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Kitamura K, Fujii M, Motomura G, Hamai S, Kawahara S, Sato T, Yamaguchi R, Hara D, Utsunomiya T, Nakashima Y. A Computer Modeling-Based Target Zone for Transposition Osteotomy of the Acetabulum in Patients with Hip Dysplasia. J Bone Joint Surg Am 2024; 106:2347-2355. [PMID: 39418339 DOI: 10.2106/jbjs.23.01132] [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: 10/19/2024]
Abstract
BACKGROUND This study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia. METHODS We created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction. RESULTS The prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70). CONCLUSIONS Acetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively. CLINICAL RELEVANCE This study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kohno Y. CORR Insights®: What Are the Sex-based Differences of Acetabular Coverage Features in Hip Dysplasia? Clin Orthop Relat Res 2024; 482:1984-1986. [PMID: 39017587 PMCID: PMC11469886 DOI: 10.1097/corr.0000000000003192] [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: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Yusuke Kohno
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Featherall J, Metz AK, Froerer DL, Rosenthal RM, O'Neill DC, Khalil AZ, Maak TG, Aoki SK. False-Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Correlate to Different Weightbearing Regions of the Acetabulum: A 3-Dimensional Analysis. Am J Sports Med 2024; 52:2603-2610. [PMID: 39135344 DOI: 10.1177/03635465241265679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND The acetabular sourcil is commonly interpreted as a reliable radiographic representation of the weightbearing dome of the acetabulum, despite limited modern data. Assessment of weightbearing acetabular coverage has been described using both the sourcil edge and bone edge as anatomic landmarks, leading to confusion and potential misguidance in surgical decision-making and thus compromised patient outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to characterize the 3-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic measurements on false-profile radiographs. It was hypothesized that the sourcil edge would represent anterolateral coverage and the bone edge would represent anterior coverage. STUDY DESIGN Descriptive laboratory study. METHODS A total of 80 hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center-edge angles, based on upper and lower quartiles of discrepancy. Three-dimensional surface mesh models and digitally reconstructed radiographs were generated from hip computed tomography scans. Sourcil-edge and bone-edge anterior center-edge angles were identified on digitally reconstructed radiographs and registered to the 3D models with fiducial markers. Intersections of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models. RESULTS The bone-edge and sourcil-edge projections intersected the acetabular rim at clockface means of 2:05 ± 0:22 and 1:12 ± 0:25, respectively. The 3D models consistently demonstrated that, in both large- and small-discrepancy groups, the sourcil edge corresponded to the acetabular area just posterior to the anterior inferior iliac spine (AIIS) projection, and the bone edge corresponded to the weightbearing region inferior to the AIIS. Additionally, in large-discrepancy hips, the bone edge corresponded to more prominent acetabular coverage in the region inferomedial to the AIIS when compared with the small-discrepancy hips. CONCLUSION On false-profile radiographs, the sourcil edge corresponds to superior femoral head coverage, and the bone edge corresponds to anterosuperior coverage. Radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate acetabular rim prominence in the region of the AIIS. CLINICAL RELEVANCE Characterizing the anatomic weightbearing regions of the acetabulum represented on false-profile radiographs facilitates improved clinical and intraoperative decision-making in hip preservation surgery, including acetabuloplasty and periacetabular osteotomy.
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Affiliation(s)
- Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Allan K Metz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Reece M Rosenthal
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Dillon C O'Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Ameen Z Khalil
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Miyajima S, Kobayashi N, Yukizawa Y, Kamono E, Choe H, Ike H, Kumagai K, Inaba Y. Shelf acetabuloplasty may inhibit range of motion: A computer simulation analysis. J Orthop Res 2024; 42:821-828. [PMID: 37805943 DOI: 10.1002/jor.25710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/17/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
Shelf acetabuloplasty has been performed in patients with developmental dysplasia of the hip (DDH); however, the appropriate position of the shelf has not been determined, particularly with respect to avoiding range of motion (ROM) loss. The aim of this study was to investigate the frequency of ROM inhibition and the influence of 3D position of the shelf following actual shelf acetabuloplasty and virtual surgery using computer simulation analysis. Computed tomography data from 15 patients with DDH who underwent shelf acetabuloplasty were collected between August 2019 and February 2022. The three-dimensional models of a hip joint were constructed using Zed Hip®. Maximal internal rotation (MIR) at 45° and 90° flexion was measured in each patient. The frequency and position of ROM inhibition was determined in a real postoperative model virtually. In addition, a second analysis using virtual acetabuloplasty was performed. Upon placing the shelf, three patterns were provided for the following four parameters: height, coronal inclination, center-edge angle (CEA), and anteroposterior position. The predictors for ROM inhibition were analyzed using a logistic regression model. In the actual postoperative model, a limitation of MIR at 90° and 45° of flexion occurred in 60% and 66.7% of patients, respectively. A higher CEA and anterior position are major factors limiting MIR. The analysis of the virtual shelf acetabuloplasty model revealed that anterior position and CEA were significant factors causing ROM inhibition. As for clinical significance, the results of the current study indicated the optimal location of the shelf to avoid iatrogenic impingement after shelf acetabuloplasty.
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Affiliation(s)
- Shunsuke Miyajima
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Emi Kamono
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
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Tachibana T, Koga H, Katagiri H, Ogawa T, Takada R, Miyatake K, Jinno T. Analysis of survivorship following periacetabular osteotomy for hip dysplasia based on three-dimensional acetabular coverage. J Hip Preserv Surg 2024; 11:30-37. [PMID: 38606334 PMCID: PMC11005789 DOI: 10.1093/jhps/hnad044] [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: 01/09/2023] [Revised: 08/05/2023] [Accepted: 10/31/2023] [Indexed: 04/13/2024] Open
Abstract
Periacetabular osteotomy (PAO) is an established procedure for correcting acetabular coverage and preventing osteoarthritis progression in hip dysplasia. However, it is unclear how acetabular coverage changes three-dimensionally after PAO and how it affects survival. Therefore, this study aimed to investigate the change in three-dimensional acetabular coverage preoperatively and postoperatively and identify demographic, clinical and radiographic factors associated with conversion to total hip arthroplasty (THA) and radiographic osteoarthritis progression after PAO. We retrospectively reviewed 46 consecutive patients (66 hips) who underwent PAO, using preoperative and postoperative radiographs and pelvic computed tomography (CT). Three-dimensional acetabular coverage based on CT data was investigated. Kaplan-Meier survival analysis was performed, and hazard ratios were calculated using univariate Cox regression models to identify the risk factors associated with conversion to THA and radiographic osteoarthritis progression after PAO as the endpoints. Radiographic osteoarthritis progression was defined as a minimum joint space of <2.0 mm. The mean follow-up was 10.7 years. Post-PAO, acetabular coverage gradually increased from the anterosuperior to the superior to the posterosuperior direction. The survival rate after PAO was 98.0% at 10 years. Less postoperative superior acetabular coverage, with a hazard ratio of 0.93, was significantly associated with conversion to THA and radiographic osteoarthritis progression after PAO (P = 0.03). In this study, poor superior acetabular coverage after PAO was a significant risk factor for conversion to THA and radiographic progression of osteoarthritis. Therefore, surgeons should attempt to prioritize the correction of the superior acetabular coverage when performing PAO.
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Affiliation(s)
- Tetsuya Tachibana
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi 343-8555, Saitama, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi 343-8555, Saitama, Japan
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ryohei Takada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi 343-8555, Saitama, Japan
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Zanchi N, Safran MR, Herickhoff P. Return to Play After Femoroacetabular Impingement. Curr Rev Musculoskelet Med 2023; 16:587-597. [PMID: 37816998 PMCID: PMC10733256 DOI: 10.1007/s12178-023-09871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE OF REVIEW Femoroacetabular impingement (FAI) is a pathomechanical process whereby abnormal contact between proximal femur and acetabulum at end range of hip motion induces chondrolabral lesions within the hip joint. Surgery followed by a rehabilitation program or physical therapy with possible addition of an intra-articular corticosteroid injection are the two predominant treatments. The majority of authors recognize that a well-designed rehabilitation protocol is essential to achieve good outcomes with both nonoperative and surgical treatment. However, there is little evidence about what is the best rehabilitation protocol and most of the literature available is based on expert level opinion. This current review investigates the recent literature on nonoperative and postoperative rehabilitation protocol and return to play in FAI patients and describes our approach. RECENT FINDINGS Historically, rehabilitation protocols for treatment of FAI as well as return to play protocols were based on experts' opinion and low-level evidence studies. In order to improve standardization of protocols and to allow a better comparison in between different protocols, different authors have created standardized rehabilitation protocols with consensus building methods comparing them with other treatment options in high-level evidence trials (FASHIoN trial, etc.). Despite the excellent results reported after nonoperative and post-surgical rehabilitation, and the high RTP rate after FAI treatment, there is a significant variability in between protocols. Further high-level evidence studies are necessary in order to establish a gold standard in rehabilitation and RTP protocols.
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Affiliation(s)
- Nicolò Zanchi
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, 1850 E Park Ave, State College, PA, USA.
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Paul Herickhoff
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, 1850 E Park Ave, State College, PA, USA
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Nakamura T, Wada A, Natori T, Kawaguchi K, Takamura K, Yanagida H, Yamaguchi T. A Novel Method for Assessing the 3-dimensional Morphology of Cartilaginous Acetabulum Via Childhood Magnetic Resonance Imaging. J Pediatr Orthop 2023; 43:640-648. [PMID: 37681305 DOI: 10.1097/bpo.0000000000002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Periarticular cartilage is abundant in children, making evaluations of 3-dimensional (D) cartilaginous acetabular morphology using x-ray or computed tomography (CT) difficult. The study aimed to visualize the 3D cartilaginous acetabular morphology in normal children and patients with pediatric developmental dysplasia of the hip (DDH). METHODS Magnetic resonance imaging (MRI) of 17 female children without acetabular dysplasia at 7.5 years and CT of 33 normal female adolescents with mature bones at 14.6 years were used as controls. Subjects were 26 female patients with unilateral DDH who underwent angulated Salter innominate osteotomy (A-SIO) at 5.5 years. Preoperative and postoperative MRIs were performed at 5.2 and 7.0 years, respectively. The MRI sequence was 3D-MEDIC. The medial intersection (point A) of the line connecting the centers of the bilateral femoral head and the femoral head were defined as point zero. The 3D coordinates (X, Y, Z) of the cartilaginous acetabular edge (point C) from anterior to posterior were calculated. Subsequently, a 3D scatter plot was created using 3D graph software. The subjects were divided into 6 groups, including control MRI, control CT, unaffected DDH before and after A-SIO, and affected DDH before and after A-SIO. The femoral head coverage ratio (FHCR: AC/AB) was used to quantify coverage and was compared in each group. RESULTS In the control MRI group, the acetabular coverage was small anteriorly, largest anterolaterally, and gradually decreased posteriorly, similar to the bony acetabulum in adolescents. In the affected DDH before A-SIO group, the coverage was significantly lower than that of the control MRI and unaffected DDH groups. After A-SIO, the morphology improved beyond the unaffected DDH and the control MRI group. CONCLUSIONS The global defect of the cartilaginous acetabulum in the affected DDH group was significantly improved to normal morphology after A-SIO. Evaluating the cartilaginous acetabulum using MRI was useful for assessing hip morphology in childhood. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Tomoyuki Nakamura
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Akifusa Wada
- Department of Othopaedic Surgery, Saga Handicapped Children's Hospital, Saga, Saga Prefecture, Japan
| | - Takahiro Natori
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Kengo Kawaguchi
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Kazuyuki Takamura
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Haruhisa Yanagida
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Toru Yamaguchi
- Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka
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Hassan MM. Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Improves Outcomes: Don't Forget the Young Guns. Arthroscopy 2023; 39:1220-1221. [PMID: 37019534 DOI: 10.1016/j.arthro.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 04/07/2023]
Abstract
It has been said that youth is wasted on the young. This notion does not apply to the value that hip arthroscopy provides in managing hip pathology in adolescents. Multiple studies have shown the efficacy of hip arthroscopy as a treatment modality in the adult population for a multitude of hip pathologies, particularly femoroacetabular impingement syndrome. The implementation of hip arthroscopy in the management of femoroacetabular impingement syndrome in the adolescent population is on the rise. More studies illustrating favorable outcomes following hip arthroscopy in adolescents will serve to reinforce its utility as a treatment option for this population. Early intervention and preservation of hip function are of critical importance in a youthful and active patient population. As a word of caution, acetabular retroversion predisposes these patients to an increased risk of revision surgery.
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Results of Arthroscopic Treatment for Femoroacetabular Impingement. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background. Femoroacetabular impingement (FAI) is one of the most frequent causes of hip pain and limited hip mobility in young and middle-aged patients. It is a result of repeated injury of hip structures, that leads to degenerative changes in hip labrum, cartilage and subchondral bone and provokes progressive development of hip osteoarthritis.
Aim of study to analyze own experience of treating patients with femoroacetabular impingement and identify factors affecting its outcomes.
Methods. Retrospective, uncontrolled, single-center clinical study included 128 patients with FAI which had 150 surgeries on 149 joints in in the period from 2013 to 2021. All patients underwent physical examination and X-ray diagnostics, their FAI type was identified. The alpha angle of external part of femoral head in anterior-posterior position and in the modified Dunn 45 position, as well as Tonnis angle, lateral central-marginal angle in Ogata modification and the height of articular gap along the lateral (LS) and medial edges (MS) of sclerosed acetabulum part were calculated. The i-HOT-33 and HOS scales were used to assess preoperative status and postoperative results.
Results. The average follow-up period was 3.9 years (SD 1.71; min 1.05 and max 8.16). The study included 55 (43.0%) women and 73 (57.0%) men which underwent 64 (42.7%) and 86 (57.3%) surgeries respectively. The most common types of FAI, according to our data, were mixed type (53% of joints) and сam type (27.5% of joints). Insufficient coverage of the femoral head by the acetabulum (borderline dysplasia) in combination with the сam deformity of the femoral head was observed in 18.1%. Pincer-type FAI was observed in 1.4% of joints. We obtained the worst results with a combination of сam deformity and borderline dysplasia in comparison with cam- and mix-type FAI according to the i-HOT-33 and HOS scales. Patients age, deep cartilage damage, irreparable labrum damage and height decrease of the lateral part of the articular gap determined negative effect on treatment results according to the i-HOT-33 and HOS scales.
Conclusion. Hip arthroscopy showed good short- and midterm outcomes in patients with FAI. Pain syndrome is most often manifested in patients with pathology of hip soft tissue structures concomitant to FAI. The combination of сam deformity and insufficient femoral head coverage, deep cartilage damage and a height decrease of the articular gap are important predictors of poor treatment results.
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Hayashi S, Kuroda Y, Nakano N, Matsumoto T, Kamenaga T, Maeda T, Kuroda R. A combination of acetabular coverage and femoral head-neck measurements can help diagnose femoroacetabular impingement. J Hip Preserv Surg 2022; 9:252-258. [PMID: 36908552 PMCID: PMC9993451 DOI: 10.1093/jhps/hnac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
This study aimed to evaluate the relationship between the radiographical features of combination of the acetabular coverage and the femoral head-neck shape and the occurrence of femoroacetabular impingement (FAI). In this study, 114 patients who had FAI with or without labral tear and mild osteoarthritis were analyzed. Plain radiographs and computed tomography (CT) were taken for evaluation of acetabular coverage and femoral head-neck measurements. The relationship between the combination angle of acetabular coverage and femoral head-neck measurements and the occurrence of FAI was evaluated. The prevalence of FAI patients with the combination angle of CT-anterior CE + α angle ≥100° was 6.1% (7/114 patients). Receiver operator characteristic curve analysis demonstrated a higher area under the curve for combination of CT-anterior center edge angle (ACEA) with the α angle at 0.94 (CT-ACEA +α angle). A threshold for the occurrence of FAI was determined using the combination CT-ACEA + α angle at 100°. The frequency of FAI surgery was significantly higher in patients with a combination angle ≥100° than in those with a smaller angle. The average modified Harris hip score was significantly lower in patients with a combination angle ≥100° than in those with a smaller angle. We suggest that the combination of lateral center edge angle ≥40°, α angle ≥50° and combined angles of CT-ACEA and α angle ≥100° may help diagnosis of FAI. Level of evidence III: retrospective cohort study.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Toshihisa Maeda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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11
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Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence. J Clin Med 2022; 11:jcm11195852. [PMID: 36233719 PMCID: PMC9572846 DOI: 10.3390/jcm11195852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: "femoroacetabular impingement", "FAI", in association with "surgery", "arthroscopy", "surgical" and "conservative", "physiotherapy", "physical therapy", "rehabilitation", "exercise". Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition.
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Seijas R, Pérez A, Barastegui D, Revilla E, López de Celis C, Català J. The natural history of alpha angle in the last seventeen centuries. Arch Orthop Trauma Surg 2022; 142:2819-2825. [PMID: 34825963 DOI: 10.1007/s00402-021-04268-2] [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: 06/05/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hip osteoarthritis is one of the most important and debilitating diseases affecting thousands of people all over the world. On the other hand, femoroacetabular impingement (FAI) is one of the known important causes of hip osteoarthritis. Cam deformity frequently presents in FAI showing an increased alpha angle. Increased alpha angle has been observed among young patients involved in demanding physical activities such as in sports (40-60%), whereas among the non-athletic population, increased alpha angle was observed in 15-20%. Although femoroacetabular pathology has been described over the recent years, it is not possible to determine when the angle increase actually begins prior to diagnosis. The aim of our study is to evaluate the femoral alpha angle in different human femurs in different civilization eras in West Mediterranean area. MATERIALS AND METHODS Available ancient femurs were selected from the Collection Center belonging to the archeological archives (ancient necropolis) from the fourth, fourteenth and eighteenth centuries. A comparison of the alpha angle was made of the measurements from the different groups accompanied by a sample of present-day femurs from the radiology database of CT scans. Data from 243 femoral bones were collected, 50 of which from the fourth century, 26 from the fourteenth century, 68 from the eighteenth century, and 99 femurs from the 20/twenty-first century. RESULTS Alpha angles in all historical samples showed pathological values (> 55º) up to a maximum of 11.5% of the cases. Meanwhile, the actual series showed pathological alpha angle in 60.1% of the cases with statistical significant differences. CONCLUSION The studied femurs of the western Mediterranean region from the fourth, fourteenth and eighteenth centuries showed pathological alpha angles in a smaller proportion than the actual sample. LEVEL OF EVIDENCE Level III, retrospective studies.
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Affiliation(s)
- Roberto Seijas
- Instituto Cugat, Hospital Quiron Barcelona Floor-1, Pza. Alfonso Comín 5, 08023, Barcelona, Spain. .,Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain. .,Garcia Cugat Foundation, Barcelona, Spain.
| | - Albert Pérez
- Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - David Barastegui
- Instituto Cugat, Hospital Quiron Barcelona Floor-1, Pza. Alfonso Comín 5, 08023, Barcelona, Spain.,Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain.,Garcia Cugat Foundation, Barcelona, Spain
| | - Emili Revilla
- Archaeological Archive of Collection Centre of MUHBA (Museu d'Història de Barcelona), Barcelona, Spain
| | - Carlos López de Celis
- Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
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Kitamura K, Fujii M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Factors Associated With Abnormal Joint Contact Pressure After Periacetabular Osteotomy: A Finite-Element Analysis. J Arthroplasty 2022; 37:2097-2105.e1. [PMID: 35526756 DOI: 10.1016/j.arth.2022.04.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/16/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Identifying factors associated with poor hip contact mechanics after periacetabular osteotomy (PAO) may help surgeons optimize acetabular corrections in individual patients. We performed individual-specific finite-element analyses to identify preoperative morphological and surgical correction factors for abnormal contact pressure (CP) after PAO. METHODS We performed finite-element analyses before and after PAO with reference to the standing pelvic position on individual-specific 3-dimensional hip models created from computed tomography images of 51 dysplastic hips. Nonlinear contact analyses were performed to calculate the joint CP of the acetabular cartilage during a single-leg stance. RESULTS The maximum CP decreased in 50 hips (98.0%) after PAO compared to preoperative values, and the resulting maximum CP was within the normal range (<4.1 MPa) in 33 hips (64.7%). Multivariate analysis identified the roundness index of the femoral head (P = .002), postoperative anterior center-edge angle (CEA; P = .004), and surgical correction of lateral CEA (Δlateral CEA; P = .003) as independent predictors for abnormal CP after PAO. A preoperative roundness index >54.3°, a postoperative anterior CEA <36.3°, and a Δlateral CEA >27.0° in the standing pelvic position predicted abnormal CP after PAO. CONCLUSION PAO normalized joint CP in 64.7% of the patients but was less likely to normalize joint CP in patients with aspheric femoral heads. Successful surgical treatment depends on obtaining adequate anterior coverage and avoiding excessive lateral correction, while considering the physiological pelvic tilt in a weight-bearing position.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Mastel MS, Federico A, Desy NM, Johnston KD. Femoral de-rotation osteotomy versus hip arthroscopy for management of femoroacetabular impingement in adult patients with decreased femoral anteversion: a matched retrospective cohort study. J Hip Preserv Surg 2022; 9:191-196. [PMID: 35992026 PMCID: PMC9389909 DOI: 10.1093/jhps/hnac033] [Citation(s) in RCA: 2] [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: 08/03/2021] [Revised: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Femoral de-rotation osteotomy (FDO) and hip arthroscopy are both recognized surgical options for the management of femoroacetabular impingement (FAI) in the setting of decreased femoral anteversion (<5°). Minimal comparative data exist regarding the difference in outcomes between these two techniques, and we believe this is the first study to provide that comparison. This retrospective cohort study included a total of 20 patients with such pathology, matched for age, gender and body mass index. A total of 10 patients were included in the FDO group [median anteversion −0.5° (true retroversion); average follow-up 17.9 months]. In total, 10 patients were included in the hip arthroscopy group [median anteversion −0.5° (true retroversion); average follow-up 28.5 months]. Both groups demonstrated statistically and clinically significant improvement in the post-operative International Hip Outcome Tool (iHOT-33) scores [median improvement: FDO group, 37.7 points (r 14–58.8; P < 0.041); hip arthroscopy group, 35.9 points (r 11.1–81; P < 0.05)], noting that the minimal clinically important difference for the iHOT-33 is 6.1 points. However, the study was not adequately powered to delineate a difference in improvement between the two groups. The findings suggest significant improvement in patient-reported outcomes, and clinical findings can be achieved with either FDO or hip arthroscopy for FAI in the setting of decreased femoral anteversion. However, selection of the most suitable surgical procedure using a patient-specific approach may optimize outcomes in this challenging population.
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Affiliation(s)
- Matthew S Mastel
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan , 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Alyssa Federico
- Faculty of Medicine, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nicholas M Desy
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Hip and Knee Clinic , #335, 401-9th Ave SW, Calgary, AB T2P 3C5, Canada
| | - Kelly D Johnston
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Hip and Knee Clinic , #335, 401-9th Ave SW, Calgary, AB T2P 3C5, Canada
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Feng R, Hatem M, Nimmons SJ, Disantis A, Martin RL, Martin HD. Hip physical examination extension loss and radiographic osseous findings in patients with low back pain and nonarthritic hips. Proc AMIA Symp 2022; 35:455-459. [DOI: 10.1080/08998280.2022.2068992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Munif Hatem
- Hip Preservation Center, Baylor University Medical Center, Dallas, Texas
| | - Scott J. Nimmons
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Ashley Disantis
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
| | - RobRoy L. Martin
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
| | - Hal David Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, Texas
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Reorientierende Beckenosteotomie bei azetabulärer Dysplasie – Wo stehen wir heute? ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kitamura K, Fujii M, Iwamoto M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Is Anterior Rotation of the Acetabulum Necessary to Normalize Joint Contact Pressure in Periacetabular Osteotomy? A Finite-element Analysis Study. Clin Orthop Relat Res 2022; 480:67-78. [PMID: 34228657 PMCID: PMC8673984 DOI: 10.1097/corr.0000000000001893] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inappropriate sagittal plane correction can result in an increased risk of osteoarthritis progression after periacetabular osteotomy (PAO). Individual and postural variations in sagittal pelvic tilt, along with acetabular deformity, affect joint contact mechanics in dysplastic hips and may impact the direction and degree of acetabular correction. Finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the effect of PAO on the contact mechanics of dysplastic hips, which may lead to improved acetabular correction during PAO. QUESTIONS/PURPOSES We performed virtual PAO using finite-element models with reference to the standing pelvic position to clarify (1) whether lateral rotation of the acetabulum normalizes the joint contact pressure, (2) risk factors for abnormal contact pressure after lateral rotation of the acetabulum, and (3) whether additional anterior rotation of the acetabulum further reduces contact pressure. METHODS Between 2016 and 2020, 85 patients (92 hips) underwent PAO to treat hip dysplasia. Eighty-two patients with hip dysplasia (lateral center-edge angle < 20°) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or spine surgery, or poor-quality images were excluded. Thirty-eight patients (38 hips) were eligible to participate in this study. All patients were women, with a mean age of 39 ± 10 years. Thirty-three women volunteers without a history of hip disease were reviewed as control participants. Individuals with a lateral center-edge angle < 25° or poor-quality images were excluded. Sixteen individuals (16 hips) with a mean age of 36 ± 7 years were eligible as controls. Using CT images, we developed patient-specific three-dimensional surface hip models with the standing pelvic position as a reference. The loading scenario was based on single-leg stance. Four patterns of virtual PAO were performed in the models. First, the acetabular fragment was rotated laterally in the coronal plane so that the lateral center-edge angle was 30°; then, anterior rotation in the sagittal plane was added by 0°, 5°, 10°, and 15°. We developed finite-element models for each acetabular position and performed a nonlinear contact analysis to calculate the joint contact pressure of the acetabular cartilage. The normal range of the maximum joint contact pressure was calculated to be < 4.1 MPa using a receiver operating characteristic curve. A paired t-test or Wilcoxon signed rank test with Bonferroni correction was used to compare joint contact pressures among acetabular positions. We evaluated the association of joint contact pressure with the patient-specific sagittal pelvic tilt and acetabular version and coverage using Pearson or Spearman correlation coefficients. An exploratory univariate logistic regression analysis was performed to identify which of the preoperative factors (CT measurement parameters and sagittal pelvic tilt) were associated with abnormal contact pressure after lateral rotation of the acetabulum. Variables with p values < 0.05 (anterior center-edge angle and sagittal pelvic tilt) were included in a multivariable model to identify the independent influence of each factor. RESULTS Lateral rotation of the acetabulum decreased the median maximum contact pressure compared with that before virtual PAO (3.7 MPa [range 2.2-6.7] versus 7.2 MPa [range 4.1-14 MPa], difference of medians 3.5 MPa; p < 0.001). The resulting maximum contact pressures were within the normal range (< 4.1 MPa) in 63% of the hips (24 of 38 hips). The maximum contact pressure after lateral acetabular rotation was negatively correlated with the standing pelvic tilt (anterior pelvic plane angle) (ρ = -0.52; p < 0.001) and anterior center-edge angle (ρ = -0.47; p = 0.003). After controlling for confounding variables such as the lateral center-edge angle and sagittal pelvic tilt, we found that a decreased preoperative anterior center-edge angle (per 1°; odds ratio 1.14 [95% CI 1.01-1.28]; p = 0.01) was independently associated with elevated contact pressure (≥ 4.1 MPa) after lateral rotation; a preoperative anterior center-edge angle < 32° in the standing pelvic position was associated with elevated contact pressure (sensitivity 57%, specificity 96%, area under the curve 0.77). Additional anterior rotation further decreased the joint contact pressure; the maximum contact pressures were within the normal range in 74% (28 of 38 hips), 76% (29 of 38 hips), and 84% (32 of 38 hips) of the hips when the acetabulum was rotated anteriorly by 5°, 10°, and 15°, respectively. CONCLUSION Via virtual PAO, normal joint contact pressure was achieved in 63% of patients by normalizing the lateral acetabular coverage. However, lateral acetabular rotation was insufficient to normalize the joint contact pressure in patients with more posteriorly tilted pelvises and anterior acetabular deficiency. In patients with a preoperative anterior center-edge angle < 32° in the standing pelvic position, additional anterior rotation is expected to be a useful guide to normalize the joint contact pressure. CLINICAL RELEVANCE This virtual PAO study suggests that biomechanics-based planning for PAO should incorporate not only the morphology of the hip but also the physiologic pelvic tilt in the weightbearing position in order to customize acetabular reorientation for each patient.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Alter TD, Knapik DM, Chapman RS, Clapp IM, Trasolini NA, Chahla J, Nho SJ. Return to Sport in Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Am J Sports Med 2022; 50:30-39. [PMID: 34825840 DOI: 10.1177/03635465211056082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data on outcomes in patients with borderline hip dysplasia (BHD) who undergo hip arthroscopy remain limited, particularly in regard to return to sport (RTS). PURPOSE To evaluate outcomes in patients with BHD and their ability to RTS after hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive patients with self-reported athletic activity and radiographic evidence of BHD, characterized by a lateral femoral center-edge angle (LCEA) between 18° and 25° and a Tönnis angle >10°, who underwent hip arthroscopy for FAIS between November 2014 and March 2017 were identified. Patient characteristics and clinical outcomes including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were analyzed at minimum 2-year follow-up. In addition, all patients completed an RTS survey. RESULTS A total of 41 patients with a mean age and body mass index (BMI) of 29.6 ± 13.4 years and 25.3 ± 5.6, respectively, were included. Mean LCEA and Tönnis angle for the study population were 22.7°± 1.8° and 13.3°± 2.9°, respectively. A total of 31 (75.6%) patients were able to RTS after hip arthroscopy at a mean of 8.3 ± 3.2 months. A total of 14 patients (45.2%) were able to RTS at the same level of activity, 16 patients (51.6%) returned to a lower level of activity, and only 1 (3.2%) patient returned to a higher level of activity. Of the 11 high school and collegiate athletes, 10 (90.9%) were able to RTS. All patients demonstrated significant improvements in all patient-reported outcome measures (PROMs) as well as in pain scores at a mean of 26.1 ± 5.4 months after surgery. Patients who were able to RTS had a lower preoperative BMI than patients who did not RTS. Analysis of minimum 2-year PROMs demonstrated better HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcomes for pain in patients able to RTS versus those who did not RTS (P < .05). CONCLUSION Of the patients with BHD studied here, 75.6% of patients successfully returned to sport at a mean of 8.3 ± 3.2 months after hip arthroscopy for FAIS. Of the patients who successfully returned to sport, 45.2% returned at the same level, and 3.2% returned at a higher activity level.
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Affiliation(s)
- Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Nicholas A Trasolini
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic 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 Orthopaedic 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 Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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Panos JA, Gutierrez CN, Wyles CC, Bingham JS, Mara KC, Trousdale RT, Sierra RJ. Addressing intraarticular pathology at the time of anteverting periacetabular osteotomy for acetabular retroversion is associated with better short-term patient-reported outcomes. J Hip Preserv Surg 2021; 8:90-104. [PMID: 34676101 PMCID: PMC8527802 DOI: 10.1093/jhps/hnab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/06/2021] [Indexed: 11/13/2022] Open
Abstract
Periacetabular osteotomy (PAO) is effective in the management of developmental
dysplasia of the hip and femoroacetabular impingement secondary to acetabular
retroversion. During anteverting PAO for acetabular retroversion, the need for
both labral treatment and femoral head–neck junction osteochondroplasty
remains equivocal. Accordingly, this study evaluated patient-reported outcome
measures (PROM) and reoperation rates after anteverting PAO with or without
intraarticular intervention. Cases of anteverting PAO performed at a single
institution between November 2009 and January 2016 were retrospectively
reviewed. Patients were divided into three groups: no intervention and
intraarticular intervention with arthrotomy or arthroscopy. Subsequently,
patients were reclassified by the intraarticular procedure performed at surgery
into major (labral repair, femoral head–neck osteochondroplasty) and
minor (labral debridement, femoral/acetabular chondroplasty) groups. The cohort
was 75% female, median age was 19.5 years and mean body mass
index was 25.0 kg/m2. Preoperative to postoperative
improvement was compared to minimal clinically important differences (MCID) for
eight PROM. Patients receiving major interventions exceeded MCID in a greater
proportion of PROM compared to minor and no intervention groups
(P < 0.007); major or minor
interventions did not increase the risk of reoperation over no intervention
(P ≥ 0.39). Based on the current
data, surgeons performing anteverting PAO for acetabular retroversion should
perform arthroscopic or open labral repair and assess for impingement after the
correction and perform a head–neck junction osteochondroplasty if
indicated.
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Affiliation(s)
- Joseph A Panos
- Mayo Clinic Alix School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Claudia N Gutierrez
- Mayo Clinic Alix School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
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Addai D, Zarkos J, Pettit M, Sunil Kumar KH, Khanduja V. Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques. Bone Joint Res 2021; 10:574-590. [PMID: 34488425 PMCID: PMC8479569 DOI: 10.1302/2046-3758.109.bjr-2020-0443.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.
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Affiliation(s)
- Daniel Addai
- Technische Universitat Dresden, Dresden, Germany.,West Suffolk Hospital, Bury St Edmunds, UK
| | | | | | | | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma & Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
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Tang N, Zhang W, Su Y, Han Z, Deng L, Li Y, Huang T, Li C. Femoroacetabular Impingement and Labral Tear: From the Most Highly Cited Articles to Research Interests. Orthop Surg 2021; 13:1922-1933. [PMID: 34423576 PMCID: PMC8523776 DOI: 10.1111/os.13037] [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: 01/17/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To highlight the characteristics of the most highly cited articles and propose the research interests over the past decades in the field of femoroacetabular impingement (FAI) and labral tear. Methods The ISI Web of Science database (Clarivate Analytics, New York, the United States) was utilized for the identification of articles on 15 December 2020. FAI and labral tear‐related articles (1138 articles) were retrieved, of which the 100 most‐cited articles (top 100) were identified. Subsequent analysis included citation density (citations/article age), authorship, institution, journal, geographic distribution, level of evidence, and theme. Results The number of citations per article ranged from 66 to 1189 with a mean of 163.31. The majority of articles were published in the United States (all articles/top 100 = 655/57) and Switzerland (85/22). University of Bern (n = 10) was the most prolific institution. The journal with the most of articles was Arthroscopy: The Journal of Arthroscopic and Related Surgery. The most prolific coauthor (all articles) or first authors (top 100) was Domb (n = 109) and Philippon (n = 6), respectively. The evidence with the most articles is level IV (n = 41). The top three most popular topics of research article were outcomes of surgery (n = 23), imaging diagnosis (n = 18), and comparison of surgery (n = 8). The top four most prevalent themes of review were labral tears (n = 3), FAI (n = 3), comparison of surgery imaging diagnosis, and outcomes of surgery (both n = 2). Six keywords with the newest average publication year, including FAI syndrome (average publication year = 2019.50), patient‐reported outcomes (2019.43), femoroplasty (2018.60), clinical outcomes (2018.17), borderline dysplasia (2018.00), and capsule (2018.00). Five keywords with the highest average citations, including outcome (average citations = 88.50), alpha angle (58.00), complications (55.86), revision hip arthroscopy (49.00), and systematic review (46.14). Conclusions Outcomes research is the most popular research interest and patient‐reported outcome instruments might be further and widely used in the emerging articles in the near future. The field of FAI and labral tear has shown an obvious trend of development and is steadily evolving. It could be predicted that there will be an increasing number of publications in the following years, with the United States and Switzerland maintaining leadership in this field.
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Affiliation(s)
- Ning Tang
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenchao Zhang
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Su
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhencan Han
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Lingwen Deng
- Medical Laboratory Department, Yongzhou First People's Hospital and Affiliation Hospital of Yongzhou Vocational Technical College, Yongzhou, China
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Tianlong Huang
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunbao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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22
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How does the cam morphology develop in athletes? A systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29:1117-1129. [PMID: 33989785 DOI: 10.1016/j.joca.2021.02.572] [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: 08/06/2020] [Revised: 02/19/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A higher prevalence of cam morphology has been reported in the athletic population but the development of the cam morphology is not fully understood. The purpose of this systematic review is to establish the timing of development of the cam morphology in athletes, the proximal femoral morphologies associated with its development, and other associated factors. DESIGN Embase, MEDLINE and the Cochrane Library were searched for articles related to development of the cam morphology, and PRISMA guidelines were followed. Data was pooled using random effects meta-analysis. Study quality was assessed using the Downs and Black criteria and evidence quality using the GRADE framework. RESULTS This search identified 16 articles involving 2,028 participants. In males, alpha angle was higher in athletes with closed physes than open physes (SMD 0.71; 95% CI 0.23, 1.19). Prevalence of cam morphology was associated with age during adolescence when measured per hip (β 0.055; 95% CI 0.020, 0.091) and per individual (β 0.049; 95% CI 0.034, 0.064). Lateral extension of the epiphysis was associated with an increased alpha angle (r 0.68; 95% CI 0.63, 0.73). A dose-response relationship was frequently reported between sporting frequency and cam morphology. There was a paucity of data regarding the development of cam morphology in females. CONCLUSIONS Very low and low quality evidence suggests that in the majority of adolescent male athletes, osseous cam morphology developed during skeletal immaturity, and that prevalence increases with age. Very low quality evidence suggests that osseous cam morphology development was related to lateral extension of the proximal femoral epiphysis.
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Zhou J, Melugin HP, Hale RF, Song BM, Okoroha KR, Levy BA, Krych AJ. Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement. J Hip Preserv Surg 2021; 8:233-239. [PMID: 35414956 PMCID: PMC8994108 DOI: 10.1093/jhps/hnab050] [Citation(s) in RCA: 1] [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: 01/21/2021] [Revised: 04/23/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to determine the sex differences in the overall prevalence of radiographic femoroacetabular impingement (FAI) deformity patients presenting with hip pain and to identify the most common radiographic findings in male and female patients. A geographic database was used to identify patients between the age of 14 and 50 years with hip pain from 2000 to 2016. A chart and radiographic review was performed to identify patients with cam, pincer and mixed-type FAI. A total of 374 (449 hips) out of 612 (695 hips) male patients and 771 (922 hips) out of 1281 (1447 hips) female patients had radiographic features consistent with FAI. Ninety-four male hips (20.9%) and 45 female hips (4.9%) had cam type, 20 male hips (4.5%) and 225 female hips (24.4%) had pincer type and 335 male hips (74.6%) and 652 female hips (70.7%) had mixed type. The overall prevalence of radiographic findings consistent with FAI in male and female patients with hip pain was 61.1% and 60.2%, respectively. Mixed type was the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°, and the most common radiographic finding for pincer-type FAI was a crossover sign. Male patients were found to have a higher prevalence of cam-type deformities, whereas female patients were found to have a higher prevalence of pincer-type deformities.
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Affiliation(s)
- Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 296 Shizi St, Cang Lang Qu, Suzhou, Jiangsu, China
| | - Heath P Melugin
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Rena F Hale
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Bryant M Song
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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24
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Femoroacetabular Impingement (FAI): Current Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Nestorovski D, Wasko M, Fowler LM, Harris MD, Clohisy JC, Nepple JJ. Prominent Anterior Inferior Iliac Spine Morphologies Are Common in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy. Clin Orthop Relat Res 2021; 479:991-999. [PMID: 33861213 PMCID: PMC8052058 DOI: 10.1097/corr.0000000000001547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior inferior iliac spine (AIIS) prominence is increasingly recognized in the setting of femoroacetabular impingement (FAI). The AIIS prominence may contribute to decreased hip flexion after acetabular reorientation in patients with acetabular dysplasia. AIIS morphologies have been characterized in numerous populations including asymptomatic, FAI, and athletic populations, but the morphology of the AIIS in patients with symptomatic acetabular dysplasia undergoing periacetabular osteotomy (PAO) has not been studied. In acetabular dysplasia, deficiency of the anterosuperior acetabular rim is commonly present and may result in the AIIS being positioned closer to the acetabular rim. Understanding morphological variation of the AIIS in patients with symptomatic dysplasia, and its relationship to dysplasia subtype and severity may aid preoperative planning, surgical technique, and evaluation of postoperative issues after PAO. QUESTIONS/PURPOSES In this study, we sought to determine: (1) the variability of AIIS morphology types in hips with symptomatic acetabular dysplasia and (2) whether the differences in the proportion of AIIS morphologies are present between dysplasia pattern and severity subtypes. METHODS Using our hip preservation database, we identified 153 hips (148 patients) who underwent PAO from October 2013 to July 2015. Inclusion criteria for the current study were (lateral center-edge angle [LCEA] < 20°), Tönnis Grade of 0 or 1 on plain AP radiographs of the pelvis, preoperative low-dose CT scan, and no prior surgery, trauma, neuromuscular, ischemic necrosis, or Perthes-like deformity. A total of 50 patients (50 hips) with symptomatic acetabular dysplasia undergoing evaluation for surgical planning of PAO remained for retrospective evaluation; we used these patients' low-dose CT scans for analysis. The median (range) age of patients in the study was 24 years (13 to 49). Ninety percent (45 of 50) of the hips were in female patients, whereas 10% (5 of 50) were in male patients. The morphology of the AIIS was classified on three-dimensional CT reconstructions according to a previously published classification to define the relationship between the AIIS and the acetabular rim. The morphology of the AIIS was classified as Type I (AIIS well proximal to acetabular rim), Type II (AIIS extending to level of acetabular rim), or Type III (AIIS extending distal to acetabular rim). Acetabular dysplasia subtype was characterized according to a prior protocol as either predominantly an anterosuperior acetabular deficiency, a posterosuperior acetabular deficiency, or a global acetabular deficiency. Acetabular dysplasia severity was distinguished as mild (LCEA 15° to 20°) or moderate/severe (LCEA < 15°). To answer our first question, regarding the proportions of each AIIS morphology in the dysplasia population, we calculated proportions and 95% CI estimates. To answer our second question, regarding the proposition of AIIS type between subtypes of dysplasia type and severity, we used a chi-square test or Fisher's exact test to compare categorical variables. A p value of < 0.05 was considered significant. RESULTS Seventy-two percent (36 of 50; 95% CI 58% to 83%) of patients had a Type II or III AIIS morphology. Type I AIIS morphology was found in 28% of patients (14 of 50; 95% CI 18% to 42%), Type II AIIS morphology in 62% (31 of 50; 95% CI 48% to 74%), and Type III AIIS/morphology in 10% (5 of 50; 95% CI 4% to 21%). A Type I AIIS was seen in seven of 15 of patients with anterosuperior acetabular deficiency, three of 18 of patients with global deficiency, and four of 17 patients with posterosuperior deficiency (p = 0.08). There was no difference in the variability of AIIS morphologies between the different subtypes of acetabular dysplasia pattern and no difference in AIIS morphology variability between patients with mild versus moderate/severe dysplasia. CONCLUSIONS The morphology of the AIIS in patients with acetabular dysplasia is commonly prominent, with 72% of hips having Type II or Type III morphologies. CLINICAL RELEVANCE The AIIS is often prominent in patients with acetabular dysplasia undergoing PAO, regardless of dysplasia pattern or severity. Prominent AIIS morphologies may affect hip flexion ROM after acetabular reorientation. AIIS morphology is a variable that should be considered during preoperative planning for PAO. Future studies are needed to assess the clinical significance of a prominent AIIS on intraoperative findings and postoperative status after PAO.
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Affiliation(s)
- Douglas Nestorovski
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Marcin Wasko
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Lucas M Fowler
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Michael D Harris
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - John C Clohisy
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Jeffrey J Nepple
- D. Nestorovski, L. M. Fowler, J. C. Clohisy, J. J. Nepple, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. Wasko, Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
- M. D. Harris, Department of Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
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Moley PJ. CORRInsights®: Can the Femoro-Epiphyseal Acetabular Roof (FEAR) Index Be Used to Distinguish Dysplasia from Impingement? Clin Orthop Relat Res 2021; 479:972-973. [PMID: 33830964 PMCID: PMC8052059 DOI: 10.1097/corr.0000000000001700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Peter J Moley
- P. J. Moley, Hospital for Special Surgery, Physiatry, New York, NY, USA
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27
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Mastel MS, El-Bakoury A, Parkar A, Sharma R, Johnston KD. Outcomes of femoral de-rotation osteotomy for treatment of femoroacetabular impingement in adults with decreased femoral anteversion. J Hip Preserv Surg 2021; 7:755-763. [PMID: 34377518 PMCID: PMC8349582 DOI: 10.1093/jhps/hnab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring –3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23–98) compared to the average pre-operative score of 42.8 points (r: 0–56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13–70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).
