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Femoral impingement

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https://www.readbyqxmd.com/read/27913129/preoperative-planning-and-operative-techniques-of-the-shorter-tapered-stem-compared-to-the-metaphyseal-fit-stem-in-cementless-total-hip-arthroplasty
#1
Hiroshi Imai, Joji Miyawaki, Tomomi Kamada, Akira Maruishi, Jun Takeba, Hiromasa Miura
BACKGROUND: In order to prevent postoperative dislocation due to prosthetic impingement as a result of total hip arthroplasty (THA), the combined anteversion (CA) theory, which combines the anteversion of the femoral stem and the acetabular socket, has been revised in recent years. Particularly, it is necessary to keep CA within the target zone. METHODS: The aim of this study was to investigate whether postoperative CA can be kept within the target zone while using the operative technique which prepares the socket first in cementless THA, by estimating the anteversion of the metaphyseal fit stem or the shorter, tapered wedge stem using preoperative 3-dimensional computerized planning, and by adjusting the anteversion of the socket using a navigation system that considers CA...
November 10, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27905061/one-third-of-hips-after-periacetabular-osteotomy-survive-30-years-with-good-clinical-results-no-progression-of-arthritis-or-conversion-to-tha
#2
Till Dominic Lerch, Simon Damian Steppacher, Emanuel Francis Liechti, Moritz Tannast, Klaus Arno Siebenrock
BACKGROUND: 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. QUESTIONS/PURPOSES: Looking at the initial group of patients with hip dysplasia undergoing PAO at the originator's institution, we asked: (1) What is the cumulative 30-year survival rate free from conversion to THA, radiographic progression of osteoarthritis, and/or a Merle d'Aubigné-Postel score < 15? (2) Did hip function improve and pain decrease? (3) Did radiographic osteoarthritis progress? (4) What are the factors associated with one or more of the three endpoints: THA, radiographic progression of osteoarthritis, and/or Merle d'Aubigné-Postel score < 15? METHODS: We retrospectively evaluated the first 63 patients (75 hips) who underwent PAO for hip dysplasia between 1984 and 1987...
November 30, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27861170/monte-carlo-study-of-the-scattered-radiation-field-near-the-eyes-of-the-operator-in-interventional-procedures
#3
Paolo Ferrari, Frank Becker, Eleftheria Carinou, Vadim Chumak, Jad Farah, Zoran Jovanovic, Dragana Krstic, Artem Morgun, Sara Principi, Pedro Teles
Interventional radiology and cardiology guarantee high benefits for patients, but are known to be associated with a high level of radiation exposure of medical staff. The recently suggested decrease of the annual dose limit for the eye lens, from 150 to 20 mSv, caused a need for a reconsideration of practices ensuring sufficient protection for the lens of the eyes of medical staff. In such context the study of the scattered radiation around the operator's head could help in finding the best solutions to be adopted for the ceiling-suspended shield and lead glasses in the most common situations in interventional practices...
November 18, 2016: Journal of Radiological Protection: Official Journal of the Society for Radiological Protection
https://www.readbyqxmd.com/read/27830486/three-patterns-of-acetabular-deficiency-are-common-in-young-adult-patients-with-acetabular-dysplasia
#4
Jeffrey J Nepple, Joel Wells, James R Ross, Asheesh Bedi, Perry L Schoenecker, John C Clohisy
BACKGROUND: 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. QUESTIONS/PURPOSES: The purposes of this study were (1) to determine the variability in 3-D acetabular deficiency in acetabular dysplasia; (2) to define subtypes of acetabular dysplasia based on 3-D morphology; (3) to determine the correlation of plain radiographic parameters with 3-D morphology; and (4) to determine the association of acetabular dysplasia subtype with patient clinical characteristics including sex, range of motion, and femoral version...
November 9, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27817118/continued-growth-after-fixation-of-slipped-capital-femoral-epiphysis
#5
Per Holmdahl, Torsten Backteman, Aina Danielsson, Johan Kärrholm, Jacques Riad
PURPOSE: When treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE. METHODS: Sixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4-15...
November 5, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27807678/both-3-t-dgemric-and-acetabular-femoral-t2-difference-may-detect-cartilage-damage-at-the-chondrolabral-junction
#6
Tobias Hesper, Evgeny Bulat, Sarah Bixby, Alireza Akhondi-Asl, Onur Afacan, Patricia Miller, Garrett Bowen, Simon Warfield, Young-Jo Kim
BACKGROUND: 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. QUESTIONS/PURPOSES: We sought to determine whether (1) 3-T delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping are both capable of detecting cartilage damage at the chondrolabral junction in patients with femoroacetabular impingement (FAI); and (2) whether there is a correlation between these two techniques for acetabular and femoral head cartilage assessment...
