Operative treatment for pincer type femoroacetabular impingement:a case report

Femoroacetabular impingement (FAI) is a condition characterized by the impingement of the femur and acetabulum. In Japan, this disorder has become recognized gradually. Here we report a rare case of surgically treated FAI, associated with an osseous protrusion on the acetabulum of a 30-year-old female. Plain computed tomography (CT) and reconstructive 3D-CT images clearly demonstrated an anterolateral bony protrusion. Hip arthroscopy showed no degeneration of the cartilage on either the femoral or acetabular side, but degeneration at the edge of labrum was observed in the region of the bony protrusion. The complete removal of the bony protrusion under hip arthroscopy was thus considered impracticable, and a small skin incision was therefore made anteriorly to approach the acetabulum. The Short-Form 36-Item Health Survey (SF-36) revealed improvement in all scores.</p

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

Background: Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population. Purpose: To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS); and completed a return-to-sport survey at 1 year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. The proportions of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS and HOS-SSS were calculated. Statistical significance was set at P =.05. Results: There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. The mean age and body mass index of the group were 40.3 years (range, 15.5-58.7 years) and 27.9 kg/m2 (range, 19.6-40.1 kg/m2), respectively. The mean follow-up was 26.4 months (range, 12-64.2 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS (P \u3c.001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8, and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%. Conclusion: At minimum 1-year follow-up, primary arthroscopic labral reconstruction, in the setting of femoroacetabular impingement syndrome and irreparable labral tears, was associated with significant improvement in PROs in athletic populations. Return to sport within 1 year of surgery was 78%

Die Hüftarthroskopie - Etablierung einer neuen minimalinvasiven Operationstechnik

Die vorliegende Habilitationsschrift spiegelt die erfolgreiche Etablierung der Hüftarthroskopie im klinischen Alltag wider. Das Interesse an dieser minimalinvasiven Operationstechnik ist wesentlich mit der Beschreibung des Krankheitsbildes des femoroazetabulären Impingements gekoppelt. Mit dieser neuen Diagnose hat sich eine relativ häufige Indikation für die Hüftarthroskopie ergeben. Für die erfolgreiche Etablierung eines neuen operativen Verfahrens ist neben einer akribischen Operationstechnik die sorgfältige Indikationsstellung für den Eingriff mit der korrekten und vollständigen Identifikation der ursächlichen Pathologie für die Beschwerden des Patienten notwendig. Dieses Bestreben wird in den ersten beiden Arbeiten thematisiert. In der frühen Phase der Hüftarthroskopie dominierten einfache operative Eingriffe wie Synoviabiopsien oder arthroskopische Spülungen. Die Arthroskopie ermöglicht hier minimalinvasiv mit niedriger Morbidität eine fragliche Pathologie direkt zu inspizieren, zu bioptieren und damit die Diagnose für ein weiteres operatives Vorgehen zu sichern oder direkt zu behandeln (Arbeit 2.3 und 2.4). Damit sich die Hüftarthroskopie in der Therapie einer Indikation durchsetzt, muss sie gegenüber dem herkömmlichen offenen Verfahren mindestens gleich gute Ergebnisse bei einer Überlegenheit in Bezug auf die Morbidität aufweisen. Die Arbeit 2.5 bestätigt dieses für die wichtigste Indikation, dem FAI, und bereitet damit den Weg für eine verstärkte Anwendung der arthroskopischen Technik zur Behandlung dieses Krankheitsbildes. Die letzte Arbeit 2.6 befasst sich schließlich mit der innovativen zellbasierten Behandlung der sekundären Knorpelschäden als wichtigsten Outcomeparameter, um so die Ergebnisse in der Behandlung des FAI weiter zu optimieren. Bei allen Möglichkeiten und Vorteilen der Hüftarthroskopie müssen die in Kapitel 3.5 beschriebenen Schwierigkeiten und Limitationen der Technik beachtet werden und eine akribische präoperative Indikationsstellung und sorgfältige Planung des Eingriffes durchgeführt werden. Es ist zu erwarten, dass das Wissen um Erkrankungen und gelenkerhaltende Therapiemöglichkeiten im Bereich der Hüfte in den nächsten Jahren deutlich zunimmt und sich die Hüftarthroskopie für immer mehr Indikationen zur wertvollen Alternative entwickelt. Perspektivisch werden sich neben der Erweiterung und Optimierung der intraartikulären Therapiemöglichkeiten immer mehr extraartikuläre Indikationen im peritrochantären und subglutealen Raum ergeben. Mit dem zunehmenden Verständnis und Bewusstsein für die Erkrankungen des Hüftgelenkes ist die Hoffnung verbunden, durch ein frühzeitiges Erkennen und minimalinvasives Adressieren der Pathologien Folgeschäden zu reduzieren oder sogar abzuwenden und so die langfristigen Ergebnisse zu optimieren

