Early Results of Treatment of Hip Impingement Syndrome in Slipped Capital Femoral Epiphysis and Pistol Grip Deformity of the Femoral Head-Neck Junction Using the Surgical Dislocation Technique

Spencer, Samantha A.; Millis, Michael B.; Kim, Young-Jo

doi:10.1097/01.bpo.0000217726.16417.74

Cited by 117 publications

(74 citation statements)

References 8 publications

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“…Cam impingement is the result of decreased head-neck offset with a gradual aspherical contour from the femoral head to the neck anterolaterally, together with a relative retroversion of the femoral head or a prominent portion engaging the articular surface of the acetabulum. 5,6 This osteochondral lesion impacts the acetabular rim during flexion and internal rotation at the hip. 7 FAI may occur in patients with coxa magna, slipped capital femoral epiphysis or secondary to abnormal physeal development 8 ; or in patients with abnormal retroversion or a deep acetabulum (pincer type) such as protrusio acetabuli or overcorrection after acetabular osteotomy, owing to the relative over-coverage by the anterior rim producing a linear contact between the rim and femoral neck 3 ; or in patients with a combined acetabular and femoral aetiology.…”

Section: Introductionmentioning

confidence: 99%

Conservative Treatment for Mild Femoroacetabular Impingement

Emara

Samir

Khan

2011

J Orthop Surg (Hong Kong)

142

167

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Purpose. To report early results of conservative treatments (including modifications in activities of daily living) for mild femoroacetabular impingement. Methods. 27 male and 10 female athletic patients aged 23 to 47 years presented with unilateral hip pain secondary to femoroacetabular impingement and an alpha angle of <60º. Patients were instructed to adapt to their safe range of movement and perform activities of daily living with minimal friction. The Harris Hip Score and non-arthritic hip score before and after treatment were compared. Open or arthroscopic hip surgery to remove the impinging bone was indicated when conservative treatment failed. Results. Patients were followed up for 25 to 28 months. Of the 37 patients, 4 underwent surgical treatment after conservative management failed. For the remaining 33 patients, the mean Harris Hip Score improved significantly from 72 before treatment to 91 at the 24-month follow-up. The mean non-arthritic hip scores improved from 72 to 91, and the mean visual analogue scores for hip pain from 6 to 2. Six of the 33 patients had recurrent hip pain and discomfort but not severe enough for surgical treatment. Conclusion. Conservative treatment did not improve the range of hip movement, despite improvement in function and symptoms. Yet it achieved good early results, as long as the patients could modify activities of daily living to adapt to their hip morphology.

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Section: Introductionmentioning

confidence: 99%

Conservative Treatment for Mild Femoroacetabular Impingement

Emara

Samir

Khan

2011

J Orthop Surg (Hong Kong)

142

167

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“…The majority of these studies, however, focused on patients older than adolescents. Other studies are of adolescent cohorts who were treated by an arthroscopic approach or include results of residual pediatric deformity such as Legg-Calvé-Perthes disease or SCFE [13,27,32]. In the current study, we analyzed a consecutive adolescent cohort who underwent surgical hip dislocation for FAI not caused by common childhood structural abnormalities such as Legg-Calvé-Perthes disease or SCFE.…”

Section: Discussionmentioning

confidence: 99%

“…The average age and associated disorders in these cohorts reveal a critical need to study younger patients whose hip disorders have not had time to progress and in whom we expect to discover a lesser degree of chondrolabral damage and joint space narrowing. Studies have described the use of surgical hip dislocation to treat children and adolescents, although patients with other deformities such as slipped capital femoral epiphysis (SCFE), Legg-Calvé-Perthes disease, osteonecrosis, and exostosis were included in the cohort [28,32].…”

