RESUMO
Hip femoroacetabular impingement syndrome is observed in 47% to 74% of patients with hip pain. Femoroacetabular impingement syndrome may result in osteoarthritis. It is well known that cam lesion volume and hip alpha angle are critical parameters determining patient outcomes. Recent research shows that a superolateral cam lesion location increases risk of hip arthroplasty at 5 years, and that this is more common in younger patients. The clinical relevance is that we may need to more aggressively treat superolateral cam lesions in younger patients, pending additional research to determine whether location is destiny.
Assuntos
Artroplastia de Quadril , Impacto Femoroacetabular , Osteoartrite do Quadril , Humanos , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/cirurgia , Artroscopia , Articulação do Quadril/cirurgia , Osteoartrite do Quadril/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: To describe the experience in the diagnostic process and treatment of patients with groin pain (GP) of neurological origin due to entrapment of the iliohypogastric (IH), ilioinguinal (IL) and genitofemoral (GF) nerves in a hip preservation clinic. METHODS: Retrospective study of patients with GP of neurological origin confirmed with ultrasound-guided nerve block. Clinical outcomes were reported in 21 cases (age, 53.3 ± 15.9 years) treated with conservative treatment from January to December 2019, and in 9 patients (age 43.7 ± 14.6 years) who underwent neurectomy from January 2015 to December 2019. Pain intensity was assessed with a numerical rating scale (NRS) before starting the diagnostic process (Day 0) and at the end of follow-up. RESULTS: All cases reported pain on groin palpation. Half of these cases also reported a positive FADIR test (flexion, adduction, internal rotation) (15/30). On day 0, the intensity of pain in cases treated with conservative treatment was severe in 19 patients (NRS 7-10) and moderate in 2 (NRS 4-6), with a median improvement of 7 points (interquartile range [IQR] 5.5-8.0) at the end of follow-up (p < 0.001). In neurectomy group, a similar improvement in pain severity was (Day 0: 9 points [IQR 8.0-9.0]; end of follow-up: 0 points [IQR: 0-2.0]; p = 0.002). At the end of the study, 17/21 patients with conservative treatment and 7/9 with neurectomy were pain free or with mild pain (NRS < 3). CONCLUSIONS: In cases with PG of neurological origin, there is a high frequency of false positives in the FADIR test. Our findings suggest that neurectomy is a treatment option for patients in whom conservative treatment fails, providing significant pain relief.
Assuntos
Artroplastia de Quadril , Impacto Femoroacetabular , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Virilha/inervação , Virilha/cirurgia , Diagnóstico Diferencial , Estudos Retrospectivos , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/cirurgia , DorRESUMO
CASE: This report presents the results of a hip arthroscopic technique that was used to treat an unusual posterior wall acetabular fracture nonunion. A 30-year-old man presented with 1 year of persistent left-sided buttock and groin pain with associated feeling of instability when climbing stairs. Magnetic resonance imaging demonstrated a small left acetabular posterior wall fracture nonunion. We describe outpatient treatment with reduction and cannulated screw fixation using arthroscopic techniques that permitted immediate partial weight bearing and achieved excellent outcomes at 1 year. CONCLUSION: Arthroscopic fixation of an acetabular posterior wall fracture nonunion may be a feasible treatment option in select cases.
Assuntos
Impacto Femoroacetabular , Fraturas do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adulto , Artroscopia/métodos , Parafusos Ósseos , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Fraturas do Quadril/cirurgia , Humanos , MasculinoRESUMO
BACKGROUND: Patients with acetabular retroversion are at risk of labral tear and hip pain. It is unknown whether femoroacetabular osteoplasty (FAO) without reverse periacetabular osteotomy can be used in these patients. This study evaluated the outcome of mini-open FAO in patients with acetabular retroversion and compared that to patients without acetabular retroversion. METHODS: Fifty-one patients (29 male, 22 female) with acetabular retroversion who had undergone FAO between 2007 and 2015 were identified. The minimum 2-year clinical and radiological outcome was compared with 550 patients without dysplasia or retroversion who underwent FAO by the same surgeon. The preoperative and postoperative alpha angle, center-edge angle, Tonnis grade, joint space, and presence of labral tear and chondral lesion were determined. RESULTS: The mean age in the retroversion cohort was 27.4 ± 9.5 years compared to 34.5 ± 11.2 years in the control. The mean follow-up was 4.8 ± 1.5 years for retroversion and 4.1 ± 1.2 years for the control. The mean preoperative Short-Form 36 Health Survey and modified Harris hip score were not different between the cohorts. At the latest follow-up, the mean modified Harris hip score and Short-Form 36 Health Survey were significantly lower in the retroversion group (75.4 and 76.5) compared to the control (83.4 and 85.6). There was a higher percentage of failure among retroversion patients (13.7%) compared to the control (2.5%). CONCLUSION: Acetabular retroversion resulting in femoroacetabular impingent may be treated by FAO, but the outcome appears to be less optimal compared to patients with femoroacetabular impingent and no evidence of dysplasia and acetabular retroversion. Hip preservation surgeons should be aware of this anatomic variation and possible inferior treatment results after FAO in these patients.