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Affiliation(s)
- M S Mastel
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
- Correspondence to: M.S. Mastel. E-mail:
| | - A El-Bakoury
- Department of Orthopaedics, University Hospitals Plymouth NHS Trust,Derriford Hospital, Derriford Road, Crownhill, Plymouth, Pl68DH, UK
- Department of Orthopaedics, Faculty of Medicine, University of Alexandria, El-Khortoum Square, Alexandria, Egypt
| | - A Parkar
- Department of Orthopaedics, Barking, Havering and Redbridge University Hospital, NHS Trust, Queen's Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - R Sharma
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Alberta Hip and Knee Clinic, 401 9 Ave SW #335, Calgary, AB T2P 3C5, Canada
| | - K D Johnston
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Alberta Hip and Knee Clinic, 401 9 Ave SW #335, Calgary, AB T2P 3C5, Canada
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Taniguchi T, Harada T, Iidaka T, Hashizume H, Taniguchi W, Oka H, Asai Y, Muraki S, Akune T, Nakamura K, Kawaguchi H, Yoshida M, Tanaka S, Yamada H, Yoshimura N. Prevalence and associated factors of pistol grip deformity in Japanese local residents. Sci Rep 2021; 11:6025. [PMID: 33727622 PMCID: PMC7966377 DOI: 10.1038/s41598-021-85521-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Pistol grip deformity (PGD) may be the main factor in femoroacetabular impingement development. This study aimed to clarify the epidemiological indices and factors related to PGD in Japanese people. This population-based cohort study included 1575 local Japanese residents. PGD, center edge angle, and joint space width were measured radiographically. We investigated the relationship between PGD and spino-pelvic parameters. Factors associated with PGD were examined using multiple logistic regression analysis, with the presence/absence of PGD as an objective variable, and sex, age, body mass index (BMI), and the presence/absence of hip pain or spino-pelvic parameters as explanatory variables. In the entire cohort, 4.9% (10.6% men, 2.1% women) had PGD on at least one side. A trend was observed between PGD and increasing age in both men and women (men: p < 0.0001, women: p = 0.0004). No relationship was observed between PGD and hip pain (risk ratio 1.0 [95% confidence interval 0.97–1.03]). Factors significantly associated with PGD were age, sex, and BMI in the multivariate model. Acquired factors may be related to PGD in Japanese people as the PGD prevalence increased with age and PGD was not significantly associated with hip pain. This study provides new insights into the etiology and clinical significance of PGD.
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Affiliation(s)
- Takaya Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan.
| | - Teiji Harada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Wataru Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toru Akune
- Rehabilitation Services Bureau, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, Japan
| | - Kozo Nakamura
- Department of Orthopaedic Surgery, Towa Hospital, Towa, Adachi-ku, Tokyo, Japan
| | - Hiroshi Kawaguchi
- Department of Orthopaedics and Spine, Tokyo Neurological Center, 4-1-17 Toranomon, Minato-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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Meheux CJ, Hirase T, Dong D, Clyburn TA, Harris JD. Healthy Hip Joints Have Different Macroscopic and Microscopic Capsular Nerve Architecture Compared With Hips With Osteoarthritis, Femoroacetabular Impingement Syndrome, and Developmental Dysplasia of the Hip: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e269-e276. [PMID: 33615274 PMCID: PMC7879181 DOI: 10.1016/j.asmr.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To perform a systematic review to identify macroscopic and microscopic patterns and differences in hip capsule innervation between normal hips and hips with osteoarthritis (OA), femoroacetabular impingement (FAI) syndrome, and developmental dysplasia of the hip (DDH). METHODS A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Multiple databases were searched for both clinical and basic science laboratory studies on hip capsule innervation. Non-innervation capsule and non-human animal studies were excluded. Macroscopic and microscopic differences in capsular innervation between normal hips, and hips with OA, FAI, and DDH were analyzed. Methodological quality assessment of all studies included in this review was completed using the Methodological Index for Non-randomized Studies. RESULTS Ten articles were analyzed (263 specimens; 211 patients, 52 cadavers; mean Methodological Index for Non-randomized Studies 10/16). The hip capsule is innervated by the sciatic and superior gluteal nerves posterosuperiorly, nerve to quadratus femoris and inferior gluteal nerve posteroinferiorly, and femoral and obturator nerves anteriorly. The anterior-superior capsule between 1:00 and 2:30 o'clock on a right hip is a safe internervous zone. The superolateral capsule has the greatest density of mechanoreceptors and sensory fibers. OA is associated with a greater expression of nerve fibers compared with normal hips but does not correlate with pain or disability. No significant differences were found in nerve fiber expression among patients with DDH, FAI, or normal hips. A negative correlation is seen with aging and pain fiber expression. CONCLUSIONS The hip capsule has a complex macroscopic and microscopic innervation pattern with varying nerve fiber expression from at least 6 separate peripheral nerves. OA is associated with a greater expression of nerve fibers, although nerve fiber expression does not correlate with painful pathology. LEVEL OF EVIDENCE IV, Systematic review of level I-IV studies.
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Affiliation(s)
- Carlos J. Meheux
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - David Dong
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Terry A. Clyburn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Joshua D. Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
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Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Augmented reality (AR)-based surgical navigation may offer new possibilities for safe and accurate surgical execution of complex osteotomies. In this study we investigated the feasibility of navigating the periacetabular osteotomy of Ganz (PAO), known as one of the most complex orthopedic interventions, on two cadaveric pelves under realistic operating room conditions. Preoperative planning was conducted on computed tomography (CT)-reconstructed 3D models using an in-house developed software, which allowed creating cutting plane objects for planning of the osteotomies and reorientation of the acetabular fragment. An AR application was developed comprising point-based registration, motion compensation and guidance for osteotomies as well as fragment reorientation. Navigation accuracy was evaluated on CT-reconstructed 3D models, resulting in an error of 10.8 mm for osteotomy starting points and 5.4° for osteotomy directions. The reorientation errors were 6.7°, 7.0° and 0.9° for the x-, y- and z-axis, respectively. Average postoperative error of LCE angle was 4.5°. Our study demonstrated that the AR-based execution of complex osteotomies is feasible. Fragment realignment navigation needs further improvement, although it is more accurate than the state of the art in PAO surgery.
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Kaplan DJ, Samim M, Burke CJ, Baron SL, Meislin RJ, Youm T. Decreased Hip Labral Width Measured via Preoperative Magnetic Resonance Imaging Is Associated With Inferior Outcomes for Arthroscopic Labral Repair for Femoroacetabular Impingement. Arthroscopy 2021; 37:98-107. [PMID: 32828937 DOI: 10.1016/j.arthro.2020.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and hip-specific validated patient self-reported outcomes at a minimum of 2 years' follow-up. METHODS We performed an institutional review board-approved retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017. The inclusion criteria were defined as patients aged 18 to 65 years with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair and had a minimum of 2 years' clinical follow-up. The exclusion criteria were defined as inadequate preoperative imaging, prior hip surgery, Tönnis grade 1 or higher, or lateral center-edge angle lower than 25°. An a priori power analysis was performed. MRI measurements of labral width were conducted by 2 blinded, musculoskeletal fellowship-trained radiologists at standardized "clock-face" locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), modified Harris Hip Score (mHHS), and Non-arthritic Hip Score (NAHS). For the mHHS, scores of 8 and 74 were used to define the minimal clinically important difference and patient acceptable symptomatic state, respectively. Patients were divided into groups by a labral width less than 1 SD below the mean (hypoplastic) or widths above 1 SD below the mean. Statistical analysis was performed using linear and polynomial regression; the Mann-Whitney U, χ2, and Fisher exact tests; and intraclass correlation coefficient testing. RESULTS A total of 103 patients (107 hips) met the inclusion criteria (mean age, 39.4 ± 17 years; body mass index, 25.0 ± 4; 51% right sided; 68% female patients; mean follow-up, 76.5 ± 19.1 months [range, 30.0-113.0 months]). Mean labral width at the 11:30 clock-face position (indirect rectus), 3-o'clock position (psoas U), and 1:30 clock-face position (point halfway between the 2 aforementioned positions) was 7.1 ± 2.2 mm, 7.0 ± 2.0 mm, and 5.5 ± 1.9 mm, respectively. Intraclass correlation coefficient agreements were good to excellent between readers at all positions (0.83-0.91, P < .001). The preoperative HHS, mHHS, and NAHS were not statistically significantly different (P > .05) between the 2 groups. Sex, laterality, and body mass index were not predictive of outcomes (P > .05). The postoperative HHS, mHHS, and NAHS were found to be significantly lower in the hypoplastic group at each location tested (P < .01), including the mHHS at the 11:30 clock-face position (69 vs 87), 3-o'clock position (70 vs 87), and 1:30 clock-face position (71 vs 87). The proportion of patients with hypoplastic labra who reached the minimal clinically important difference was significantly lower (P < .001) at the 11:30 clock-face position (50% vs 91%), 3-o'clock position (56% vs 90%), and 1:30 clock-face position (58% vs 91%) in comparison to the non-hypoplastic labrum group. The proportion of patients with hypoplastic labra above the patient acceptable symptomatic state was significantly lower (P < .001) at the 11:30 clock-face position (44% vs 83%), 3-o'clock position (37.5% vs 84%), and 1:30 clock-face position (42% vs 85%) in comparison to the non-hypoplastic labrum group. Linear regression modeling was not significant at any position (P > .05). Polynomial regression was significant at the 11:30 clock-face position (R2 = 0.23, P < .001), 3-o'clock position (R2 = 0.17, P < .001), and 1:30 clock-face position (R2 = 0.26, P < .004). CONCLUSIONS Hip labral width less than 1 SD below the mean measured via preoperative MRI was associated with significantly worse functional outcomes after arthroscopic labral repair and treatment of femoroacetabular impingement. The negative relation between labral width and outcomes may be nonlinear. LEVEL OF EVIDENCE Level IV, case series with subgroup analysis.
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Affiliation(s)
- Daniel J Kaplan
- Orthopaedic Department, Division of Sports Medicine, New York Langone Medical Center, New York, New York, U.S.A.
| | - Mohammad Samim
- Radiology Department, Musculoskeletal Division, New York Langone Medical Center, New York, New York, U.S.A
| | - Christopher J Burke
- Radiology Department, Musculoskeletal Division, New York Langone Medical Center, New York, New York, U.S.A
| | - Samuel L Baron
- Orthopaedic Department, Division of Sports Medicine, New York Langone Medical Center, New York, New York, U.S.A
| | - Robert J Meislin
- Orthopaedic Department, Division of Sports Medicine, New York Langone Medical Center, New York, New York, U.S.A
| | - Thomas Youm
- Orthopaedic Department, Division of Sports Medicine, New York Langone Medical Center, New York, New York, U.S.A
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Van Houcke J, Khanduja V, Audenaert EA. Accurate Arthroscopic Cam Resection Normalizes Contact Stresses in Patients With Femoroacetabular Impingement. Am J Sports Med 2021; 49:42-48. [PMID: 33237821 DOI: 10.1177/0363546520974378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is increasingly recognized as a cause of hip pain in young adults. The condition leads to chondrolabral separation and chondral delamination and eventually predisposes to osteoarthritis of the hip. FAI that inflicts cartilage damage has been observed in hips with abnormal morphological characteristics and is related to a long-term evolution toward osteoarthritis. Arthroscopic surgery, which allows for correction of morphological characteristics and restores impingement-free motions, is the current standard of treatment. HYPOTHESIS Arthroscopic cam resection can restore the normal mechanical environment of the hip joint in cam-type FAI. STUDY DESIGN Descriptive laboratory study. METHODS Patient-specific discrete element models from 10 patients with cam-type FAI (all male; age, 18-40 years) were defined based on preoperative computed tomography scans and postoperative magnetic resonance imaging (MRI) scans. Complete cam resection postoperatively on MRI was confirmed with alpha angles <55°. The preoperative and postoperative peak contact stress findings during impingement testing were compared against a matched control group. RESULTS Peak contact stress was significantly elevated in patients with cam-type FAI during impingement testing, with increasing amounts of internal hip rotation (26.6 ± 11.64 MPa in cam patients preoperatively, 12.1 ± 4.62 MPa in those same patients postoperatively, and 11.4 ± 1.72 MPa in the virtual control group during impingement testing at 20° of internal hip rotation; P < .01). This effect was normalized after arthroscopic cam resection and loading patterns matched those of the control group. CONCLUSION Accurate arthroscopic cam resection restored the normal peak joint contact stresses in the hip joint. This highlights the importance of early and complete cam resections in the face of a positive diagnosis of cam-type FAI. CLINICAL RELEVANCE Treatment of cam-type FAI effectively normalizes hip joint contact mechanics.
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Affiliation(s)
- Jan Van Houcke
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium
| | - Vikas Khanduja
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium.,Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Hale RF, Melugin HP, Zhou J, LaPrade MD, Bernard C, Leland D, Levy BA, Krych AJ. Incidence of Femoroacetabular Impingement and Surgical Management Trends Over Time. Am J Sports Med 2021; 49:35-41. [PMID: 33226833 PMCID: PMC8025987 DOI: 10.1177/0363546520970914] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a well-known cause of hip pain in adolescents and young adults. However, the incidence in the general population has not been clearly defined. PURPOSE To (1) define the population-based incidence of diagnosis of FAI in patients with hip pain, (2) report the trends in diagnosis of FAI over time, and (3) determine the changes in the rate and type of surgical management over time. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A geographic database was used to identify patients who were 14 to 50 years old with hip pain between the years 2000 and 2016. Chart and radiographic review was performed to determine which patients had FAI. To be included, patients had to have a triad of clinical symptoms, physical examination signs, and imaging findings consistent with FAI. Medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Statistical analysis determined the overall age- and sex-adjusted annual incidence of FAI diagnosis and trends over time. RESULTS There were 1893 patients evaluated with hip pain, and 716 (38%; 813 hips) had diagnosed FAI. The mean ± SD age was 27.2 ± 8.4 years, and 67% were female. The incidence of FAI diagnosis was 54.4 per 100,000 person-years. Female patients had a higher incidence than male patients (73.2 vs 36.1 per 100,000 person-years; P < .01). Incidence of FAI diagnosis were higher from 2010 to 2016 (72.6 per 100,000 person-years; P < .01) as compared with 2005 to 2009 (45.3) and 2000 to 2004 (40.3). Hip arthroscopy, surgical hip dislocation, and periacetabular osteotomy utilization increased from the 2000-2004 to 2010-2016 periods, respectively: 1 (1%) to 160 (20%; P = .04), 2 (1%) to 37 (5%; P = .01), and 1 (1%) to 22 (3%; P = .58). CONCLUSION The overall incidence of FAI diagnosis was 54.4 per 100,000 person-years, and it consistently increased between 2000 and 2016. Female patients had a higher incidence than male patients. The utilization of joint preservation operations, including hip arthroscopy, surgical hip dislocation, and anteverting periacetabular osteotomy, increased over time.
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Affiliation(s)
- Rena F. Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Heath P. Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Matthew D. LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Devin Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Address correspondence to Aaron J. Krych, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA ()
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Kiarostami P, Dennler C, Roner S, Sutter R, Fürnstahl P, Farshad M, Rahm S, Zingg PO. Augmented reality-guided periacetabular osteotomy-proof of concept. J Orthop Surg Res 2020; 15:540. [PMID: 33203429 PMCID: PMC7672946 DOI: 10.1186/s13018-020-02066-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Ganz' periacetabular osteotomy (PAO) consists of four technically challenging osteotomies (OT), namely, supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular OT (raOT). PURPOSE We performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience. METHODS A 3D preoperative plan of a PAO was created from segmented computed tomography (CT) data of an anatomic plastic pelvis model (PPM). The plan was then embedded in a software application for an AR head-mounted device. Soft tissue coverage was imitated using foam rubber. The 3D plan was then registered onto the PPM using an anatomical landmark registration. Two surgeons (one experienced and one novice PAO surgeon) each performed 15 freehand (FH) and 15 AR-guided PAOs. The starting point distances and angulation between the planned and executed OT planes for the FH and the AR-guided PAOs were compared in post-intervention CTs. RESULTS AR guidance did not affect the performance of the expert surgeon in terms of the mean differences between the planned and executed starting points, but the raOT angle was more accurate as compared to FH PAO (p = 0.0027). AR guidance increased the accuracy of the performance of the novice surgeon for iOT (p = 0.03). An intraarticular osteotomy performed by the novice surgeon with the FH technique could be observed only once. CONCLUSION AR guidance of osteotomies for PAOs is feasible and seems to increase accuracy. The effect is more accentuated for less-experienced surgeons. CLINICAL RELEVANCE This is the first proof of concept study documenting the feasibility of AR guidance for PAO. Based on these findings, further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures.
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Affiliation(s)
- Pascal Kiarostami
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Cyrill Dennler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Simon Roner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research & Development Group, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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Ometti M, Schipani D, Conte P, Pironti P, Salini V. The efficacy of intra-articular HYADD4-G injection in the treatment of femoroacetabular impingement: results at one year follow up. J Drug Assess 2020; 9:159-166. [PMID: 33235816 PMCID: PMC7671711 DOI: 10.1080/21556660.2020.1843860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceutici) in FAI. Methods All patients received two weekly intra-articular injections of Hymovis at baseline and after 7 days. Clinical and functional assessments were performed at baseline and was repeated after 1, 3, 6 and 12 months. Functional measures included visual analogue scale (VAS) for pain, Harris Hip score (HHS), Lequesne Index (LI), Tegner activity level scale (TALS) and monthly consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). Results Twenty-one hips (19 patients, 2 bilateral cases) were treated. The variables VAS, HHS as well as Lequesne improved significantly from T0 to T4 (at 12 months) with the best improvement between T0 and T1. At the same time, a reduction in NSAIDs monthly intake was registered. On the other hand, a significant improvement in Tegner scale was not observed. No adverse events were registered. Conclusion This study states that one cycle of HYADD4-G could be a safe and effective treatment in patients with FAI, showing significative results in term of pain control as well as hip functionality and quality of life up to 1 year.
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Affiliation(s)
- Marco Ometti
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pietro Conte
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Pierluigi Pironti
- Università degli Studi di Milano, Scuola di Specializzazione in Ortopedia e Traumatologia, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute, Milan, Italy
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You JS, Flores SE, Friedman JM, Lansdown DA, Zhang AL. The Learning Curve for Hip Arthroscopic Surgery: A Prospective Evaluation With 2-Year Outcomes in Patients With Femoroacetabular Impingement. Orthop J Sports Med 2020; 8:2325967120959140. [PMID: 33178877 PMCID: PMC7592324 DOI: 10.1177/2325967120959140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background The use of hip arthroscopic surgery in the treatment of femoroacetabular impingement (FAI) is increasing, but it is universally known as a technically demanding procedure with a "steep" learning curve. There are limited data investigating the correlation between surgeon experience and patient-reported outcomes (PROs) as well as procedure and traction times. Purpose To prospectively evaluate the relationship between surgeon experience and PROs after hip arthroscopic surgery for the treatment of FAI. Study Design Cohort study; Level of evidence, 2. Methods A total of 190 patients undergoing primary hip arthroscopic surgery for FAI were prospectively enrolled during a sports medicine fellowship-trained surgeon's first 36 months of practice. A radiographic evaluation as well as PRO surveys including the 12-Item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS) were administered preoperatively and at 2 years postoperatively. Logistic regression as well as analysis of variance was performed to evaluate for correlations between surgical experience and PROs, procedure time, and traction time. Results Of the 190 patients, 168 (88%; mean age, 35.3 ± 9.6 years; mean body mass index, 25.07 ± 3.98) completed a 2-year follow-up and were included for analysis. The mean procedure time was 91.5 ± 23.9 minutes, and the mean traction time was 54.0 ± 17.7 minutes. Patients demonstrated significant improvements at 2 years after surgery for all PRO scores (mHHS, HOOS, and SF-12 physical component summary; P < .001), except the SF-12 mental component summary, which had no change (P = .43). The procedure time significantly decreased after 70 cases, while the traction time continued to decrease until 110 cases (R 2 = 0.99; P < .0001). There was no correlation between increasing case volume and 2-year PRO scores (P > .2 for mHHS, HOOS, and SF-12). There was also no difference with increasing case volume and amount of improvement from preoperative to 2-year postoperative PRO scores for the SF-12 and HOOS. Case volume did not affect the complication rate, as this cohort experienced 4 minor cases of neurapraxia. Conclusion Surgical efficiency in hip arthroscopic surgery for the treatment of FAI was maximized after 110 cases in this cohort. However, significant PRO improvements can be achieved early in a surgeon's practice prior to maximizing surgical efficiency.
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Affiliation(s)
- Jae S You
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sergio E Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James M Friedman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Thiagarajah S, Bingham JS, Grammatopoulos G, Witt J. A minimally invasive periacetabular osteotomy technique: minimizing intraoperative risks. J Hip Preserv Surg 2020; 7:591-595. [PMID: 33948215 PMCID: PMC8081413 DOI: 10.1093/jhps/hnaa040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/24/2020] [Accepted: 08/15/2020] [Indexed: 11/14/2022] Open
Abstract
The periacetabular osteotomy (PAO) is an extensive surgical procedure associated with potential risk to the adjacent neurovascular structures. A steep learning curve exists, with surgeon experience an important factor in outcome. Little detail exists of the osteotomies themselves, and how to make them safe and reproducible. This article describes our PAO technique with emphasis on specific safety steps. When performing the posterior column cut, migration of the osteotome beyond the lateral pelvis may lead to damage of the sciatic nerve. The safety features detailed include novel measurement of the posterior column width and the use of specific-width osteotomes to complete this osteotomy. To plan the cut, several computerized tomography-based measurements are taken starting just above the greater sciatic notch and continuing down to the inferior part of the acetabulum. The angle of this cut is determined by acetabular morphology and the width of the posterior column. These posterior column width measurements will determine the width of the osteotomes used to perform the cut with little risk that an osteotome will penetrate too far on the lateral side of the pelvis. To ensure the lateral cortex has been cut completely proximally, an osteotome with pre-measured depths may be used from a medial to a direct lateral trajectory. The senior author has been performing this modified approach since 2010 (n = 530 PAOs) and has witnessed no vascular injuries and no nerve injuries aside from minor lateral femoral cutaneous nerve issues. Utilization of these techniques has prevented any major nerve injury without the need for intraoperative electromyography.
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Affiliation(s)
- Shankar Thiagarajah
- Department of Orthopaedic Surgery, Doncaster & Bassetlaw Teaching Hospitals, Thorne Road, Doncaster DN2 5LT, UK
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo BLVD, Phoenix, AZ 85054, USA
| | - George Grammatopoulos
- Orthopaedic Department, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Johan Witt
- Department of Hip Preservation, University College London Hospitals, 235 Euston Road, London NW12PQ, UK
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Iwamoto M, Fujii M, Komiyama K, Sakemi Y, Shiomoto K, Kitamura K, Yamaguchi R, Nakashima Y. Is lateral acetabular rotation sufficient to correct anterolateral deficiency in periacetabular reorientation osteotomy? A CT-Based simulation study. J Orthop Sci 2020; 25:1008-1014. [PMID: 32035753 DOI: 10.1016/j.jos.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. METHODS We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. RESULTS After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). CONCLUSIONS Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°-15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.
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Affiliation(s)
- Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuta Sakemi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Hatem M, Nimmons SJ, Khoury AN, Martin HD. Spinopelvic Parameters Do Not Predict the Sagittal Orientation of the Acetabulum. Orthop J Sports Med 2020; 8:2325967120957420. [PMID: 33117848 PMCID: PMC7570799 DOI: 10.1177/2325967120957420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The orientation of the acetabulum has a fundamental role in impingement and instability of the hip, and the spinopelvic parameters are thought to predict the sagittal orientation of the acetabulum (SOA). However, similar to the acetabular version (axial orientation) and inclination (coronal orientation), the cephalic or caudal orientation of the acetabulum in the sagittal plane, or SOA, may primarily be an intrinsic feature of the acetabulum itself. Purpose: To determine whether the spinopelvic parameters predict the sagittal orientation of the acetabulum in individuals without lumbar deformity. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A retrospective analysis was performed in 89 patients (94 hips; 62 female, 27 male; mean ± SD age, 45.9 ± 15.4 years) without lumbosacral deformity who underwent magnetic resonance arthrogram (MRA) for assessment of hip pain. The SOA was determined in the sagittal cut MRA. A line was drawn at the distal limit of the anterior and posterior acetabular horns longitudinally to the transverse ligament, and the angle between this line and the axial plane represented the SOA. The sacral slope, pelvic incidence, and spinopelvic tilt were determined using a 3-dimensional cursor and the axial, sagittal, and coronal cuts. All MRA studies were performed with the patient in the supine position. Results: The SOA had a mean ± SD cephalic orientation of 18° ± 6.6°. No significant correlation was observed between the SOA and the sacral slope (r = –0.03; P = .77). A weak correlation was observed between the SOA and the pelvic incidence (r = 0.22; P = .03) and between the SOA and the spinopelvic tilt (r = 0.41; P < .01). Conclusion: The SOA cannot be presumed based on the spinopelvic parameter. Similar to the well-known parameters to assess the axial and coronal orientation of the acetabulum, the assessment of the SOA demands acetabular-specific parameters. Additional studies are necessary to assess the SOA in asymptomatic hips, including disparities between genders. Clinically significant values for abnormal SOA of the acetabulum remain to be defined.
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Affiliation(s)
- Munif Hatem
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Scott J Nimmons
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
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Melugin HP, Hale RF, Zhou J, LaPrade M, Bernard C, Leland D, Levy BA, Krych AJ. Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention. Am J Sports Med 2020; 48:2881-2886. [PMID: 32822223 PMCID: PMC8087082 DOI: 10.1177/0363546520949179] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and total hip arthroplasty (THA) at a young age. Unfortunately, little is known about the specific factors associated with an increased risk of OA. PURPOSE To (1) report the overall rate of symptomatic hip OA and/or THA in patients with FAI without surgical intervention and (2) identify radiographic features and patient characteristics associated with hip OA. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A geographic database was used to identify all patients with hip pain and radiographs between 2000 and 2016. Chart review was performed to identify patients with FAI. Patient medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Kaplan-Meier analysis was used to determine the rate of hip OA. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. RESULTS The study included 952 patients (649 female; 303 male; 1104 total hips) with FAI. The majority of hips had mixed type (n = 785; 71.1%), 211 (19.1%) had pincer type, and 108 (9.8%) had cam type. Mean age at time of presentation was 27.6 ± 8.7 years. Mean follow-up time was 24.7 ± 12.5 years. The rate of OA was 13.5%. THA was performed in 4% of patients. Male sex, body mass index (BMI) greater than 29, and increased age were risk factors for OA (male sex: hazard ratio [HR], 2.28; P < .01; BMI >29: HR, 2.11; P < .01; per year of increased age: HR, 1.11; P < .01.). Smoking and diabetes mellitus were not significant risk factors. No radiographic morphological features were found to be significant risk factors for OA. CONCLUSION At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. BMI greater than 29, male sex, and increased age at the time of presentation with hip pain were risk factors for hip OA. The cohort consisted of a large percentage of mixed-type FAI morphologies, and no specific radiographic risk factors for OA were identified.
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Affiliation(s)
- Heath P. Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rena F. Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Matthew LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Devin Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
- Kenki Matsumoto
- Cambridge University School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Reinhold Ganz
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge, UK
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Kamenaga T, Hayashi S, Hashimoto S, Fukuda K, Takayama K, Tsubosaka M, Takashima Y, Niikura T, Kuroda R, Matsumoto T. Pelvic morphology medial to the femoral head center predicts anterior coverage and range of motion after curved periacetabular osteotomy. J Orthop Res 2020; 38:2031-2039. [PMID: 32034795 DOI: 10.1002/jor.24624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/30/2020] [Indexed: 02/04/2023]
Abstract
This study observed anterior coverage extent after lateral rotation of the acetabulum, without anterior or posterior rotation, during curved periacetabular osteotomy by three-dimensional simulation, and determined if preoperative pelvic morphology affects postoperative anterior coverage and range of motion. Thirty patients scheduled for consecutive primary curved periacetabular osteotomy for developmental hip dysplasia at our hospital between 2016 and 2017 were included. Virtual acetabular osteotomies were performed to achieve a postoperative lateral center-edge angle of 30°. We measured anterior center-edge angles before curved periacetabular osteotomy through the medial one-third and one-quarter of the femoral head as an index reflecting the pelvic morphology medial to the femoral head center. The range of motion simulation was performed after virtual curved periacetabular osteotomy. Single linear regression analysis was performed to examine correlations between preoperative pelvic morphology parameters and anterior center-edge angles after virtual osteotomy. Furthermore, linear regression analysis was used to assess correlations between center-edge angles and simulated range of motions (P < .05). Anterior center-edge angle after virtual osteotomy was more strongly correlated with the anterior center-edge angle through the medial one-third (r = .92, P < .0001) and one-quarter (r = .84, P < .0001) of the femoral head. Flexion angle and internal rotation at 90° flexion showed significant correlations with anterior center-edge angle through the medial one-third (r = -.62, P = .0003; r = -.57, P = .001) and one-quarter (r = -.60, P = .0005; r = -.55, P = .002) of the femoral head and anterior center-edge angle after virtual osteotomy (r = -.67, P = .0005; r = -.62, P = .0003). Measuring preoperative parameters reflecting pelvic morphology enables surgeons to predict postoperative anterior coverage and range of motion in curved periacetabular osteotomy cases.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Takashima
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Kamenaga T, Niikura T, Kuroda R. Preoperative anterior coverage of the medial acetabulum can predict postoperative anterior coverage and range of motion after periacetabular osteotomy: a cohort study. J Orthop Surg Res 2020; 15:312. [PMID: 32778126 PMCID: PMC7419220 DOI: 10.1186/s13018-020-01818-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We hypothesized that preoperative pelvic morphology may affect postoperative anterior coverage and postoperative clinical range of motion (ROM) leading to postoperative pincer type femoroacetabular impingement (FAI). The aim of this study was to evaluate the relationships between preoperative bone morphology and postoperative ROMs to prevent postoperative FAI after periacetabular osteotomy. METHODS Sixty-eight patients (71 hips) with hip dysplasia participated in this study and underwent curved PAO. The acetabular fragment was usually moved only by lateral rotation of the acetabulum, without intraoperative anterior or posterior rotation. The pre- and postoperative three-dimensional center-edge (CE) angles were measured and compared to the postoperative ROM. RESULTS Preoperative medial anterior CE angle was significantly associated with postoperative anterior CE angle, and the correlation coefficient of medial anterior CE and postoperative anterior CE was higher than the coefficient of preoperative anterior CE and postoperative anterior CE (preoperative anterior CE, rr = 0.27, p = 0.020; preoperative medial anterior CE, rr = 0.54, p < 0.001). Femoral anteversion correlated with postoperative internal rotation angle at 90° flexion (r = 0.32, p = 0.021). In multiple linear regressions, postoperative internal rotation angle at 90° flexion angle was significantly affected by both medial CE angle through the medial one fourth of femoral head and femoral anteversion. CONCLUSIONS Preoperative medial anterior acetabular coverage was associated with postoperative anterior acetabular coverage. Further, the combination with preoperative medial anterior acetabular coverage and femoral anteversion can predict postoperative internal rotation at 90° flexion. Therefore, the direction of acetabular reorientation should be carefully considered when the patients have high preoperative medial anterior CE angle and small femoral anteversion.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
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Hamada H, Takao M, Ando W, Sugano N. Incidence and determinants of anteflexion impairment after rotational acetabular osteotomy. J Orthop Res 2020; 38:1787-1792. [PMID: 31989697 DOI: 10.1002/jor.24600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 02/04/2023]
Abstract
This study aimed to identify the incidence of anteflexion impairment after rotational acetabular osteotomy based on patient-reported outcome measures, and the morphological factors and postoperative bony range of motion associated with anteflexion impairment at 2 years postoperatively. We analyzed 26 patients with developmental dysplasia of the hip who underwent rotational acetabular osteotomy at our institution. Using questionnaires, we defined anteflexion impairment as difficulty in clipping toenails and pulling up and removing socks. Morphological parameters and bony range of motion measured using a postoperative three-dimensional surface model, were compared between the subjects with and without anteflexion impairment. The incidence of anteflexion impairment was 69% at 6 months, 35% at 1 year, and 12% at 2 years after rotational acetabular osteotomy. The mean bony flexion angle was smaller in subjects with impairment than in those without impairment. The mean internal rotation (IR) angle at 90° of flexion was smaller in subjects with impairment than in those without impairment. The incidence of impairment was significantly higher in subjects with both less than or equal to 105° of bony flexion and less than or equal to 20° of IR at 90° of flexion than in the remaining subjects. No significant difference was observed in postoperative femoral head coverage and preoperative morphological parameters including spinal condition between the two groups. To prevent femoroacetabular impingement after rotational acetabular osteotomy, surgeons need to reorient the acetabulum to restore postoperative bony flexion to more than or equal to 105° and/or postoperative IR range of motion to more than or equal to 20° at 90° of flexion.