Femoral neck fractures as a complication of hip arthroscopy: a systematic review.

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%

Lesiones del labrum acetabular. Etiología, lesiones artroscópicas e indicaciones de tratamiento

En la última década se ha experimentado un notable incremento en el número de cirugías artroscópicas de cadera realizadas en nuestros hospitales. Las lesiones de labrum acetabular son probablemente la principal causa por la que un cirujano ortopédico realiza una artroscopia de cadera. El objetivo del siguiente artículo es revisar las diferentes lesiones del labrum que podemos encontrarnos en la práctica diaria y atendiendo a los cambios anatomopatológicos que se han producido. Esto nos va a permitir entender de manera global cuál es el problema fundamental al que nos enfrentamos cuando tratamos a pacientes con dolor inguinal y lesiones del labrum acetabular, y así poder elegir la mejor estrategia terapéutica. Se describen de forma superficial las diferentes opciones terapéuticas, sin profundizar en ellas, puesto que no es el objetivo de la presente revisiónDuring the last decade, an increasing rate in the number of hip arthroscopies has been experienced in our hospitals. Acetabular labrum injuries are likely the main cause by which an orthopedic surgeon perform a hip arthroscopy. The objective of the following paper is to review the different labral injuries we can find in our daily practice and indentify the its anatomopathological changes. This is going to let us know, in a global way, which is the main problem we are facing when we are treating patients with groin pain and acetabular labral injuries, and then we can choose the best treatment option. Different treatment options are superficialy described, becaus it’s not the objective of this revie

Hip Capsule Dimensions in Patients With Femoroacetabular Impingement: A Pilot Study

Background: Joint-preserving hip surgery, either arthroscopic or open, increasingly is used for the treatment of symptomatic femoroacetabular impingement (FAI). As a consequence of surgery, thickening of the joint capsule and intraarticular adhesions between the labrum and joint capsule and between the femoral neck and the joint capsule have been observed. These alterations are believed to cause persistent pain and reduced range of motion. Because the diagnosis is made with MR arthrography, knowledge of the normal capsular anatomy and thickness on MRI in patients is important. To date there is no such information available. Questions/Purposes: The purpose of this study was to establish thickness, length of the hip capsule, and the size of the perilabral recess in patients with FAI. Methods: We reviewed the preoperative MR arthrography of 30 patients (15 men) with clinical symptoms of FAI. We measured capsular thickness and made observations on the perilabral recess. Results: The joint capsule was thickest (6mm) anterosuperiorly between 1 and 2 o'clock. The average length from the femoral head-neck junction to the femoral insertion of the capsule ranged from 19 to 33mm. A perilabral recess was present circumferentially, even across the acetabular notch, where the labrum is supported by the transverse acetabular ligament. The shortest recess occurred superiorly. Conclusions: Knowledge of the capsular anatomy in patients with FAI before surgery is important to judge the postoperative changes and to plan potential further therapy including arthroscopic treatment of intraarticular adhesion

Complicaciones en artroscopia de cadera. Artroscopia fallida de cadera y artroscopia de revisión

