Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 475 | Issue 4 | Apr, 2017
Articles

Lawnmowers Versus Children: The Devastation Continues

Mariano Garay BS, William L. Hennrikus MD, Joseph Hess RN, Erik B. Lehman MS, Douglas G. Armstrong MD

Accidents with lawnmowers can cause mutilating injuries to children. Safety guidelines regarding the use of lawnmowers were promoted by professional organizations beginning in 2001. The Pennsylvania Trauma Systems Foundation maintains a database including all admissions to accredited Levels 1 to 4 trauma centers in the state. The annual rates of admission for children in our state and the severity of injuries subsequent to introduction of safety guidelines have not been reported, to our knowledge. Ride-on lawnmowers have been associated with more severe injuries in children.

ArtiFacts: Femoroacetabular Impingement—A New Pathology?

Corinne A. Zurmühle MD, Marco Milella PhD, Simon D. Steppacher MD, Markus S. Hanke MD, Christoph E. Albers MD, Moritz Tannast MD

Acetabular Version Increases After Closure of the Triradiate Cartilage Complex

Christoph E. Albers MD, Andrea Schwarz MD, Markus S. Hanke MD, Karl-Philipp Kienle MD, Stefan Werlen MD, Klaus A. Siebenrock MD

Although the etiology of primary femoroacetabular impingement (FAI) is considered developmental, the underlying pathogenic mechanisms remain poorly understood. In particular, research identifying etiologic factors associated with pincer FAI is limited. Knowledge of the physiologic growth patterns of the acetabulum during skeletal maturation might allow conclusions on deviations from normal development that could contribute to pincer-related pathomorphologies.

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

K. C. Geoffrey Ng MASc, Giulia Mantovani PhD, Mario Lamontagne PhD, Michel R. Labrosse PhD, Paul E. Beaulé MD, FRCSC

It is still unclear why many individuals with a cam morphology of the hip do not experience pain. It was recently reported that a decreased femoral neck-shaft angle may also be associated with hip symptoms. However, the effects that different femoral neck-shaft angles have on hip stresses in symptomatic and asymptomatic individuals with cam morphology remain unclear.

Is Increased Acetabular Cartilage or Fossa Size Associated With Pincer Femoroacetabular Impingement?

Stephanie Y. Pun MD, Andreas Hingsammer MD, Michael B. Millis MD, Young-Jo Kim MD, PhD

Surgical treatment for pincer femoroacetabular impingement (FAI) of the hip remains controversial, between trimming the prominent acetabular rim and reverse periacetabular osteotomy (PAO) that reorients the acetabulum. However, rim trimming may decrease articular surface size to a critical threshold where increased joint contact forces lead to joint degeneration. Therefore, knowledge of how much acetabular articular cartilage is available for resection is important when evaluating between the two surgical options. In addition, it remains unclear whether the acetabulum rim in pincer FAI is a prominent rim because of increased cartilage size or increased fossa size.

Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies

Lucas A. Anderson MD, Mike B. Anderson MSc, Jill A. Erickson PA-C, Jesse Chrastil MD, Christopher L. Peters MD

The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy.

Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia

Jeffrey J. Nepple MD, Joel Wells MD, MPH, James R. Ross MD, Asheesh Bedi MD, Perry L. Schoenecker MD, John C. Clohisy MD

Detailed recognition of the three-dimensional (3-D) deformity in acetabular dysplasia is important to help guide correction at the time of reorientation during periacetabular osteotomy (PAO). Common plain radiographic parameters of acetabular dysplasia are limited in their ability to characterize acetabular deficiency precisely. The 3-D characterization of such deficiencies with low-dose CT may allow for more precise characterization.

Femoral Morphology in the Dysplastic Hip: Three-dimensional Characterizations With CT

Joel Wells MD, MPH, Jeffrey J. Nepple MD, Karla Crook BS, James R. Ross MD, Asheesh Bedi MD, Perry Schoenecker MD, John C. Clohisy MD

Hip dysplasia represents a spectrum of complex deformities on both sides of the joint. Although many studies have described the acetabular side of the deformity, to our knowledge, little is known about the three-dimensional (3-D) head and neck offset differences of the femora of dysplastic hips. A thorough knowledge of proximal femoral anatomy is important to prevent potential impingement and improve results after acetabular reorientation.

Both 3-T dGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction

Tobias Hesper MD, Evgeny Bulat MA, Sarah Bixby MD, Alireza Akhondi-Asl PhD, Onur Afacan PhD, Patricia Miller MS, Garrett Bowen BS, Simon Warfield PhD, Young-Jo Kim MD, PhD

In addition to case reports of gadolinium-related toxicities, there are increasing theoretical concerns about the use of gadolinium for MR imaging. As a result, there is increasing interest in noncontrast imaging techniques for biochemical cartilage assessment. Among them, T2 mapping holds promise because of its simplicity, but its biophysical interpretation has been controversial.

T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest?

Helen Anwander MD, Kawan S. Rakhra MD, Gerd Melkus PhD, Paul E. Beaulé MD

T1ρ MRI has been shown feasible to detect the biochemical status of hip cartilage, but various region-of-interest strategies have been used, compromising the reproducibility and comparability between different institutions and studies.

How Does the dGEMRIC Index Change After Surgical Treatment for FAI? A Prospective Controlled Study: Preliminary Results

Florian Schmaranzer MD, Pascal C. Haefeli MD, Markus S. Hanke MD, Emanuel F. Liechti MD, MSc, Stefan F. Werlen MD, Klaus A. Siebenrock MD, Moritz Tannast MD

Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) allows an objective, noninvasive, and longitudinal quantification of biochemical cartilage properties. Although dGEMRIC has been used to monitor the course of cartilage degeneration after periacetabular osteotomy (PAO) for correction of hip dysplasia, such longitudinal data are currently lacking for femoroacetabular impingement (FAI).

Operative Fluoroscopic Correction Is Reliable and Correlates With Postoperative Radiographic Correction in Periacetabular Osteotomy

James D. Wylie MD, MHS, Jeremy A. Ross MD, Jill A. Erickson PA-C, Mike B. Anderson MSc, Christopher L. Peters MD

Intraoperative fluoroscopy is commonly used to both guide the osteotomy and judge correction of the acetabular fragment in periacetabular osteotomy (PAO). Prior studies that have compared intraoperative fluoroscopic correction with postoperative radiographic correction were small studies that did not report intra- or interreader reliability.

Does Surgeon Experience Impact the Risk of Complications After Bernese Periacetabular Osteotomy?

Eduardo N. Novais MD, Patrick M. Carry BA, Lauryn A. Kestel BS, Brian Ketterman BS, Christopher M. Brusalis BA, Wudbhav N. Sankar MD

Bernese periacetabular osteotomy (PAO) is a technically challenging procedure with potential risk for major complications and a previously reported steep learning curve. However, the impact of contemporary hip preservation fellowships on the learning curve of PAO has not been established.

Do Radiographic Parameters of Dysplasia Improve to Normal Ranges After Bernese Periacetabular Osteotomy?

Eduardo N. Novais MD, Stephen Duncan MD, Jeffrey Nepple MD, Gail Pashos BS, Perry L. Schoenecker MD, John C. Clohisy MD

The goal of periacetabular osteotomy (PAO) is to improve the insufficient coverage of the femoral head and achieve joint stability without creating secondary femoroacetabular impingement. However, the complex tridimensional morphology of the dysplastic acetabulum presents a challenge to restoration of normal radiographic parameters. Accurate acetabular correction is important to achieve long-term function and pain improvement. There are limited data about the proportion of patients who have normal radiographic parameters restored after PAO and the factors associated with under- and overcorrection.

What Are the Results of Surgical Treatment of Hip Dysplasia With Concomitant Cam Deformity?

Jens Goronzy MD, Lea Franken MD, Albrecht Hartmann MD, Falk Thielemann MD, Anne Postler MD, Tobias Paulus MD, Klaus-Peter Günther MD

Periacetabular osteotomy (PAO) is a reliable procedure to correct the deficient acetabular coverage in hips with developmental dysplasia. It is unclear how the presence of additional femoral cam-type deformity might influence the clinical and radiographic treatment results of PAO.

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Corinne A. Zurmühle MD, Helen Anwander MD, Christoph E. Albers MD, Markus S. Hanke MD, Simon D. Steppacher MD, Klaus A. Siebenrock MD, Moritz Tannast MD

Acetabular retroversion can cause impaction-type femoroacetabular impingement leading to hip pain and osteoarthritis. It can be treated by anteverting periacetabular osteotomy (PAO) or acetabular rim trimming with refixation of the labrum. There is increasing evidence that acetabular retroversion is a rotational abnormality of the entire hemipelvis and not a focal overgrowth of the anterior acetabular wall, which favors an anteverting PAO. However, it is unknown if this larger procedure would be beneficial in terms of survivorship and Merle d’Aubigné scores in a midterm followup compared with rim trimming.

One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA

Till Dominic Lerch MD, Simon Damian Steppacher MD, Emanuel Francis Liechti MD, Moritz Tannast MD, Klaus Arno Siebenrock MD

Since its first description in 1984, periacetabular osteotomy (PAO) has become an accepted treatment for hip dysplasia. The 30-year survivorship with this procedure has not been reported. Because these patients are often very young at the time of surgery, long-term followup and identification of factors associated with poor outcome could help to improve patient selection.

What Are the Risk Factors for Revision Surgery After Hip Arthroscopy for Femoroacetabular Impingement at 7-year Followup?

Pascal Cyrill Haefeli MD, Christoph Emanuel Albers MD, Simon Damian Steppacher MD, Moritz Tannast MD, Lorenz Büchler MD

In recent years, surgical treatment of symptomatic femoroacetabular impingement (FAI) has been increasingly performed using arthroscopy. Bony pathomorphologies and damage to the labrum as well as cartilage defects can be addressed with comparable results to open surgery with overall less surgery-related complications. Despite the increasing importance of hip arthroscopy, however, reports on midterm clinical and radiographic outcomes and comparison to open surgical hip dislocation are scarce.

Labral Reattachment in Femoroacetabular Impingement Surgery Results in Increased 10-year Survivorship Compared With Resection

Helen Anwander MD, Klaus A. Siebenrock MD, Moritz Tannast MD, Simon D. Steppacher MD

Since the importance of an intact labrum for normal hip function has been shown, labral reattachment has become the standard method for open or arthroscopic treatment of hips with femoroacetabular impingement (FAI). However, no long-term clinical results exist evaluating the effect of labral reattachment. A 2-year followup comparing open surgical treatment of FAI with labral resection versus reattachment was previously performed at our clinic. The goal of this study was to report a concise followup of these patients at a minimum of 10 years.

What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

Markus S. Hanke MD, Simon D. Steppacher MD, Helen Anwander MD, Stefan Werlen MD, Klaus A. Siebenrock MD, Moritz Tannast MD

Magnetic resonance arthrogram (MRA) with radial cuts is presently the best available preoperative imaging study to evaluate chondrolabral lesions in the setting of femoroacetabular impingement (FAI). Existing followup studies for surgical treatment of FAI have evaluated predictors of treatment failure based on preoperative clinical examination, intraoperative findings, and conventional radiography. However, to our knowledge, no study has examined whether any preoperative findings on MRA images might be associated with failure of surgical treatment of FAI in the long term.

High Survivorship and Little Osteoarthritis at 10-year Followup in SCFE Patients Treated With a Modified Dunn Procedure

Kai Ziebarth MD, Milan Milosevic MD, Till D. Lerch MD, Simon D. Steppacher MD, Theddy Slongo MD, Klaus A. Siebenrock MD

The modified Dunn procedure has the potential to restore the anatomy in hips with slipped capital femoral epiphyses (SCFE) while protecting the blood supply to the femoral head and minimizing secondary impingement deformities. However, there is controversy about the risks associated with the procedure and mid- to long-term data on clinical outcomes, reoperations, and complications are sparse.

Iatrogenic Hip Instability Is a Devastating Complication After the Modified Dunn Procedure for Severe Slipped Capital Femoral Epiphysis

Vidyadhar V. Upasani, Oliver Birke, Kevin E. Klingele, Michael B. Millis

The modified Dunn procedure facilitates femoral capital realignment for slipped capital femoral epiphysis (SCFE) through a surgical hip dislocation approach. Iatrogenic postoperative hip instability after this procedure has not been studied previously; however, we were concerned when we observed several instances of this serious complication, and we wished to study it further.

No Clinically Important Difference in Knee Scores or Instability Between Transtibial and Inlay Techniques for PCL Reconstruction: A Systematic Review

Young-Soo Shin MD, Hyun-Jung Kim MPH, PhD, Dae-Hee Lee MD, PhD

It is unclear whether the biomechanical superiority of the inlay technique over the transtibial technique, arising from avoidance of the killer turn at the graft-tunnel margin of the proximal tibia during posterior cruciate ligament (PCL) reconstruction, leads to better knee scores or greater knee stability.

Can We Estimate Short- and Intermediate-term Survival in Patients Undergoing Surgery for Metastatic Bone Disease?

Jonathan A. Forsberg MD, PhD, Rikard Wedin MD, PhD, Patrick J. Boland MD, John H. Healey MD

Objective means of estimating survival can be used to guide surgical decision-making and to risk-stratify patients for clinical trials. Although a free, online tool () can estimate 3- and 12-month survival, recent work, including a survey of the Musculoskeletal Tumor Society, indicated that estimates at 1 and 6 months after surgery also would be helpful. Longer estimates help justify the need for more durable and expensive reconstructive options, and very short estimates could help identify those who will not survive 1 month and should not undergo surgery. Thereby, an important use of this tool would be to help avoid unsuccessful and expensive surgery during the last month of life.

“Knuckle Cracking”: Can Blinded Observers Detect Changes with Physical Examination and Sonography?

Robert D. Boutin MD, Anuj P. Netto MD, MPH, David Nakamura MD, Cyrus Bateni MD, Robert M. Szabo MD, MPH, Michael Cronan RDMS, Brent Foster BS, William R. Barfield PhD, J. Anthony Seibert PhD, Abhijit J. Chaudhari PhD

Voluntary knuckle cracking is a common habit, with a reported prevalence of 25% to 45%. Habitual knuckle cracking also is a frequent source of questions for physicians, and the largest study to date reported an association with functional hand impairments.

Erratum to: What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

Markus S. Hanke MD, Simon D. Steppacher MD, Helen Anwander MD, Stefan Werlen MD, Klaus A. Siebenrock MD, Moritz Tannast MD
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