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Affiliation(s)
- Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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McQuivey KS, Secretov E, Domb BG, Levy BA, Krych AJ, Neville M, Hartigan DE. A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle. Am J Sports Med 2020; 48:1608-1615. [PMID: 32343594 DOI: 10.1177/0363546520914942] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy has been previously demonstrated to be an effective treatment for adult mild hip dysplasia. There are many radiographic parameters used to classify hip dysplasia, but to date few studies have demonstrated which parameters are of most importance for predicting surgical outcomes. PURPOSE To identify preoperative radiographic parameters that are associated with poor outcomes in the arthroscopic treatment of adult mild hip dysplasia. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Radiographic analysis was performed in patients with mild hip dysplasia who underwent arthroscopic surgery between 2009 and 2015. Preoperative radiographic measurements included lateral center edge angle, Tönnis angle, neck shaft angle, anterior center edge angle, alpha angle, femoral head extrusion index, and acetabular depth-to-width ratio. Failure was defined as failure to achieve the minimal clinically important difference (MCID) utilizing the modified Harris Hip Score or as the need for secondary operation. The equal variance t test was used to analyze radiographic parameters. Statistical significance was determined using a P value of .05. RESULTS A total of 373 hips underwent analysis with an average follow-up of 41 months (range, 24-102 months). Of these, 46 hips (12%) required secondary operation, and 95 (25%) failed to meet the MCID. The overall failure rate was 32.4%. There was no single measurement or combination thereof associated with failure to reach the MCID. Higher preoperative Tönnis angles were associated with secondary operation, with a mean of 6.7° (95% CI, 5.3°-8.1°) in the secondary operation group versus 4.8° (95% CI, 4.4°-5.3°) in the nonsecondary operation group (P = .006). The odds ratio was 1.12 (95% CI, 1.0-1.2; P = .05) per degree increase in Tönnis angle for secondary operation. In patients with a Tönnis angle >10°, 84% required secondary operation. CONCLUSION Higher Tönnis angles portend a higher risk for revision surgery. The probability of secondary operation was increased by a magnitude of 1.12 with each degree increase in the Tönnis angle. In patients with a Tönnis angle >10°, 84% required a secondary operation.
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Affiliation(s)
- Kade S McQuivey
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Erwin Secretov
- Department of Orthopedics, University of Illinois, Chicago, Illinois, USA
| | - Benjamin G Domb
- Department of Orthopedics, American Hip Institute, Des Plaines, Illinois, USA
| | - Bruce A Levy
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew Neville
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David E Hartigan
- Department of Orthopedic Surgery, Twin Cities Orthopedics, Minneapolis, Minnesota, USA
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[Diagnostic algorithm "FAI and sports hernia" : Results of the consensus meeting for groin pain in athletes]. DER ORTHOPADE 2020; 49:211-217. [PMID: 31515590 DOI: 10.1007/s00132-019-03775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As a result of the complexity and diversity of diseases in the region of the groin, differentiation of the various soft-tissue and bone pathologies remains a challenge for differential diagnosis in routine clinical practice. In the case of athletes with pain localized in the area of the groin, femoroacetabular impingement (FAI) and athlete's groin must be considered as important causes of the groin pain, whereby the common occurrence of double pathologies further complicates diagnosis. Despite the importance of groin pain and its differential diagnoses in everyday clinical practice, there has been a lack of recognized recommendations for diagnostic procedure to date. To this end, a consensus meeting was held in February 2017, in which a group composed equally of groin and hip surgeons took part. With the formulation of recommendations and the establishment of a practicable diagnostic path, colleagues that are involved in treating such patients should be sensitized to this issue and the quality of the diagnosis of groin pain improved in routine clinical practice.
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Zhou J, Melugin HP, Hale RF, Leland DP, Bernard CD, Levy BA, Krych AJ. The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients With Hip Pain. Am J Sports Med 2020; 48:647-653. [PMID: 31922893 DOI: 10.1177/0363546519896355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiography is the initial imaging modality used to evaluate femoroacetabular impingement (FAI), and diagnostic radiographic findings are well-established. However, the prevalence of these radiographic findings in patients with hip pain is unknown. PURPOSE The purpose was 3-fold: (1) to determine the overall prevalence of radiographic FAI deformities in young patients presenting with hip pain, (2) to identify the most common radiographic findings in patients with cam-type FAI, and (3) to identify the most common radiographic findings in patients with pincer-type FAI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A geographic database was used to identify patients aged 14 to 50 years with hip pain between the years 2000 to 2016. The following were evaluated on radiographs: cam type: typical pistol grip deformity, alpha angle >55°; pincer type: crossover sign (COS), coxa profunda or protrusio acetabuli, lateral center edge angle (LCEA) ≥40°, Tönnis angle <0°; and mixed type: both cam- and pincer-type features. Posterior wall sign (PWS) and ischial spine sign (ISS) were also evaluated. The prevalence of each was determined. Descriptive statistics were performed on all radiographic variables. RESULTS There were 1893 patients evaluated, and 1145 patients (60.5%; 1371 hips; 374 male and 771 female; mean age, 28.8 ± 8.4 years) had radiographic findings consistent with FAI. Of these hips, 139 (10.1%) had cam type, 245 (17.9%) had pincer type, and 987 (72.0%) had mixed type. The prevalence of a pistol grip deformity and an alpha angle >55° was 577 (42.1%) and 1069 (78.0%), respectively. The mean alpha angle was 66.9°± 10.5°. The prevalence of pincer-type radiographic findings was the following: COS, 1062 (77.5%); coxa profunda, 844 (61.6%); ISS, 765 (55.8%); PWS, 764 (55.7%); Tönnis angle <0°, 312 (22.8%); LCEA ≥40°, 170 (12.4%); and protrusio acetabuli, 7 (0.5%). CONCLUSION The overall prevalence of radiographic findings consistent with FAI in young patients with hip pain was 60.5%. Radiographic findings for mixed-type FAI were the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°. The most common radiographic finding for pincer-type FAI was the COS.
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Affiliation(s)
- Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heath P Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rena F Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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El-Liethy NE, Zeitoun R, Kamal HA, El-Azeem AHA. Magnetic Resonance Arthrography, a valuable pre-operative imaging modality in femoro-acetabular impingement. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The diagnostic accuracy of MR arthrography in preoperative assessment of labral tears and chondral abnormalities in femoroacetabular impingement patients.
A non-randomized control study including 31 FAI patients (17 male and 14 females, mean age 31.9 years). All patients underwent MR arthrography after US-guided intra-articular contrast injection. Conventional and MR arthrography images were evaluated for bone abnormalities (including alpha angle and acetabular depth measurements), labral tears, and chondral abnormalities. The results were correlated to arthroscopy as the gold standard. Sensitivity, specificity, PPV, and NPV in the detection of labral tears and chondral abnormalities were statistically calculated.
Results
The included FAI patients presented cam (mean age 30.4 years ± 6.8 years), pincer (mean age 33.6 years ± 9.8 years), and mixed (mean age 36.6 years ± 12.9 years) types with the predominance of cam type. Cam type predominated in the male, while pincer and mixed types predominated in female patients. MR arthrography detected 41 labral tears in 23 patients with 87.5%, 71.4%, 91.3%, and 62.5% sensitivity, specificity, PPV, and NPV, respectively, and detected chondral abnormalities in 13 patients with 66.7%, 92.3%, 92.3%, and 66.7% sensitivity, specificity, PPV, and NPV, respectively.
Conclusion
MR arthrography is a valuable imaging modality in preoperative assessment of FAI patients. Besides identifying the type of impingement through alpha angle and acetabular depth measurements, it detects labral tears with high sensitivity and PPV. Although less sensitive in detection of chondral abnormalities, our results showed high specificity.
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Pierannunzii L. Femoroacetabular impingement: question-driven review of hip joint pathophysiology from asymptomatic skeletal deformity to end-stage osteoarthritis. J Orthop Traumatol 2019; 20:32. [PMID: 31686267 PMCID: PMC6828870 DOI: 10.1186/s10195-019-0539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/28/2019] [Indexed: 11/10/2022] Open
Abstract
Femoroacetabular impingement (FAI), together with its two main pathomechanisms, cam and pincer, has become a trending topic since the end of the 1990s. Despite massive academic research, this hip disorder still conceals obscure aspects and unanswered questions that only a question-driven approach may settle. The pathway that leads a FAI asymptomatic morphology through a FAI syndrome to a FAI-related osteoarthritis is little known. Contact mechanics provides a shareable and persuasive perspective: cam FAI is based on shear contact stress at joint level with consequent cartilage wear; pincer FAI, contrariwise, determines normal contact stress between acetabular rim and femoral neck and squeezes the labrum in between, with no cartilage wear for many years from the onset. Pincer prognosis is then far better than cam. As a matter of fact, cartilage wear releases fragments of extracellular matrix which in turn trigger joint inflammation, with consequently worsening lubrication and further enhanced wear. Inflammation pathobiology feeds pathotribology through a vicious loop, finally leading to hip osteoarthritis. The association of cam and pincer, possibly overdiagnosed, is a synergic combination that may damage the joint rapidly and severely. The expectations after FAI surgical correction depend strictly on chondral layer imaging, on time elapsed from the onset of symptoms and on clinic-functional preoperative level. However, preemptive surgical correction is not recommended yet in asymptomatic FAI morphology. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- L Pierannunzii
- Orthopaedic Surgeon, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari, 1, 20122, Milan, Italy.
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Rhyu KH, Chun YS, Jung GY, Cho YJ. Age and sex-related distribution of alpha angles and the prevalence of the cam morphology of the hip in Asians do not differ from those of other ethnicities. Knee Surg Sports Traumatol Arthrosc 2019; 27:3125-3132. [PMID: 29876864 DOI: 10.1007/s00167-018-4980-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was performed to evaluate the effects of age on the alpha angle and the incidence of asymptomatic cam morphology. METHODS The radiographs of asymptomatic individuals between ages 8 and 22 were retrospectively collected. A total of 1417 individuals were included and grouped according to age: 8-12 (Group A), 13-18 (Group B), and 19-22 (Group C) years. Radiographic measurements of the alpha angles of the right hip were obtained from anteroposterior (AP) and frog-leg lateral (FL) radiographs. The correlations among alpha angles, the presence of cam morphology, and age were determined. RESULTS The mean alpha angles of the three groups were statistically different (p < 0.001, each). The alpha angles on both radiographs were positively correlated with age. Intra-group analysis revealed that this correlation was only evident on the FL images of males in Group B. The presence of a radiographic cam morphology also positively correlated with age (p < 0.001 in both AP and FL images). The cam morphology on AP radiographs was 0 in Group A, 17(3.0%) in Group B, and 21(4.8%) in Group C; that on FL radiographs was 2(0.3%) in Group A, 45(7.9%) in Group B, and 103(23.6%) in Group C. Intra-group analysis revealed that the correlation was only significant in males in Group B. CONCLUSIONS Higher alpha angles and the presence of cam morphology were positively correlated with age, particularly in males at or before the time of skeletal maturation. The prevalence of cam morphology did not differ from those in other ethnicities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea
| | - Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul, 05278, Republic of Korea
| | - Gwang Young Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea
| | - Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea.
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