ResumenLa artroscopia de cadera es una técnica quirúrgica poco invasiva y bastante segura. Si bien las complicaciones severas son infrecuentes (infecciones, fracturas, luxaciones, necrosis avascular entre otras) existe una alta frecuencia de complicaciones menores como son los daños condrales, las lesiones del labrum y las parestesias del nervio pudendo. Estas están relacionadas preferentemente con el posicionamiento del paciente y la técnica quirúrgica. Pese a que las consecuencias clínicas son poco relevantes debe darse especial énfasis en la prevención de estas complicaciones optimizando al máximo los detalles de un posicionamiento seguro y una depurada técnica quirúrgica.Los fallos o malos resultados postartroscopia de cadera están provocados sobre todo por la inadecuada selección de los pacientes, la progresión de daños condrales (evolución hacia artrosis de cadera) o la resección inadecuada de la deformidad ósea en el pinzamiento femoroacetabular. La resección insuficiente es causa de un pinzamiento persistente con el riesgo de generar nuevas lesiones articulares. La resección no anatómica o excesiva es causa de inestabilidad de cadera o fractura de cuello femoral. Como prevención deberá hacerse especial énfasis en planificar detalladamente la cuantía de la resección ósea y realizar esta en forma completa y con una depurada técnica quirúrgica.AbstractHip arthroscopy is a safe and less invasive surgical technique. Mayor complications such as infections, fractures, dislocations or avascular necrosis are exceptional. Minor complications are more frequent, such as pudendal paraesthesias, labral damage, or chondral lesions. These complications are mostly related with the positioning of the patient and the surgical technique. Even if the clinical consequences are not so significant, emphasis must be made on preventing these iatrogenic lesions by optimising the details for a safe positioning of the patient, as well as the optimal surgical technique.Failure or unsatisfactory results after hip arthroscopy can be a consequence of poor patient selection, progression of chondral damage, or failure to correct the bony alteration causing femoroacetabular impingement. The insufficient resection either at the acetabular or femoral side leads to a persistent impingement. It is one of the main causes for revision hip arthroscopy. The excessive or non-anatomical resection at the acetabular or femoral side can cause hip instability or femoral neck fractures. Essential to prevent these complications are the detailed planning of the amount of bony resection, as well as the correct surgical technique

Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study

BACKGROUND: Current literature describing the periacetabular osteotomy (PAO) is mostly limited to retrospective case series. Larger, prospective cohort studies are needed to provide better clinical evidence regarding this procedure. The goals of the current study were to (1) report minimum 2-year patient-reported outcomes (pain, hip function, activity, overall health, and quality of life), (2) investigate preoperative clinical and disease characteristics as predictors of clinical outcomes, and (3) report the rate of early failures and reoperations in patients undergoing contemporary PAO surgery. METHODS: A large, prospective, multicenter cohort of PAO procedures was established, and outcomes at a minimum of 2 years were analyzed. A total of 391 hips were included for analysis (79% of the patients were female, and the average patient age was 25.4 years). Patient-reported outcomes, conversion to total hip replacement, reoperations, and major complications were documented. Variables with a p value of ≤0.10 in the univariate linear regressions were included in the multivariate linear regression. The backward stepwise selection method was used to determine the final risk factors of clinical outcomes. RESULTS: Clinical outcome analysis demonstrated major clinically important improvements in pain, function, quality of life, overall health, and activity level. Increasing age and a body mass index status of overweight or obese were predictive of improved results for certain outcome metrics. Male sex and mild acetabular dysplasia were predictive of lesser improvements in certain outcome measures. Three (0.8%) of the hips underwent early conversion to total hip arthroplasty, 12 (3%) required reoperation, and 26 (7%) experienced a major complication. CONCLUSIONS: This large, prospective cohort study demonstrated the clinical success of contemporary PAO surgery for the treatment of symptomatic acetabular dysplasia. Patient and disease characteristics demonstrated predictive value that should be considered in surgical decision-making. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence