Hip preservation

Abstract

Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described: (1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’). Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results. Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074

The Surgical Treatment of Osteoarthritis

“…Typical indications for hip-preserving surgery are: femoroacetabular impingement (intra- and extra-articular) (FAI), hip dysplasia, slipped capital femoral epiphysis (SCFE), residual deformities after Perthes disease, and avascular necrosis (AVN) of the femoral head [ 41 ]. If left unaddressed, these pathologies may lead to osteoarthritis.…”

“…An unaddressed leg-length discrepancy may lead to osteoarthritis of the hip as well [ 42 ]. FAI and labral damage can be treated either with arthroscopy, surgical hip dislocation, and/or acetabular or femoral osteotomy [ 41 ]. Nowadays, severe or unstable SCFE can be treated open using surgical hip dislocation with the development of a retinacular soft tissue flap to perform a subcapital realignment of the slipped epiphysis, the so-called ‘modified Dunn’ procedure [ 41 ].…”

“…FAI and labral damage can be treated either with arthroscopy, surgical hip dislocation, and/or acetabular or femoral osteotomy [ 41 ]. Nowadays, severe or unstable SCFE can be treated open using surgical hip dislocation with the development of a retinacular soft tissue flap to perform a subcapital realignment of the slipped epiphysis, the so-called ‘modified Dunn’ procedure [ 41 ]. Residual deformities after Perthes disease can be treated with a semi-circumferential femoral osteochondroplasty, whereas a femoral head reduction osteotomy can be considered in selective cases if the containment of the femoral head cannot be achieved with femoral osteochondroplasty alone [ 41 ].…”

“…Nowadays, severe or unstable SCFE can be treated open using surgical hip dislocation with the development of a retinacular soft tissue flap to perform a subcapital realignment of the slipped epiphysis, the so-called ‘modified Dunn’ procedure [ 41 ]. Residual deformities after Perthes disease can be treated with a semi-circumferential femoral osteochondroplasty, whereas a femoral head reduction osteotomy can be considered in selective cases if the containment of the femoral head cannot be achieved with femoral osteochondroplasty alone [ 41 ]. Depending on the localization, extension, and stage of the AVN, multiple therapeutic options are available (rotational osteotomies, bone grafting, core decompression, and varus/flexion femoral osteotomy ( Figure 4 )) [ 41 ].…”

The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

“…На рентгенограмах на ранніх стадіях захворювання зміни кісткової структури не діагностують, тому в разі несвоєчасного звернення, діагностики та лікування у 80 % випадків розвивається вторинний остеоартроз кульшового суглоба [5,6]. Частота ендопротезування за умов вторинного остеоартрозу з первинним діагнозом АНГСК коливається від 2 до 12 % серед пацієнтів молодого віку [2,3,7]. Сьогодні «золотим стандартом» ранньої діагностики АНГСК є магнітно-резонансна томографія (МРТ), яка дозволяє побачити перші ознаки захворювання у вигляді набряку головки стегнової кістки, розростання мезенхімальних тканин, синовіт, хондроматозні тіла, розрив ацетабулярної губи.…”