Open Therapy of Femoroacetabular Impingement

Tannast, Moritz; Siebenrock, Klaus A.

doi:10.1007/s00064-010-3001-7

Cited by 19 publications

(7 citation statements)

References 11 publications

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“…The goal is to restore range of motion without extra- or intraarticular impingement. Concomitant procedures such as transposition of the lesser trochanter, head reduction osteotomies, treatment of cartilage and labral lesions or femoral torsion can be performed [ 18 ]. …”

Section: Advantagesmentioning

confidence: 99%

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg–Calve–Perthes disease

Leibold

Vuillemin

Büchler

et al. 2022

Oper Orthop Traumatol

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Objective Correction of post-LCP (Legg–Calve–Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the native hip joint. Indications Typical post-LCP deformity with external and internal hip impingement due to aspherical enlarged femoral head and shortened femoral neck with high riding trochanter major without advanced osteoarthritis (Tönnis classification ≤ 1) in the younger patient (age < 50 years). Contraindications Advanced global osteoarthritis (Tönnis classification ≥ 2). Surgical technique By performing surgical hip dislocation, full access to the hip joint is gained which allows intra-articular corrections like cartilage and labral repair. Relative femoral neck lengthening involves osteotomy and distalization of the greater trochanter with reduction of the base of the femoral neck, while maintaining vascular perfusion of the femoral head by creation of a retinacular soft-tissue flap. Postoperative management Immediate postoperative mobilization on a passive motion device to prevent capsular adhesions. Patients mobilized with partial weight bearing of 15 kg with the use of crutches for at least 8 weeks. Results In all, 81 hips with symptomatic deformity of the femoral head after healed LCP disease were treated with surgical hip dislocation and offset correction between 1997 and 2020. The mean age at operation was 23 years; mean follow-up was 9 years; 11 hips were converted to total hip arthroplasty and 1 patient died 1 year after the operation. The other 67 hips showed no or minor progression of arthrosis. Complications were 2 subluxations due to instability and 1 pseudarthrosis of the lesser trochanter; no hip developed avascular necrosis.

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Section: Advantagesmentioning

confidence: 99%

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg–Calve–Perthes disease

Leibold

Vuillemin

Büchler

et al. 2022

Oper Orthop Traumatol

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“…The indications and contraindications to SHD have been well described in the literature [21]. Age over 40 has been associated with less favorable results in patients undergoing other joint-preserving procedures about the hip, specifically PAO for hip dysplasia [11].…”

Section: Introductionmentioning

confidence: 99%

Caution Should be Taken in Performing Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Patients over the Age of 40

Boone¹,

Pagnotto

Walker

et al. 2012

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Open and arthroscopic procedures are treatment options for patients with femoroacetabular impingement (FAI). Age has been found to be a predictive factor in the outcome of patients undergoing periacetabular osteotomy (PAO) for hip dysplasia. It is unclear if older age contraindicates joint preservation through a surgical hip dislocation (SHD). Questions/Purpose: The purpose of this retrospective case series was to evaluate the short-term outcomes of patients over 40 years of age without radiographic evidence of end-stage arthritis who underwent SHD for the treatment of FAI and to determine whether older age should be a contraindication for joint-preserving procedures in these patients. Our specific aims included (1) documenting the intraoperative findings and procedures, (2) assessing pain relief provided, and (3) assessing treatment failures and postoperative complications, noting the number of patients that ultimately required total hip arthroplasty (THA). Patients and Methods: All patients at age 40 and older who had SHD for the treatment of FAI were identified from a series of patients treated with SHD. Clinical notes, radiographs, and operative reports were reviewed to determine clinical results, complications, and the need for additional procedures. The minimum follow-up was 1 year (mean 3.9 years; range 1-8 years). Results: At final follow-up, 11/22 (50%) of hips had pain relief, while 11/22 (50%) either continued having significant symptoms or required THA. Five (23%) reported nontrochanteric pain symptoms that were the same or worse than before surgery, and six hips (27%) underwent subsequent THA). The average time between SHD and THA was 1.9 years (0.9-6.2). The average age of patients who went on to require THA was 45 (42-50) years. Conclusions: Surgical hip dislocation can be used for the treatment of FAI in patients over age 40, but strict selection criteria should be adhered to, as only half of the patients experienced significant improvement in their hip pain. THA was required in one-third of hips for continued pain and radiographic progression of arthritis. SHD for treatment of pathology that is not amenable to hip arthroscopy should remain a surgical option in older patients with FAI only if joint degeneration is not present.

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“…Various surgical treatment approaches have been utilized to treat FAI 3 4 12 13 14) . SHD, advocated by Ganz et al 2) , is a technique with full access to the femoral head and acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…SHD, advocated by Ganz et al 2) , is a technique with full access to the femoral head and acetabulum. It has been used for treating FAI 12 13 14) . So, it was thought to be the gold standard for FAI approach.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

Cho

2015

Hip & Pelvis

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PurposeWe report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years.Materials and MethodsBetween May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared.ResultsAcetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area.ConclusionOpen surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.

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Open Therapy of Femoroacetabular Impingement

Cited by 19 publications

References 11 publications

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg–Calve–Perthes disease

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg–Calve–Perthes disease

Caution Should be Taken in Performing Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Patients over the Age of 40

Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

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