Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery 27 articles

Articles

Can the Alpha Angle Assessment of Cam Impingement Predict Acetabular Cartilage Delamination?

Paul E. Beaulé MD, FRCSC, Kelly Hynes MD, Gillian Parker BSc, Kyle A. Kemp MSc

Substantial acetabular cartilage damage is commonly present in patients suffering from femoral acetabular impingement (FAI). A better understanding of which patient is at risk of developing substantial cartilage damage is critical for establishing appropriate treatment guidelines.

Early Experience With a Comprehensive Hip Preservation Service Intended to Improve Clinical Care, Education, and Academic Productivity

Christopher L. Peters MD, Stephen K. Aoki MD, Jill A. Erickson PA-C, Lucas A. Anderson MD, Andrew E. Anderson PhD

The field of hip preservation surgery has grown substantially over the past decade. Although open hip procedures reportedly relieve pain and restore function, arthroscopic treatment has increasingly become a reasonable alternative. In 2008, we formed a comprehensive hip preservation service (HPS) to address clinical, educational, and research needs.

Radiographic Features Associated With Differing Impinging Hip Morphologies With Special Attention to Coxa Profunda

Gregory Boone BS, Michael R. Pagnotto MD, Justin A. Walker MD, Robert T. Trousdale MD, Rafael J. Sierra MD

Combined with clinical examination and MRI, radiographs have been mainstays in the management femoroacetabular impingement (FAI). Because hip morphology often portends intraoperative damage, radiographic features should inform surgical management.

Anterior Delayed Gadolinium-enhanced MRI of Cartilage Values Predict Joint Failure After Periacetabular Osteotomy

Sang Do Kim MD, Rebecca Jessel MD, David Zurakowski PhD, Michael B. Millis MD, Young-Jo Kim MD, PhD

Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs).

Patient Selection Criteria for Periacetabular Osteotomy or Rotational Acetabular Osteotomy

Yuji Yasunaga MD, Takuma Yamasaki MD, Mitsuo Ochi MD

Hip dysplasia is the most common cause of secondary osteoarthritis (OA). Periacetabular osteotomy (PAO) or rotational acetabular osteotomy (RAO) has been used as a joint-preserving procedure. However, the patient selection criteria are not clearly defined.

Hip Ontogenesis: How Evolution, Genes, and Load History Shape Hip Morphotype and Cartilotype

Tom Hogervorst MD, PhD, Wouter Eilander MD, Joost T. Fikkers MSc, Ingrid Meulenbelt PhD

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not.

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

Jeffrey J. Nepple MD, John M. Martel MD, Young-Jo Kim MD, Ira Zaltz MD, John C. Clohisy MD

Three-dimensional imaging (CT and MRI) is the gold standard for detecting femoral head-neck junction malformations in femoroacetabular impingement, yet plain radiographs are used for initial diagnostic evaluation. It is unclear, however, whether the plain radiographs accurately reflect the findings on three-dimensional imaging.

Coxa Profunda: Is the Deep Acetabulum Overcovered?

Lucas A. Anderson MD, Ashley L. Kapron BS, Stephen K. Aoki MD, Christopher L. Peters MD

Coxa profunda, or a deep acetabular socket, is often used to diagnose pincer femoroacetabular impingement (FAI). Radiographically, coxa profunda is the finding of an acetabular fossa medial to the ilioischial line. However, the relative position of the acetabular fossa to the pelvis may not be indicative of acetabular coverage.

What Are the Factors Associated With Acetabular Correction in Perthes-like Hip Deformities?

John C. Clohisy MD, James R. Ross MD, Joshua D. North MD, Jeffrey J. Nepple MD, Perry L. Schoenecker MD

Perthes-like hip deformities encompass variable proximal femoral abnormalities and associated acetabular dysplasia that can be reconstructed with contemporary hip preservation procedures. Nevertheless, the necessity and indications for surgical correction of associated acetabular dysplasia have not been established.

Preliminary Pain and Function After Labral Reconstruction During Femoroacetabular Impingement Surgery

Justin A. Walker MD, Michael Pagnotto MD, Robert T. Trousdale MD, Rafael J. Sierra MD

Labral refixation rather than resection provides better pain relief and function after femoroacetabular impingement (FAI) surgery. When the labrum is absent, degenerated, or is irreparable, reconstruction may provide a favorable biomechanical environment for the hip. However, it is unclear whether labral reconstruction relieves pain and restores function.

Save the Torn Labrum in Hips With Borderline Acetabular Coverage

Niraj V. Kalore MD, William A. Jiranek MD

Hip arthroscopy for labral tears improves short-term function, but reoperations occur in 5% to 47% of patients. The effect of borderline acetabular coverage on reoperation rate has been debated. Labral repair rather than débridement has been proposed to improve function, but the effect on reoperation rate is unclear.

Hip Capsule Dimensions in Patients With Femoroacetabular Impingement: A Pilot Study

Jan Weidner MD, Lorenz Büchler MD, Martin Beck MD

Joint-preserving hip surgery, either arthroscopic or open, increasingly is used for the treatment of symptomatic femoroacetabular impingement (FAI). As a consequence of surgery, thickening of the joint capsule and intraarticular adhesions between the labrum and joint capsule and between the femoral neck and the joint capsule have been observed. These alterations are believed to cause persistent pain and reduced range of motion. Because the diagnosis is made with MR arthrography, knowledge of the normal capsular anatomy and thickness on MRI in patients is important. To date there is no such information available.

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Klaus A. Siebenrock MD, Lea Kistler, Joseph M. Schwab MD, Lorenz Büchler MD, Moritz Tannast MD

Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool.

Pelvic Morphology Differs in Rotation and Obliquity Between Developmental Dysplasia of the Hip and Retroversion

Moritz Tannast MD, Peter Pfannebecker MD, Joseph M. Schwab MD, Christoph E. Albers MD, Klaus A. Siebenrock MD, Lorenz Büchler MD

Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality.

Is Posterior Hip Instability Associated with Cam and Pincer Deformity?

Aaron J. Krych MD, Matt Thompson MD, Christopher M. Larson MD, J. W. Thomas Byrd MD, Bryan T. Kelly MD

Posterior hip instability is an increasingly recognized injury in athletes; however, the function of patients after these injuries and an understanding of the pathoanatomy and underlying mechanism are currently unclear.

Surgical Technique: Second-generation Bone Marrow Stimulation via Surgical Dislocation to Treat Hip Cartilage Lesions

Michael Leunig MD, Lisa M. Tibor MD, Florian D. Naal MD, Reinhold Ganz MD, Matthias R. Steinwachs MD

Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct.

Parafoveal Chondral Defects Associated with Femoroacetabular Impingement

Ira Zaltz MD, Michael Leunig MD

Cam-type, pincer, and mixed femoroacetabular impingement (FAI) are accepted causes of labral and acetabular rim injury; however, the abnormal contact stresses associated with motion may damage other areas of the hip. Although cartilage damage to the femoral head has been reported previously in athletes, FAI-associated focal parafoveal chondral defects differ from previously reported lesions and represent a rare manifestation of the complex pathomechanics associated with FAI.

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Eduardo N. Novais MD, Michael B. Millis MD

Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term.

Report of Breakout Session: Strategies to Improve Hip Preservation Training

Christopher L. Peters MD, Paul E. Beaulé MD, Martin Beck MD, Moritz Tannast MD, William Jiranek MD, Rafael J. Sierra MD

The Biomechanical Case for Labral Débridement

Ira Zaltz MD

Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair.

MRI of Hip Cartilage: Joint Morphology, Structure, and Composition

Stephanie L. Gold BA, Alissa J. Burge MD, Hollis G. Potter MD

Accurate, reproducible, and noninvasive assessment of hip cartilage is clinically relevant and provides a means by which to assess the suitability of candidates for arthroscopic or open surgical procedures and the response to such interventions over time. Given the relatively thin cartilage of the hip and the complex spherical anatomy, however, accurately assessing the cartilage poses a challenge for traditional MRI techniques.