Femoroacetabular impingement (FAI) has been identified as a common cause of hip pain in young adults. However, treatment is not well standardized. We retrospectively reviewed 97 patients (100 hips) who underwent osteochondroplasty of the femoral head-neck for FAI using a mini-open anterior Hueter approach with arthroscopic assistance. The mean age of the patients was 33.4 years. The labrum was refixed in 40 hips, partially excised in 39 cases, completely excised in 14 cases, and left intact in seven. Six patients were lost to followup, leaving 91 (94 hips) with a minimum followup of 28.6 months (mean, 58.3 months; range, 28.6-104.4 months). We assessed patients clinically using the nonarthritic hip score (NAHS). One patient had a femoral neck fracture 3 weeks postoperatively. At the last followup, the mean NAHS score increased by 29.1 points (54.8 +/- 12 preoperatively to 83.9 +/- 16 points at last followup). Eleven hips developed osteoarthritis and subsequently had total hip arthroplasty. The best results were obtained in patients younger than 40 years old with a 0 Tönnis grade. Refixation of the labrum did not correlate with a higher NAHS score (87 +/- 11 with refixation versus 82 +/- 19 points without) at the last followup. The technique for FAI treatment allowed direct visualization of the anterior femoral head-neck junction while avoiding surgical dislocation, had a low complication rate, and improved functional scores.

IntroductionThe treatment of most spinal diseases is a difficult task because of the rate of immediate, mid-and long-term complications and failures [16]. Surgical planning and clinical follow up often rely on postural and/or dynamic X-ray exams, among other imaging options.Many authors investigated the radiological parameters liable to rule patient's evolution, such as postural and balance parameters [2,4,8,9,11,12,26]. These parameters might be classified in pelvic parameters, either morphologic (incidence) or positional (sacral slope [4,11,12], pelvic angle [8,9]), and spinal parameters (such as lordosis, kyphosis [4,11,12] or plumblines [8,9]). Their measurement is tedious and time consuming while the accuracy of the results may be highly variable depending on the method employed. Furthermore, when trying to compare the results between studies, a major difficulty comes from the differences in the definition, identification and measurement of parameters.Recent computer-based tools allowed for a rapid progress in quantitative measurements of a large range of parameters [9,17,19,20,23,26]. Moreover, these tools allow easy standardisation of X-ray films measurements, which is of paramount importance when comparing studies in multicentric analysis. However, validation of these tools is essential [3,17,18].In 1999, the team of LBM and LIO developed an Xray films analysis software (SpineView 1.0) allowing for the measurement of the main lumbar dynamic and sagittal postural parameters of the spine. The evaluation of this first software was achieved by comparison with direct measurements on plain X-ray films [17,18], and showed good reliability of the measurements. Abstract The objective of this study was to evaluate an X-ray films analysis software, i.e. to estimate the reliability and validity of clinical measurements by means of this software. The authors first performed tests of precision and reproducibility of measures. The precision for dynamic modules was estimated at ±2°for the lumbar analysis and ±3°for the cervical one. Mean reproducibility coefficients calculated for postural modules are about 4°for the angular parameters and 3 mm for the linear ones. We also evaluated clinical applicability of the software through its validity. Reference values calculated on a population of healthy subjects showed agreement with the literature. Then, when analysing postural X-ray films of severe scoliotic patients, we found that inter-observer reproducibility coefficients show a lower reliability of measurements; the main cause seems to be the low visibility of anatomic landmarks due to the quality of X-ray films and to the degree of deformity. This study allowed to better estimate the reliability and the usefulness of this tool, allowing for multicentric studies and exchanges.Keywords Spine AE X-ray AE Quantitative analysis AE Software AE Motion AE Balance Eur Spine J (2006) 15: 982-991

Results confirmed the efficacy and low associated morbidity of arthroscopy in the management of femoroacetabular impingement. Short-term functional results matched those of the literature. Planning and assessment seem not yet to be fully standardized. Preoperative osteoarthritis on X-ray was associated with poorer functional results. This attitude does not seem to be indicated for hips showing evolved osteoarthritis (>grade 1).

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