Alterations in Internal Rotation and Alpha Angles Are Associated With Arthroscopic Cam Decompression in the Hip

Kelly, Bryan T.; Bedi, Asheesh; Robertson, Catherine; Torre, Katrina Dela; Giveans, M. Russell; Larson, Christopher M.

doi:10.1177/0363546512437731

Cited by 96 publications

(91 citation statements)

References 19 publications

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“…Successful removal of the mechanical block to motion should be expected to restore ROM and thus explains the difference in motion between those undergoing revision FAI surgery and those patients who were surgically treated with adequate decompression of the cam deformity. This agrees with an investigation by Kelly et al [12], which demonstrated improvement in functional ROM after restoration of the femoral head-neck junction to an alpha angle less than 50°. Kelly et al specifically noted a mean clinical increase of 18°in IRF at 3 months, which is similar to the dynamic results of our study when comparing preoperative CT scans of revision patients with postoperative CT scans of patients who underwent successful primary surgery by a high-volume hip arthroscopist.…”

Section: Discussionsupporting

confidence: 93%

Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study

Ross

Larson

Adeoye

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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143

116

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Background Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. An awareness of the most frequent locations of the residual deformities may be critical to minimize these failures. Questions/purposes The purposes of this study were to (1) define the three-dimensional (3-D) morphology of hips with residual symptoms before revision femoroacetabular impingement (FAI) surgery; (2) determine the limitation in range of motion (ROM) in these patients using dynamic, computer-assisted, 3-D analysis; and (3) compare these measures with a cohort of patients who underwent successful arthroscopic surgery for FAI by a high-volume hip arthroscopist. Methods Between 2008 and 2013, one senior surgeon (BTK) performed revision arthroscopic FAI procedures on patients with residual FAI deformity and symptoms after prior unsuccessful arthroscopic surgery; all of these 47 patients (50 hips) had preoperative CT scans. Mean patient age was 29 ± 9 years (range, 16-52 years). Three-dimensional models of the hips were created to allow measurements of femoral and acetabular morphology and ROM to bony impingement using a validated, computerbased dynamic imaging software. During the same time period, 65 patients with successful primary arthroscopic treatment of FAI by the same surgeon underwent preoperative CT scans for the symptomatic contralateral hip; this group of 65 patients thus fortuitously provided postoperative evaluation of the originally operated hip and served as a control group.

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Section: Discussionsupporting

confidence: 93%

Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study

Ross

Larson

Adeoye

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

143

116

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“…A decrease in femoral version equated to a decrease in internal rotation. Kelly et al 19 reported a similar correlation between femoral version and internal rotation. This relation highlights the importance of a thorough physical examination because increased internal rotation found during clinical assessment may be a signal of abnormal femoral version.…”

Section: Discussionmentioning

confidence: 72%

Patient-Centered Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears Are Not Different in Patients With Normal, High, or Low Femoral Version

Ferro

Briggs

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Thus, identifying anatomic factors that compensate for or exacerbate FAI or instability is important when treating young patients with hip pain. Femoral and acetabular retroversion are known to exacerbate or contribute to impingement [16,25,28,43,48], while femoral and acetabular anteversion may exacerbate mild underlying Values are expressed as mean ± SD.…”

Section: Discussionmentioning

confidence: 99%

Two or More Impingement and/or Instability Deformities Are Often Present in Patients With Hip Pain

Tibor¹,

Liebert

Sutter

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery. Questions/purposes We determined (1) the influence of sex on the expression of impingement-related or instability-related factors, (2) the associations among these factors, and (3) how often both impingement and/or instability factors occur in the same hip.Methods We retrospectively reviewed a cohort of 170 hips (145 patients) undergoing MR arthrography of the hip for any reason. We excluded 58 hips with high-grade dysplasia, Perthes' sequelae, previous surgery, or incomplete radiographic information, leaving 112 hips (96 patients). We measured femoral version and alpha angles on MR arthrograms. Acetabular anteversion, lateral CEA, and neck-shaft angle were measured on pelvic radiographs. Results We observed a correlation between sex and alpha angle. Weak or no correlations were observed between the other five parameters. In 66% of hips, two or more (of five) impingement parameters, and in 51% of hips, two or more (of five) instability parameters were found. Conclusions Patients with hip pain frequently have several anatomic factors potentially contributing to chondrolabral damage. To address pathologic hip loading due to impingement and/or instability, all of the anatomic influences should be known. As we found no associations between anatomic factors, we recommend an individualized assessment of each painful hip. Level of Evidence Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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Alterations in Internal Rotation and Alpha Angles Are Associated With Arthroscopic Cam Decompression in the Hip

Abstract: Arthroscopic decompression results in improvement of the radiographic alpha angle and normalization of internal rotation in impingement-related disease of the hip. Internal rotation improvements can be achieved even in the setting of femoral retroversion.

Cited by 96 publications

References 19 publications

Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study

Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A Three-dimensional CT Study

Patient-Centered Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears Are Not Different in Patients With Normal, High, or Low Femoral Version

Two or More Impingement and/or Instability Deformities Are Often Present in Patients With Hip Pain

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