1
|
Lazaro LE, Dyke JP, Cady A, Banffy MB. Femoral Head Vascularity After Arthroscopic Femoral Osteochondroplasty: An In Vivo Dynamic Contrast-Enhanced MRI Study. Orthop J Sports Med 2022; 10:23259671221139355. [PMID: 36582928 PMCID: PMC9793043 DOI: 10.1177/23259671221139355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background A serious concern with surgical procedures around the hip joint is iatrogenic injury of the arterial supply to the femoral head (FH) and consequent development of FH osteonecrosis. Cam-type morphology can extend to the posterosuperior area. Understanding the limit of the posterior superior extension of the femoral osteochondroplasty is paramount to avoid underresection and residual impingement while maintaining FH vascularity. Purpose/Hypothesis The aim of this study was to quantify the impact of arthroscopic femoral osteochondroplasty on the FH vascular supply. It was hypothesized that keeping the superior extension of the resection zone anterior to the 12-o'clock position would maintain FH vascularity. Study Design Case series; Level of evidence, 4. Methods Ten adult patients undergoing arthroscopic femoroacetabular impingement (FAI) surgery were included in the study. Computed tomography (CT) scans were obtained before and after arthroscopic osteochondroplasty to define the extension of resection margins. To quantify FH vascularity, postoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was obtained at 2 time points: immediately after surgery and at the 3-month follow-up. Custom MRI analysis software was used to quantify perfusion. Results CT scan analysis demonstrated that the superior resection margin was maintained anterior to the 12-o'clock position in half of the patients. The remining 5 patients had a mean posterior extension of 11.4° ± 7.5°. The immediate postoperative DCE-MRI revealed diminished venous outflow in the operative side but no difference in overall FH perfusion. At the 3-month follow-up DCE-MRI, there was no perfusion difference between the operative and nonoperative FHs. Conclusion This study provides previously unreported quantitative MRI data on in vivo perfusion of the FH after the commonly performed arthroscopic femoral osteochondroplasty for the treatment of cam-type FAI. Maintaining resection margins anterior to the 12-o'clock position, or even 10° posteriorly, was not observed to impair perfusion to the FH.
Collapse
Affiliation(s)
- Lionel E. Lazaro
- Doctors’ Center Hospital, San Juan and Dorado, Puerto Rico.,Lionel E. Lazaro, MD, Doctors’ Center Hospital, San Juan and
Dorado, 00909, Puerto Rico (
)
| | - Jonathan P. Dyke
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New
York, New York, USA
| | - Adam Cady
- Cedar-Sinai Kerlan-Jobe Institute, Los Angeles, California,
USA
| | | |
Collapse
|
2
|
Wininger AE, Barter LE, Boutris N, Pulido LF, Ellis TJ, Nho SJ, Harris JD. Hip arthroscopy for lateral cam morphology: how important are the vessels? J Hip Preserv Surg 2020; 7:183-194. [PMID: 33163203 PMCID: PMC7605776 DOI: 10.1093/jhps/hnaa027] [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: 04/03/2020] [Revised: 05/17/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this narrative review is to identify the anatomy and relevant blood supply to the femoral head as it pertains to hip arthroscopy and lateral cam morphology. The primary blood supply to the femoral head is the lateral ascending superior retinacular vessels, which are terminal branches of the medial femoral circumflex artery. These vessels penetrate the femoral head at the posterolateral head–neck junction. Surgeons performing posterolateral femoral osteoplasty must respect this vasculature to avoid iatrogenic avascular necrosis (AVN). Avoidance of excessive traction, avoidance of distal posterolateral capsulotomy and avoidance of disruption of the superior retinacular vessels should keep the risk for AVN low. Hip extension, internal rotation and distraction are useful in hip arthroscopy to better visualize lateral/posterolateral cam morphology to facilitate an accurate comprehensive cam correction and avoid vascular disruption.
Collapse
Affiliation(s)
- Austin E Wininger
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Lindsay E Barter
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Nickolas Boutris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Luis F Pulido
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Thomas J Ellis
- Orthopedic One, 4605 Sawmill Road, Upper Arlington, OH 43220, USA
| | - Shane J Nho
- Midwest Orthopedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| |
Collapse
|
4
|
Zhang Y, Sun R, Zhang L, Feng L, Liu Y. Effect of blood biochemical factors on nontraumatic necrosis of the femoral head : Logistic regression analysis. DER ORTHOPADE 2018; 46:737-743. [PMID: 28364349 DOI: 10.1007/s00132-017-3408-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This case-control study aimed to identify the risk factors of nontraumatic necrosis of the femoral head (NONFH). METHODS In all, 242 patients with NONFH treated at the hip disease research center of our hospital between March 2012 and October 2015 were included. After excluding 19 patients with tumor or tuberculosis, 223 patients were enrolled. Controls comprised 223 healthy persons selected from our hospital database. Single-factor variance analysis and t test were performed to select the index of statistical significance. The 95% confidence interval (95% CI) and normal range of the selected indicators were compared, and abnormal related indexes were selected from the femoral head necrosis group. The selected indicators were based on the increase or decrease to locate the risk indicators and render their corresponding assignment. Logistic regression analysis of the risk factors was performed after the assignment. RESULTS The necrotic group of patients with decreased carbon dioxide combining power (CO2CP), increased total cholesterol, increased low-density lipoprotein, and decreased high-density lipoprotein levels had statistically significant partial regression coefficient values and the odds ratios were 73.5 (95% CI 24.59-219.74), 7.15 (3.51-14.85), 633.07 (121.7-3304.78), and 20.11 (9.36-43.8), respectively, indicating that these are strong risk factors for NONFH. CONCLUSIONS Abnormal lipid metabolism is a strong risk factor of NONFH. Lipid examination can be used as a screening tool for NONFH in high-risk populations, for alcoholism, and many hormone applications. The decreased CO2CP was associated with NONFH, and bone microcirculation was considered to possibly lead various conditions such as ischemia and hypoxia-related bone metabolic acidosis. However, further study is needed.