Assuntos
Retroversão Óssea/complicações , Impacto Femoroacetabular/cirurgia , Acetábulo/cirurgia , Adolescente , Adulto , Artrodese , Artroscopia , Feminino , Impacto Femoroacetabular/complicações , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Período Pós-Operatório , Radiografia , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The optimal treatment for patients with symptomatic hip dysplasia presenting with labral tear is unknown. Although femoroacetabular osteoplasty (FAO) has excellent outcome for most femoroacetabular impingement patients, the presence of concomitant hip dysplasia has been implicated as an adverse prognostic factor. This study evaluated the outcome of FAO in a group of dysplastic hips and compared the outcome to a cohort of patients without dysplasia. METHODS: Seventy-three patients (38 males, 35 females) with hip dysplasia who underwent FAO between 2007 and 2015 were identified. The minimum 2-year clinical, functional (modified Harris Hip Score and Short-Form 36 Health Survey), and radiological outcome was compared with 550 patients without dysplasia who underwent FAO by the same surgeon. The preoperative and postoperative alpha angle, Tonnis grade, joint space, and presence of chondral lesion were determined and compared. Conversion to total hip arthroplasty or revision FAO was considered as treatment failure. RESULTS: The mean age in the dysplasia cohort was 30.7 ± 11.8 years compared to 34.5 ± 11.2 in the nondysplastic group. The mean follow-up was 4.3 years for dysplasia cohort and 4.1 for the nondysplastic group. The mean modified Harris Hip Score and Short-Form 36 Health Survey6 was significantly lower in the dysplastic group at 75.1 and 74.3 compared to 83.4 and 85.6 for the comparison group. There was a higher percentage of failure at 28.8% among dysplasia patients compared to 2.5% in the nondysplastic group. CONCLUSION: Although labral repair and FAO may be an option for patients with hip dysplasia, the outcome in this population appears to be less optimal compared to femoroacetabular impingement patients with no evidence of dysplasia. Labral repair and osteoplasty should be limited to those with mild and borderline dysplasia.
Assuntos
Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/cirurgia , Luxação do Quadril/complicações , Adulto , Artroplastia de Quadril , Artroscopia , Estudos de Coortes , Feminino , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Femoral version measurement techniques based on magnetic resonance imaging (MRI) studies have been developed as an alternative to the high levels of ionizing radiation associated with computed tomography (CT)-based methods. Previous studies have not evaluated the reliability, repeatability, and accuracy of MRI-based femoral version measurements in an adolescent population. METHODS: Subjects who underwent MRI and CT studies for clinical suspicion of hip pain secondary to hip dysplasia or femoroacetabular impingement between 2011 and 2013 were identified. Rapid sequence femoral version images were obtained from MRI Hip dGEMRIC and/or postarthrogram studies. Femoral version images were also obtained from bilateral CT lower extremity, without contrast, studies. Measurements were made by 1 fellowship-trained, pediatric hip preservation attending surgeon, 2 pediatric orthopaedic surgical fellows, and 1 fellowship-trained musculoskeletal radiologist on 2 separate occasions. Linear mixed models were used to estimate the reliability and repeatability associated with CT-based and MRI-based measurements (intraclass correlation coefficients) and to estimate the agreement (CT-MRI) between the 2 techniques. RESULTS: The mean age of 36 subjects was 15.4 years (±4.1 y). Interrater reliability was 0.91 (95% CI, 0.86-0.95) for the CT technique compared with 0.90 (95% CI, 0.86-0.94) for the rapid sequence MRI technique. Intrarater reliability for the CT technique was 0.96 (95% CI, 0.91-0.98) compared with 0.95 (95% CI, 0.90-0.97) for the MRI technique. The agreement between the MRI-based and CT-based techniques (bias: 1.9 degrees, limits of agreement: -11.3 to 14.9 degrees) was similar to the agreement between consecutive MRI measurements (bias: 0.4 degrees, limits of agreement: -7.8 to 8.6 degrees) as well as consecutive CT measurements (bias: 0.5 degrees, limits of agreement: -8.8 to 9.9 degrees). CONCLUSIONS: The interrater and intrarater reliability and repeatability estimates (intraclass correlation coefficient values) associated with both techniques was excellent (>0.90). Acquirement of axial images at the pelvis and knee during MRI for investigation of adolescents with hip pain allows for reliable measurement of femoral version. LEVEL OF EVIDENCE: Level II-diagnostic study.
Assuntos
Mau Alinhamento Ósseo/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Mau Alinhamento Ósseo/complicações , Criança , Feminino , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico por imagem , Luxação do Quadril/complicações , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
Femoroacetabular impingement (FAI) syndrome is a frequent cause of pain and in recent years considered to be a precursor of premature hip osteoarthritis. The structural abnormalities which characterize FAI syndrome, such as the cam-type deformity, are associated with morphological alterations that may lead to hip osteoarthritis. The aim of this study was to determine the prevalence and topographic and morphometric features of the cam deformity in a series of 326 femur specimens obtained from a Mexican population, as well as changes in prevalence in relation to age and gender. The specimens were subdivided into groups according to gender and age. A standardized photograph of the proximal femur of each specimen was taken, and the photograph was used to determine the alpha angle using a computer program; the location of the lesion was determined by quadrant and the morphometric characteristics were determined by direct observation. The overall prevalence of cam deformities in the femur specimens was 29.8 % (97/326), with a prevalence by gender of 35.2 % (64/182) in men and 22.9 % (33/144) in women. The mean alpha angle was 54.6° ± 8.5° in all of the osteological specimens and 65.6° ± 7.5° in those specimens exhibiting a cam deformity. Cam deformities were found topographically in the anterior-superior quadrant of the femoral head-neck junction in 86.6 % (84/97) of the femurs. Deformities were found in 28.2 % of the right femurs and 31.3 % of the left femurs. The prevalence of cam deformity was higher in the femur specimens of young men and in those of middle-aged and older women. There were no significant differences in this deformity in relation to the alpha angle according to age and gender.