November 2, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27796801/the-femoro-epiphyseal-acetabular-roof-fear-index-a-new-measurement-associated-with-instability-in-borderline-hip-dysplasia
#7
Michael Wyatt, Jan Weidner, Dominik Pfluger, Martin Beck
BACKGROUND: The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making-specifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. QUESTIONS/PURPOSES: (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral center-edge angle (LCEA) and acetabular index (AI), with respect to intra- and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips...
October 28, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27765733/preoperative-outcome-scores-are-predictive-of-achieving-the-minimal-clinically-important-difference-after-arthroscopic-treatment-of-femoroacetabular-impingement
#8
Benedict U Nwachukwu, Kara Fields, Brenda Chang, Danyal H Nawabi, Bryan T Kelly, Anil S Ranawat
BACKGROUND: There is increasing interest in defining meaningful improvement in patient-reported outcomes. Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) outcomes is evolving. PURPOSE: To define preoperative outcome score thresholds and determine clinical/demographic patient factors predictive for achieving the minimal clinically important difference (MCID) after arthroscopic FAI surgery. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2...
October 20, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27752989/femoral-morphology-in-the-dysplastic-hip-three-dimensional-characterizations-with-ct
#9
Joel Wells, Jeffrey J Nepple, Karla Crook, James R Ross, Asheesh Bedi, Perry Schoenecker, John C Clohisy
BACKGROUND: 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. QUESTIONS/PURPOSES: (1) Are there common proximal femoral characteristics in patients with symptomatic hip dysplasia undergoing periacetabular osteotomy (PAO)? (2) Where is the location of maximal femoral head and neck offset deformity in hip dysplasia? (3) Do certain subgroups of dysplastic hips more commonly have cam-type femoral morphology? (4) Is there a relationship between hip ROM as well as impingement testing and 3-D head and neck offset deformity? METHODS: Using our hip preservation database, 153 hips (148 patients) underwent PAO from October 2013 to July 2015...
October 17, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27744594/labral-reattachment-in-femoroacetabular-impingement-surgery-results-in-increased-10-year-survivorship-compared-with-resection
#10
Helen Anwander, Klaus A Siebenrock, Moritz Tannast, Simon D Steppacher
BACKGROUND: 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...
October 15, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27726746/postoperative-imaging-in-the-setting-of-hip-preservation-surgery
#11
Megan K Mills, Colin D Strickland, Mary K Jesse, Peter A Lowry, Omer Mei-Dan, Jonathan A Flug
Osteoarthritis of the hip remains a prevalent disease condition that influences ever-changing treatment options. Procedures performed to correct anatomic variations, and, in turn, prevent or slow the progression of osteoarthritis, are aptly referred to as types of hip preservation surgery (HPS). Conditions that predispose individuals to femoroacetabular impingement (FAI), including pincer- and cam-type morphology, and hip dysplasia are specifically targeted in HPS. Common surgical interventions include acetabuloplasty, osteochondroplasty, periacetabular osteotomy (PAO), and derotational femoral osteotomy (DFO)...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27718121/what-are-the-risk-factors-for-revision-surgery-after-hip-arthroscopy-for-femoroacetabular-impingement-at-7-year-followup
#12
Pascal Cyrill Haefeli, Christoph Emanuel Albers, Simon Damian Steppacher, Moritz Tannast, Lorenz Büchler
BACKGROUND: 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...
October 7, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27709422/how-does-the-dgemric-index-change-after-surgical-treatment-for-fai-a-prospective-controlled-study-preliminary-results
#13
Florian Schmaranzer, Pascal C Haefeli, Markus S Hanke, Emanuel F Liechti, Stefan F Werlen, Klaus A Siebenrock, Moritz Tannast
BACKGROUND: 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). QUESTIONS/PURPOSES: (1) How does the mean acetabular and femoral dGEMRIC index change after surgery for FAI at 1-year followup compared with a similar group of patients with FAI treated without surgery? (2) Does the regional distribution of the acetabular and femoral dGEMRIC index change for the two groups over time? (3) Is there a correlation between the baseline dGEMRIC index and the change of patient-reported outcome measures (PROMs) at 1-year followup? (4) Among those treated surgically, can dGEMRIC indices distinguish between intact and degenerated cartilage? METHODS: We performed a prospective, comparative, nonrandomized, longitudinal study...
