correction was performed in 1505 hips (93.2%), and 1273 hips (78.8%) underwent a labral repair procedure. The most common event was postoperative lateral femoral cutaneous (LFC) nerve disturbance (16.5%), which persisted beyond 6 months in only 1.6%. The incidence of iatrogenic chondral injuries was 1.2%, iatrogenic labral punctures was 0.9%, superficial portal infections was 1.1%, sensory deficits about the foot was 0.8%, deep venous thrombosis was 0.1%, pulmonary embolism was 0.1%, perineal numbness (pudendal nerve) was 1.4%, heterotopic ossification was 0.8%, and femoral neck stress fractures was 0.1%. There was no iatrogenic instability, avascular necrosis, or extra-abdominal fluid extravasation identified in this cohort. The overall complication rate, not including temporary LFC periportal and thigh numbness (sequela), was 8.3% (134 hips). Overall, a grade 1 complication was seen in 7.2% (117 hips), grade 2 in 0.6% (10 hips), grade 3 in 0.4% (6 hips), and grade 4 in 0.1% (1 hip). There was a significantly higher rate of complications for longer surgical time and traction time (P < .01) and for female patients as compared with male patients (P = .017). Most notably, traction time longer than 60 minutes was associated with a significantly increased complication rate (P < .001). Hips with pudendal nerve neurapraxia had longer traction times than those without (61.5 vs 43.8 minutes, respectively; P < .001). No differences were found between primary versus revision cases (P = .123) or between labral repair versus debridement (P = .209), and body mass index had no effect on the complication rate (P = .103). CONCLUSION The overall complication rate after hip arthroscopic surgery at tertiary hip centers was 8.3%, with higher rates reported for longer traction times (>60 minutes) and for female patients. Compared with surgical hip dislocation using the same classification system, the overall rate of complications was similar, but the rate of higher grade complications was lower for arthroscopic hip procedures.
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Affiliation(s)
- Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Bryan T Kelly
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
| | - M Russell Giveans
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Rebecca M Stone
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Kathryn M Samuelson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
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