Hip instability: a review of hip dysplasia and other contributing factors

Kraeutler, Matthew J.; Garabekyan, Tigran; Pascual‐Garrido, Cecilia; Mei-Dan, Omer

doi:10.11138/mltj/2016.6.3.343

Cited by 33 publications

(11 citation statements)

References 72 publications

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“… 4 Increased femoral anteversion has also been associated with posterior greater trochanteric impingement, 9 , 31 decreased abductor power by <28% due to diminished femoral offset, 18 and hip instability. 32 Psoas irritation may be due to anterior instability; the tendon may act as a dynamic stabilizer and releasing it may exacerbate the problem. 2 , 33 Patients with symptomatic ischiofemoral impingement with diminished clearance between these two structures are more likely to have excessive femoral anteversion compared to asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Femoral Derotation Osteotomy in Adults for Version Abnormalities

Buly

Sosa

Poultsides

et al. 2018

J Am Acad Orthop Surg

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Background:Version abnormalities of the femur can cause pain and hip joint damage due to impingement or instability. A retrospective clinical review was conducted on patients undergoing a subtrochanteric derotation osteotomy for either excessive anteversion or retroversion of the femur.Methods:A total of 55 derotation osteotomies were performed in 43 patients: 36 females and 7 males. The average age was 29 years (range, 14 to 59 years). The osteotomies were performed closed with an intramedullary saw. Fixation was performed with a variety of intramedullary nails. Twenty-nine percent of patients had a retroversion deformity (average, −9° of retroversion; range, +2° to −23°) and 71% had excessive anteversion of the femur (average, +37° of anteversion; range, +22° to +53°). The etiology was posttraumatic in 5 patients (12%), diplegic cerebral palsy in 2 patients (5%), Prader-Willi syndrome in 1 patient (2%), and idiopathic in 35 patients (81%). Forty-nine percent underwent concomitant surgery with the index femoral derotation osteotomy, including hip arthroscopy in 40%, tibial derotation osteotomy in 13%, and a periacetabular osteotomy in 5%. Tibial osteotomies were performed to correct a compensatory excessive external tibial torsion that would be exacerbated in the correction of excessive femoral anteversion.Results:No patient was lost to follow-up. Failures occurred in three hips in three patients (5%): two hip arthroplasties and one nonunion that healed after rerodding. There was one late infection treated successfully with implant removal and antibiotics with an excellent final clinical outcome. At an average follow-up of 6.5 years (range, 2 to 19.7 years), the modified Harris Hip Score improved by 29 points in the remaining 52 cases (P < 0.001, Wilcoxon signed-rank test). The results were rated as excellent in 75%, good in 23%, and fair in 2%. Subsequent surgery was required in 78% of hips, 91% of which were implant removals.Conclusions:A closed, subtrochanteric derotation osteotomy of the femur is a safe and effective procedure to treat either femoral retroversion or excessive anteversion. Excellent or good results were obtained in 93%, despite the need for subsequent implant removal in more than two-thirds of the patients.

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Section: Discussionmentioning

confidence: 99%

Femoral Derotation Osteotomy in Adults for Version Abnormalities

Buly

Sosa

Poultsides

et al. 2018

J Am Acad Orthop Surg

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“…Inclusion criteria for patients selected for this study were as follows: (i) persistent hip pain and mechanical symptoms refractory to nonoperative management lasting at least 3 months, (ii) reproducible clinical examination findings suggestive of impingement and (iii) joint space width more than 3 mm on all views of plain radiography and three-dimensional (3D) computed tomography (CT). Exclusion criteria included patients with hip instability (hip dysplasia or hyperlaxity) [27], as the authors always perform repair of the interportal capsulotomy in these patients; patients who required microfracture or postoperative non-weight bearing precautions and patients undergoing additional surgical treatment for diagnoses of slipped capital femoral epiphysis (SCFE), Legg–Calvé–Perthes disease, osteochondromatosis or post-dislocation syndrome.…”

Section: Methodsmentioning

confidence: 99%

A multicenter, double-blind, randomized controlled trial comparing magnetic resonance imaging evaluation of repaired versus unrepaired interportal capsulotomy in patients undergoing hip arthroscopy for femoroacetabular impingement

