Instrumental Diagnosis and Preoperative Planning of Hip Arthroscopy in Femoroacetabular Impingement Syndrome: Lecture

Relevance. Femoroacetabular impingement (FAI) is one of the most common causes of pain and limitation of mobility in the hip joint in young and middle-aged individuals. The purpose of the study. The purpose of the study was to assess the effect of different hip deformities on the patient-reported outcome, to determine the influence of the structure of the acetabulum in conditions of borderline developmental dysplasia of the hip (BDDH) on the result of arthroscopy. Materials and methods. A retrospective, uncontrolled, single-center clinical trial was performed. It included 121 patients (40.5% female, and 59.5% male) who underwent arthroscopy on 135 hips. All patients underwent physical examination, hip radiographs and MRI. In patients with BDDH, the acetabulum version was evaluated. The i-HOT-33 and HOS scales were used pre- and postoperatively. Patients were divided into 4 groups according to the type of deformity. Outcomes. The best results were obtained from patients with isolated Cam deformity (group 1). The results of patients with a mixed type of deformity (group 2) did not differ from group 1 according to the HOS but differed according to i-HOT-33. The results of patients with a combination of Cam deformity, BDDH, and retroversion (group 4) did not differ from the group 1. In the group of patients with a combination of Cam deformity and BDDH (group 3), according to the HOS-Sport, a substantial clinical benefit (SCB) was achieved in 30%, while in the remaining groups it was not lower than 58%. First 2 postoperative years all patients show a significant improvement, but then, there is a downward trend in the performance of groups 2 and 3. Conclusion. The best results of arthroscopy are shown by patients with isolated Cam-deformity, patients with mixed type of FAI show slightly worse results. In conditions of BDDH, the effectiveness of arthroscopy depends on the structure of the anterior wall of the acetabulum. The worst results are observed in patients with BDDH and insufficiently developed anterior wall of the acetabulum, in the treatment of these patients it may be necessary to give preference to isolated, or in combination with arthroscopy, periacetabular osteotomy.

Results of Arthroscopic Treatment of Patients With Femoroacetabular Impingement Depending on the Type of Hip Deformity

Bogopolskiy,

Filonov,

Tikhilov

2023

Tactics of Surgical Treatment of Slipped Capital Femoral Epiphysis Associated With Mild Chronic Epiphyseal Displacement

Barsukov

Bortulev

Baskov

et al. 2022

Background. The appearing of data on cam-type FAI in patients with sequelae of slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement suggests that along with fixation of the proximal femoral epiphysis, modeling of the head-neck transition and restoration of the femoral offsets using arthroscopic techniques should be performed. Meanwhile, it is well known that after epiphyseal fixation, complete remodeling of the epimetaphysis and, consequently, disappearance of the morphological substrate of potential FAI can occur due to the ongoing enchondral and echondral growth. In this regard, the issue of indications for intraarticular interventions in studied patients remains currently open. The aim of the study was to determine the incidence of FAI in the postoperative period in patients with slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement, and to estimate the requirement of further surgical treatment. Methods. The results of the examination of 32 patients with mild chronic epiphyseal displacement in the typical posterior inferior direction who underwent cannulated epiphyseal screw fixation were analyzed for the severity of epimetaphysis remodeling and the presence of FAI in the postoperative period. Clinical, radiological, magnetic resonance, and statistical methods were used. Results. At the age of 18-19 years, FAI with pain syndrome in everyday life was found in 9 (28.1%) patients 8 of them did not have even partial remodeling of the femoral component of the joint, another 9 (28.1%) patients did not suffer from pain syndrome in everyday life, but had other clinical, radiological and MR signs of cam-type FAI. Complete or almost complete remodeling of the proximal femoral epimetaphysis occurred in 14 (43.8%) patients. Conclusion. In our opinion, therapeutic and diagnostic arthroscopy of the hip joint for the purpose of modeling the head-neck transition at the age of 18-19 years is indicated for more than one quarter (28.1%) of the investigated patients because of the presence of reliable signs of FAI.

Results of Arthroscopic Treatment for Femoroacetabular Impingement

Bogopolskiy¹,

Trachuk²,

Spetsialnyi³

et al. 2022

Self Cite

Background. Femoroacetabular impingement (FAI) is one of the most frequent causes of hip pain and limited hip mobility in young and middle-aged patients. It is a result of repeated injury of hip structures, that leads to degenerative changes in hip labrum, cartilage and subchondral bone and provokes progressive development of hip osteoarthritis. Aim of study to analyze own experience of treating patients with femoroacetabular impingement and identify factors affecting its outcomes. Methods. Retrospective, uncontrolled, single-center clinical study included 128 patients with FAI which had 150 surgeries on 149 joints in in the period from 2013 to 2021. All patients underwent physical examination and X-ray diagnostics, their FAI type was identified. The alpha angle of external part of femoral head in anterior-posterior position and in the modified Dunn 45 position, as well as Tonnis angle, lateral central-marginal angle in Ogata modification and the height of articular gap along the lateral (LS) and medial edges (MS) of sclerosed acetabulum part were calculated. The i-HOT-33 and HOS scales were used to assess preoperative status and postoperative results. Results. The average follow-up period was 3.9 years (SD 1.71; min 1.05 and max 8.16). The study included 55 (43.0%) women and 73 (57.0%) men which underwent 64 (42.7%) and 86 (57.3%) surgeries respectively. The most common types of FAI, according to our data, were mixed type (53% of joints) and сam type (27.5% of joints). Insufficient coverage of the femoral head by the acetabulum (borderline dysplasia) in combination with the сam deformity of the femoral head was observed in 18.1%. Pincer-type FAI was observed in 1.4% of joints. We obtained the worst results with a combination of сam deformity and borderline dysplasia in comparison with cam- and mix-type FAI according to the i-HOT-33 and HOS scales. Patients age, deep cartilage damage, irreparable labrum damage and height decrease of the lateral part of the articular gap determined negative effect on treatment results according to the i-HOT-33 and HOS scales. Conclusion. Hip arthroscopy showed good short- and midterm outcomes in patients with FAI. Pain syndrome is most often manifested in patients with pathology of hip soft tissue structures concomitant to FAI. The combination of сam deformity and insufficient femoral head coverage, deep cartilage damage and a height decrease of the articular gap are important predictors of poor treatment results.