Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects?

Claßen, Tim; Körsmeier, Konrad; Kamminga, Michael; Beck, Sascha; Rekowski, Jan; Jäger, Markus; Landgraeber, Stefan

doi:10.1007/s00167-014-3332-7

Cited by 33 publications

(24 citation statements)

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“…Bipolar hemiarthroplasty also might lead to early failure due to central migration of the bipolar head, because he already had a grade IV cartilage defect (classification system of Outerbridge and Dunlop [39] ) at the time of surgery. Recently, it has been reported that the timing of surgery and the patient’s age are important factors in avoiding the occurrence of chondral defects in patients with symptomatic cam-type FAI [40] . In this case, it might have been possible to avoid the occurrence of a chondral defect if the patient's disease had been diagnosed precisely and earlier.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

Fukui

Kaneuji

Matsumoto

2016

International Journal of Surgery Case Reports

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HighlightsIt is important to accurately diagnose the status of idiopathic osteonecrosis of the femoral head and to consider another possible pathogenesis when a patient with idiopathic osteonecrosis of the femoral head has hip pain even without femoral-head collapse.Ignored or misdiagnosed concomitant femoroacetabular impingement in a patient with idiopathic osteonecrosis of the femoral head might leads to poor outcomes of surgical treatments such as bipolar hemiarthroplasty or osteotomies.In a patient with idiopathic osteonecrosis of the femoral head, it should be paid attention if concomitant femoroacetabular impingement exists or not.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

Fukui

Kaneuji

Matsumoto

2016

International Journal of Surgery Case Reports

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“…Sollte ein Patient bei entsprechender klinischer Symptomatik und gegebener Indikation jedoch für einen gelenkerhaltenden Hüfteingriff geeignet sein, sollte dieser möglichst zeitnah erfolgen, um das Fortschreiten degenerativer Veränderungen und die Entstehung destruktiver Arthrosen zu verhindern [10,99]. Dies gilt umso mehr für junge Patienten, da eine hieraus resultierende endoprothetische Versorgung nach einer mittleren Standzeit von 15 bis 25 Jahren bei den meisten Implantaten in einer aseptischen Lockerung oder einer Revision aus anderen Gründen resultiert.…”

Section: Indikation Und Empfehlungen Zur Biologischen Knorpelrekonstrunclassified

“…Auffällig war hierbei ein häufig längerer Zeitraum zwischen Beschwerdebeginn und Diagnosestellung mit teils mehrfachen Konsultationen, bis das Hüftgelenk als Schmerzursache erkannt wurde [9]. Eine Beschwerdedauer von 9,5 Monaten gilt dabei als positiver Prädiktor für das Auftreten lokalisierter Knorpelschäden, bei einer Dauer von mehr als 23,5 Monaten ist mit einem signifikant schlechteren klinischen Ergebnis nach Hüftarthroskopie zu rechnen [10]. Ähnlich wie für andere Gelenke [2] gilt also, dass sich die Prognose mit dem Defektausmaß und der Chronifizierung der Beschwerden verschlechtert [8,10,11].…”

Section: Introductionunclassified

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

et al. 2017

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Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

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“…As the mixed variant of FAI is common, patients frequently present with evidence of both chondral and labral damage resulting from cam and pincer deformities, respectively ( 3 ). Notably, poor preoperative cartilage status in symptomatic FAI patients is associated with delayed time till surgery and is a harbinger of potentially worse outcomes ( 13 – 15 ). Overall, the bony lesions of FAI induce variable damage to the hip joint, with cam lesions preferentially affecting the acetabular cartilage and pincer lesions affecting the labrum and peripheral acetabulum in a more circumferential manner ( 16 ).…”

Section: How Does Fai Damage the Hip Joint?mentioning

confidence: 99%

The Natural History of Femoroacetabular Impingement

et al. 2015

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Femoroacetabular impingement (FAI) is a clinical syndrome resulting from abnormal hip joint morphology and is a common cause of hip pain in young adults. FAI has been posited as a precursor to hip osteoarthritis (OA); however, conflicting evidence exists and the true natural history of the disease is unclear. The purpose of this article is to review the current understanding of how FAI damages the hip joint by highlighting its pathomechanics and etiology. We then review the current evidence relating FAI to OA. Lastly, we will discuss the potential of hip preservation surgery to alter the natural history of FAI, reduce the risk of developing OA and the need for future arthroplasty.

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Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects?

Abstract: Therapeutic study, Level III.

Cited by 33 publications

References 34 publications

Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

The Natural History of Femoroacetabular Impingement

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