Kraeutler

Strickland

Brick

et al. 2018

Journal of Hip Preservation Surgery

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The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearance of the hip capsule in patients with femoroacetabular impingement (FAI) undergoing hip arthroscopy with capsular repair versus non-repair. A multicenter clinical trial was performed with 31 patients (49 hips) undergoing hip arthroscopy for treatment of FAI. A small- to moderate-sized interportal capsulotomy was performed. Each hip was randomized to capsular repair versus non-repair of the interportal capsulotomy. MRI was performed at 6 and 24 weeks postoperatively and was analyzed by two musculoskeletal radiologists. Patients and the radiologists were blinded to the treatment applied. Capsular defect size and capsule thickness were recorded on each scan. Mean patient age was 31.4 years. Capsular repair was performed in 23 (46.9%) hips. Mean capsulotomy length was 35 mm at Center X and 23 mm at Center Y. At 6 weeks postoperatively, a healed hip capsule (with no apparent capsulotomy defect) was observed in 10 (43.4%) hips that underwent capsular repair and 4 (15.4%) hips that did not undergo capsular repair (P = 0.13). At 24 weeks postoperatively, 25/30 hips (83.3%) achieved complete closure of the capsulotomy defect, with no significant difference between treatment groups. Repair of an interportal capsulotomy following hip arthroscopy for FAI results in a non-significantly higher percentage of healed hip capsules at 6 weeks postoperatively compared with leaving the capsule unrepaired, though the difference normalizes by 24-week follow-up. Repair of a small- to moderate-sized interportal capsulotomy does not provide a radiographic advantage following hip arthroscopy for FAI.

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“…Inclusion criteria for patients undergoing these procedures were as follows: (1) persistent hip pain and mechanical symptoms refractory to non-operative management (physical therapy, non-steroidal anti-inflammatory drugs, activity modifications, corticosteroid injections) lasting at least 3 months, (2) reproducible clinical examination findings suggestive of intra-articular pathology and (3) joint-space width exceeding 3 mm on all views of plain radiography and cross-sectional imaging. Some of the physical examination tests used included passive hip range of motion (supine, lateral, prone), the FADIR (flexion, adduction, internal rotation) test, the FABER (flexion, abduction, external rotation) test, the ligamentum teres (LT) test, the posterior impingement test, use of the Beighton Hypermobility score and subjective reports of hip instability [ 25 ]. The lateral center edge angle (LCEA) was determined on anteroposterior (AP) pelvis radiographs as described previously [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis

Kraeutler

Garabekyan

Mei-Dan

2018

Journal of Hip Preservation Surgery

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There are currently no established guidelines for appropriate antithrombotic prophylaxis following periacetabular osteotomy (PAO) or derotational femoral osteotomy (DFO). The purpose of this study was to determine the incidence of clinical deep venous thrombosis (DVT) following PAO and/or DFO wherein a portable, mechanical device and low-dose aspirin were used postoperatively for DVT prophylaxis. Patients who had undergone staged hip arthroscopy and primary PAO and/or DFO were prospectively reviewed. Following PAO/DFO, patients were prophylactically treated for thromboembolic disease with a portable, mechanical compression device for 3 weeks and low-dose aspirin for 4 weeks. Patients were followed in clinic until 24 months postoperatively. During the study period, 145 hips (124 patients) underwent surgery (PAO: 109, DFO: 24, PAO + DFO: 12). Overall, the incidence of clinically apparent DVT was 0% in the study cohort. Average estimated blood loss during surgery was 601 mL and five cases required blood transfusions of 1 or 2 units. Ten patients were seen in the emergency room 10–20 days after surgery presenting with calf tenderness and DVT was ruled out in all cases with ultrasound. There were no postoperative bleeding or wound complications. A portable, mechanical compression device and low-dose aspirin effectively lessens the risk of DVT following staged hip arthroscopy and PAO/DFO without an increased risk of bleeding complications.

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Hip instability: a review of hip dysplasia and other contributing factors

Abstract: SummaryBackground: Hip instability has classically been associated with developmental dysplasia of the hip (DDH) in newborns and children. However, numerous factors may contribute to hip instability in children, adolescents, and adults.

Cited by 33 publications

References 72 publications

Femoral Derotation Osteotomy in Adults for Version Abnormalities

Femoral Derotation Osteotomy in Adults for Version Abnormalities

A multicenter, double-blind, randomized controlled trial comparing magnetic resonance imaging evaluation of repaired versus unrepaired interportal capsulotomy in patients undergoing hip arthroscopy for femoroacetabular impingement

Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis

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