Collapse
Affiliation(s)
- Ying Zhang
- Medical Center for the Hip, Luoyang Orthopedic-Traumatological Hospital, No. 82 South Qiming Road, 471002, Luoyang, China
| | - Ruibo Sun
- Medical Center for the Hip, Luoyang Orthopedic-Traumatological Hospital, No. 82 South Qiming Road, 471002, Luoyang, China
| | - Leilei Zhang
- Medical Center for the Hip, Luoyang Orthopedic-Traumatological Hospital, No. 82 South Qiming Road, 471002, Luoyang, China
| | - Lizhi Feng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Youwen Liu
- Medical Center for the Hip, Luoyang Orthopedic-Traumatological Hospital, No. 82 South Qiming Road, 471002, Luoyang, China.
| |
Collapse
|
6
|
Lazaro LE, Nawabi DH, Klinger CE, Sculco PK, van der List JP, Dyke JP, Helfet DL, Kelly BT, Lorich DG. Quantitative Assessment of Femoral Head Perfusion Following Arthroscopic Femoral Osteochondroplasty: A Cadaveric Study. J Bone Joint Surg Am 2017; 99:2094-2102. [PMID: 29257015 DOI: 10.2106/jbjs.16.01556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Disruption of the arterial supply to the femoral head, and subsequent development of femoral head osteonecrosis, is of serious concern with intracapsular hip procedures. However, the effect of arthroscopic femoral osteochondroplasty on femoral head perfusion is unknown. We aimed to quantify the effects of both standard and posterosuperior extension of arthroscopic femoral osteochondroplasty on femoral head vascularity. We hypothesized that extension of the superior resection zone posteriorly would negatively affect femoral head perfusion. METHODS In 12 cadaveric pelvic specimens, we cannulated the medial femoral circumflex artery (MFCA). One hip per pelvis was randomly selected to be in 1 of 2 experimental groups based on the superior extent of the osteochondroplasty: standard resection (resection anterior to the 12 o'clock [0° of 360°] position) or extended resection (resection extended posterior to the 12 o'clock position). Computed tomography (CT) scans were obtained prior to and following arthroscopic resection to delineate the resection margins. Gadolinium enhancement on magnetic resonance imaging (MRI) was quantified in the femoral head by volumetric analysis using custom software. A polyurethane compound was injected and gross dissection of the vasculature was performed. RESULTS Extension of the osteochondroplasty posteriorly (the extended-resection group), to a mean of 41.3° (range, 34° to 47°) posterior to the 12 o'clock position, decreased femoral head perfusion by a mean of 28% (range, 18% to 38%). The standard-resection group demonstrated a mean decrease in femoral head perfusion of 7% (range, 4% to 11%). Correlation analysis demonstrated a significant negative correlation (correlation coefficient, -0.877; p < 0.001; R = 0.747). For every 1° that the superior resection margin extended posteriorly, a corresponding 0.88% decrease in femoral head perfusion was found. CONCLUSIONS Femoral head perfusion is almost fully maintained with arthroscopic osteochondroplasty when the superior resection margin is anterior to the 12 o'clock position. Perfusion is also well maintained if the superior resection margin is extended no more than 10° posterior to 12 o'clock. Further posterior extension correlated with greater decreases in femoral head perfusion. CLINICAL RELEVANCE Our study provides previously unreported quantitative MRI data on femoral head perfusion following arthroscopic femoral osteochondroplasty for the treatment of cam-type femoroacetabular impingement.
Collapse
Affiliation(s)
- Lionel E Lazaro
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Danyal H Nawabi
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Craig E Klinger
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Peter K Sculco
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Jelle P van der List
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Jonathan P Dyke
- Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - David L Helfet
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Bryan T Kelly
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| | - Dean G Lorich
- Sports Medicine Service (D.H.N. and B.T.K.), Orthopaedic Trauma Service (C.E.K, D.L.H., and D.G.L.), Adult Reconstruction and Joint Replacement Service (P.K.S.), and Center for Hip Preservation (D.H.N., D.L.H., B.T.K., and D.G.L.), Hospital for Special Surgery and New York Presbyterian Hospital (L.E.L. and J.P.v.d.L.), New York, NY.,Citigroup Biomedical Imaging Center (J.P.D.), Weill Cornell Medicine (L.E.L., D.H.N., C.E.K., P.K.S., J.P.v.d.L., J.P.D., D.L.H., B.T.K., and D.G.L.), New York, NY
| |
Collapse
|