Section: Introductionmentioning

confidence: 99%

Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

Sink

Fabricant

Pan

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress. Questions We assessed (1) how validated measures of patient-oriented assessment of hip function and quality of life change after surgical hip dislocation; (2) whether any patient-related or technique variables correlated with changes in the outcome scores; and (3) what the complications of treatment are and how many reoperations we performed on these patients. Methods We retrospectively reviewed a consecutive series of 71 hips in adolescents younger than 21 years who underwent surgical hip dislocation for FAI. The final cohort consisted of 44 patients (52 hips) with a mean age of 16 years. We analyzed changes in outcome variables after surgical hip dislocation and recorded reoperations during the study period. Results The minimum followup was 12 months (average, 27 months; range, 12-60 months). Modified Harris hip scores increased from a mean of 57.7 preoperatively to a mean of 85.8 postoperatively. Mean SF-12 scores increased from 42.3 to 50.6. Mean preoperative hip flexion increased from 97.5°to 106.2°. Mean internal rotation of the affected hip at 90°flexion increased from 18.19°to 34°. Conclusions Early results revealed improvements in hip function, patient quality of life, and ROM after surgical hip dislocation for the majority of this group of adolescents with FAI. However, 10% of the patients did not improve, and an additional 15% improved but still did not consider their hips good or excellent. This points toward the need for further studies in this population of patients.

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“…Spencer et al 34 were reported. In a study of 29 patients with SCFE by Rebello et al, 32 of whom 17 had prior pinning in situ, the surgical procedures performed were femoral head-neck osteochondroplasty (n = 7), intertrochanteric osteotomy (n = 5), femoral head-neck osteochondroplasty with intertrochanteric osteotomy (n = 8), femoral neck osteotomy (n = 4) and open reduction and internal fixation (n = 5).…”

Section: Figmentioning

confidence: 99%

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

Azegami

Kosuge

Ramachandran

2013

The Bone & Joint Journal

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Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage. These procedures should be considered for patients with symptoms due to a deformity of the hip secondary to SCFE. Slipped capital femoral epiphysis (SCFE) is the most common adolescent disorder of the hip and the incidence is likely to increase, given the current epidemic of obesity in childhood. 1,2 It has been reported that the age at onset decreases with increasing obesity. 3 SCFE creates a complex deformity of the hip that can result in femoroacetabular impingement (FAI), which may lead to the early development of osteoarthritis (OA) of the hip. 4 Retrospective studies of patients with untreated SCFE and of pinning in situ without realignment suggest that the severity of the slip correlates with the subsequent radiological evidence of OA and poor clinical outcome scores, but is not necessarily predictive of FAI. 5,6 In a retrospective study by Dodds et al, 6 32% of patients (16 of 49) who previously presented to their institution with SCFE were found to have clinical signs of FAI.In situ pinning is commonly undertaken and is a relatively low risk procedure relying on remodelling of the proximal femur. However, it may still result in radiological osteoarthritic changes and a poor clinical outcome. Surgical management of FAI is aimed at restoring a more normal femoral head-neck offset in order to increase clearance and prevent femoral abutment against the acetabular edge. Various management strategies have been described, including arthroscopic osteochondroplasty, arthroscopically assisted osteochondroplasty via arthrotomy, surgical dislocation osteochondroplasty, proximal femoral osteotomy and peri-acetabular osteotomy. PathophysiologyBased on the type of abnormal morphology, FAI can be divided into three types: cam, pincer, and mixed-type. 4 In cam-type impingement the prominent area, typically on the anterolateral femoral neck, abuts the acetabular rim during forceful movement, especially in flexion and internal rotation, leading to damage of the labral-chondral complex. 7 In pincertype impingement the abnormality is on the acetabular side, involving focal or global overcoverage of the femoral head leading to damage of the femoral head-neck region and labrum. 8,9 FAI can also be classified as primary and secondary (Fig. 1).In SCFE, the relative positioning of the femoral head leads to prominence of the anterolateral femoral metaphysis (Fig. 2). 10 Th...

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Early Results of Treatment of Hip Impingement Syndrome in Slipped Capital Femoral Epiphysis and Pistol Grip Deformity of the Femoral Head-Neck Junction Using the Surgical Dislocation Technique

Cited by 117 publications

References 8 publications

Conservative Treatment for Mild Femoroacetabular Impingement

Conservative Treatment for Mild Femoroacetabular Impingement

Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

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