General Radiography of the Hip Joint

Background Patients with femoroacetabular impingement (FAI) often develop pain, impaired function, and progression of osteoarthritis (OA); this is commonly treated using surgical hip dislocation, femoral neck and acetabular rim osteoplasty, and labral reattachment. However, results with these approaches, in particular risk factors for OA progression and conversion to THA, have varied. Questions/purposes We asked if patients undergoing surgical hip dislocation with labral reattachment to treat FAI experienced (1) improved hip pain and function; and (2) prevention of OA progression; we then determined (3) the survival of the hip at 5-year followup with the end points defined as the need for conversion to THA, progression of OA by at least one Tönnis grade, and/or a Merle d'Aubigné-Postel score less than 15; and calculated (4) factors predicting these end points. Methods Between July 2001 and March 2003, we performed 146 of these procedures in 121 patients. After excluding 35 patients (37 hips) who had prior open surgery and 11 patients (12 hips) who had a diagnosis of Perthes disease, this study evaluated the 75 patients (97 hips, 66% of the procedures we performed during that time) who had a mean followup of 6 years (range, 5-7 years). We used the anterior impingement test to assess pain, the Merle d'Aubigné-Postel score to assess function, and the Tönnis grade to assess OA. Survival and predictive factors were calculated using the method of Kaplan and Meier and Cox regression, respectively. Results The proportion of patients with anterior impingement decreased from 95% to 17% (p \ 0.001); the Merle d'Aubigné-Postel score improved from a mean of 15 to 17 (p \ 0.001). Seven hips (7%) showed progression of OA and another seven hips (7%) converted to THA Survival free from any end point (THA, progression of OA, or a Merle d'Aubigné-Postel \ 15) of well-functioning joints at 5 years was 91%; and excessive acetabular rim trimming, preoperative OA, increased age at operation, and weight were predictive factors for the end points. Conclusions At 5-year followup, 91% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment showed no THA, progression of OA, or an insufficient clinical result, but excessive acetabular trimming, OA, increased age, and weight were associated with early failure. To prevent early deterioration of the joint, excessive rim trimming or trimming of borderline dysplastic hips has to be avoided.

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Steppacher

Huemmer

Schwab

et al. 2014

“…All patients presented with a history of hip pain for at least 3 months, radiographic criteria of hip dysplasia (lateral center-edge angle of Wiberg [28] 20°or less or anterior center-edge angle [10] 20°or less, or both), and radiographic evidence of minimal or no hip osteoarthritis (Tönnis [22] Grade 0 or 1). No patients were contacted specifically for this study and the data from all patients were obtained from retrospective assessment of medical records, and previously, prospectively collected hip-specific questionnaires obtained during the clinical visit.…”

Section: Methodsmentioning

confidence: 99%

“…The measurements were made on standing AP, lateral, and false-profile [10] pelvic radiographs obtained preoperatively and at the most recent clinic visit. The radiographic dependent variables of interest included the lateral center-edge angle of Wiberg [28], the acetabular roof obliquity angle of Tönnis [22], and the anterior center-edge angle of Lequesne and de Séze [10]. Radiographic grade of osteoarthritis was assessed using the Tönnis [22] grading scheme.…”

Section: Methodsmentioning

confidence: 99%

The Bernese Periacetabular Osteotomy: Is Transection of the Rectus Femoris Tendon Essential?

Novais

Kim

Carry

et al. 2014

Background The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. Questions/purposes The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. Methods A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Results Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p \ 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p \ 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, À1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center-edge angle (p = 0.4463), anterior center-edge angle (p = 0.0936), and Tönnis angle (p = 0.7953) improvement when compared with the classic approach. Conclusions The rectus-preserving approach for PAO is as safe and effective as the classic approach to achieve radiographic correction and HHS improvement at minimum 1 year. Additional investigation is needed to determine whether the rectus-preserving approach allows for improvement in functional recovery including hip flexion strength.

“…In all cases after conventional radiography, a specific MR arthrography for the hip had been performed [18]. We excluded 42 patients (48 hips) with a history of known hip disorders (eg, LeggCalvé-Perthes disease), two patients (two hips) with muscle disorders (eg, muscle dystrophy), 79 patients (90 hips) with previous hip surgery, six patients (six hips) with skeletally immature hips (Stage 4 or less, according to Risser [20]), 12 patients (14 hips) with advanced osteoarthritis (Stage 2 or greater, according to Tönnis [27]), and 51 patients (58 hips) with incomplete or nondigital radiographic documentation. This left 229 patients (262 hips).…”

Section: Patients and Materialsmentioning

confidence: 99%

The Iliocapsularis Muscle: An Important Stabilizer in the Dysplastic Hip

Babst

Steppacher

Ganz

et al. 2011

111

155

Background The iliocapsularis muscle is a little known muscle overlying the anterior hip capsule postulated to function as a stabilizer of dysplastic hips. Theoretically, this muscle would be hypertrophied in dysplastic hips and, conversely, atrophied in stable and well-constrained hips. However, these observations have not been confirmed and the true function of this muscle remains unknown. Questions/purposes We quantified the anatomic dimensions and degree of fatty infiltration of the iliocapsularis muscle and compared the results for 45 hips with deficient acetabular coverage (Group I) with 40 hips with excessive acetabular coverage (Group II). Patients and Methods We used MR arthrography to evaluate anatomic dimensions (thickness, width, circumference, cross-sectional area [CSA], and partial volume) and the amount of fatty infiltration.