Incidence and Characteristics of Femoral Deformities in the Dysplastic Hip

Self Cite

Femoral head-neck junction osteochondroplasty is commonly used to treat femoroacetabular impingement, yet remodeling of the osteochondroplasty site is not well described. We therefore describe bony remodeling at the osteochondroplasty site and analyze clinical outcomes and complications associated with femoral osteochondroplasty. We retrospectively reviewed 135 patients (150 hips) who underwent femoral head-neck osteochondroplasty combined with hip arthroscopy, surgical hip dislocation, periacetabular osteotomy, or proximal femoral osteotomy. The minimum clinical followup was 10 months (mean, 22.3 months; range, 10-65 months). We assessed the femoral-head neck offset, head-neck offset ratio, alpha angle, and cortical remodeling. We used the Harris hip score to determine hip function. We observed an increase in the head-neck offset, offset ratio, and decrease in the alpha angle postoperatively and at latest followup. Ninety-eight of 113 (87%) hips had partial or complete recorticalization at the osteochondroplasty site. The mean Harris hip score improved from 64 to 85. We excised heterotopic bone in one hip. There were no femoral neck fractures. The deformity correction achieved with femoral head-neck osteochondroplasty is maintained and recorticalization occurs in the majority of cases during the first two years.

Section: Methodsmentioning

confidence: 99%

Osseous Remodeling After Femoral Head-neck Junction Osteochondroplasty

Nassif

Pekmezci

Pashos

et al. 2010

Self Cite

“…Coxa valga is often associated with acetabular dysplasia [5,19] and neuromuscular disorders [18] but may also occur as an isolated entity. Coxa valga can be combined with excessive femoral antetorsion [6].…”

Section: Introductionmentioning

confidence: 99%

Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI

Siebenrock

Steppacher

Haefeli

et al. 2013

151

205

Background Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI). Questions/purposes We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI. Methods Surface models based on CT scan reconstructions of 13 valgus hips with increased antetorsion, 22 hips with FAI, and 27 normal hips were included. Validated three-dimensional collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and the femoral sides. Results Hips with coxa valga and antetorsion showed decreased extension, external rotation, and adduction, whereas internal rotation in 90°of flexion was increased. Impingement zones were more anteroinferior on the femur and posteroinferior on the acetabular (pelvic) side; and the zones were more frequently extraarticular, posterior, or to a lesser degree anterior against the inferior iliac spine. We found a higher prevalence of extraarticular impingement for valgus hips with increased antetorsion. Conclusions Valgus hips with increased antetorsion predispose to posterior extraarticular FAI and to a lesser degree anteroinferior spine impingement. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

“…Furthermore, there is evidence that anatomy predisposing to impingement and anatomy predisposing to instability can coexist in the same hip. About 20% of patients with dysplasia, an instability factor, have acetabular retroversion [15] and more than 70% have decreased head-neck offset [12], both of which are impingement factors [16,36]. Sex may also influence both the kind and magnitude of pathoanatomy.…”

Section: Introductionmentioning

confidence: 99%

Two or More Impingement and/or Instability Deformities Are Often Present in Patients With Hip Pain

Tibor¹,

Liebert

Sutter

et al. 2013

Background Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery. Questions/purposes We determined (1) the influence of sex on the expression of impingement-related or instability-related factors, (2) the associations among these factors, and (3) how often both impingement and/or instability factors occur in the same hip.Methods We retrospectively reviewed a cohort of 170 hips (145 patients) undergoing MR arthrography of the hip for any reason. We excluded 58 hips with high-grade dysplasia, Perthes' sequelae, previous surgery, or incomplete radiographic information, leaving 112 hips (96 patients). We measured femoral version and alpha angles on MR arthrograms. Acetabular anteversion, lateral CEA, and neck-shaft angle were measured on pelvic radiographs. Results We observed a correlation between sex and alpha angle. Weak or no correlations were observed between the other five parameters. In 66% of hips, two or more (of five) impingement parameters, and in 51% of hips, two or more (of five) instability parameters were found. Conclusions Patients with hip pain frequently have several anatomic factors potentially contributing to chondrolabral damage. To address pathologic hip loading due to impingement and/or instability, all of the anatomic influences should be known. As we found no associations between anatomic factors, we recommend an individualized assessment of each painful hip. Level of Evidence Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.