October 5, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27709031/arthroscopic-femoral-osteochondroplasty-for-cam-type-femoroacetabular-impingement-the-trough-technique
#14
Stephen K Aoki, James T Beckmann, James D Wylie
Arthroscopic osteochondroplasty has become the most common treatment for cam-type femoroacetabular impingement. However, gauging the appropriate depth and location of the femoral osteochondroplasty remains challenging, given the parallax observed from using a 70° arthroscope across multiple viewing perspectives. Consequently, reliable techniques must use a combination of arthroscopic and fluoroscopic checks and balances to assess the femoral head-neck junction to help guide bony resection. We have developed a technique for osteochondroplasty that has made the process more efficient and reliable in our hands...
August 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/27686463/increased-revision-rate-with-posterior-tibial-tunnel-placement-after-using-the-70-degree-tibial-guide-in-acl-reconstruction
#15
Eivind Inderhaug, Sveinung Raknes, Thomas Østvold, Eirik Solheim, Torbjørn Strand
PURPOSE: To map knee morphology radiographically in a population with a torn ACL and to investigate whether anatomic factors could be related to outcomes after ACL reconstruction at mid- to long-term follow-up. Further, we wanted to assess tibial tunnel placement after using the 70-degree "anti-impingement" tibial tunnel guide and investigate any relation between tunnel placement and revision surgery. METHODS: Patients undergoing ACL reconstruction involving the 70-degree tibial guide from 2003 to 2008 were included...
September 29, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27686411/management-of-a-patient-with-acute-acetabular-labral-tear-and-femoral-acetabular-impingement-with-intra-articular-steroid-injection-and-a-neuromotor-training-program
#16
Joel R Narveson, Matthew D Haberl, Patrick J Grabowski
Study Design Case report. Background Intra-articular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement. Case Description The patient was an 18-year-old woman with recent onset of right groin pain who underwent intra-articular corticosteroid injection and therapeutic exercise for the management of an acute acetabular labral tear identified on radiographic imaging...
November 2016: Journal of Orthopaedic and Sports Physical Therapy
https://www.readbyqxmd.com/read/27671286/popliteus-impingement-after-tka-may-occur-with-well-sized-prostheses
#17
Michel P Bonnin, Arnoud de Kok, Matthias Verstraete, Tom Van Hoof, Catherine Van der Straten, Mo Saffarini, Jan Victor
PURPOSE: To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. METHODS: The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid...
September 26, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27650107/decreasing-pelvic-incidence-is-associated-with-greater-risk-of-cam-morphology
#18
W Z Morris, C A Fowers, R T Yuh, J J Gebhart, M J Salata, R W Liu
OBJECTIVES: The spinopelvic relationship (including pelvic incidence) has been shown to influence pelvic orientation, but its potential association with femoroacetabular impingement has not been thoroughly explored. The purpose of this study was to prove the hypothesis that decreasing pelvic incidence is associated with increased risk of cam morphology. METHODS: Two matching cohorts were created from a collection of cadaveric specimens with known pelvic incidences: 50 subjects with the highest pelvic incidence (all subjects > 60°) and 50 subjects with the lowest pelvic incidence (all subjects < 35°)...
September 2016: Bone & Joint Research
https://www.readbyqxmd.com/read/27646418/do-radiographic-parameters-of-dysplasia-improve-to-normal-ranges-after-bernese-periacetabular-osteotomy
#19
Eduardo N Novais, Stephen Duncan, Jeffrey Nepple, Gail Pashos, Perry L Schoenecker, John C Clohisy
BACKGROUND: 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...
September 19, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27646313/native-femoral-anteversion-should-not-be-used-as-reference-in-cementless-total-hip-arthroplasty-with-a-straight-tapered-stem-a-retrospective-clinical-study
#20
Michael Worlicek, Markus Weber, Benjamin Craiovan, Michael Wörner, Florian Völlner, Hans R Springorum, Joachim Grifka, Tobias Renkawitz
BACKROUND: Improper femoral and acetabular component positioning can be associated with instability, impingement, component wear and finally patient dissatisfaction in total hip arthroplasty (THA). The concept of "femur first"/"combined anteversion", incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position of the stem relative to the cup intraoperatively. In the present study we asked two questions: (1) Do native femoral anteversion and anteversion of the implant correlate? (2) Do anteversion of the final broach and implant anteversion correlate? METHODS: In a secondary analysis of a prospective controlled trial, a subgroup of 55 patients, who underwent computer-assisted, cementless THA with a straight, tapered stem through an anterolateral, minimally invasive (MIS) approach in a lateral decubitus position were examined retrospectivly...
2016: BMC Musculoskeletal Disorders
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