Surgical Treatment of Femoroacetabular Impingement Improves Hip Kinematics

Bedi, Asheesh; Dolan, Michael J.; Hetsroni, Iftach; Magennis, Erin; Lipman, Joseph; Buly, Robert L.; Kelly, Bryan T.

doi:10.1177/0363546511414635

Cited by 143 publications

(158 citation statements)

References 42 publications

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“…Simulated hip ROM to the point of osseous impingement was performed with the 3-D-generated model as previously described [2,3] with the pelvis in the orientation of the supine and standing positions. No clinical ROM measurements were made in this series, because we measured the differences and changes in the ROM between the two various pelvic positions using the 3-D-generated models.…”

Section: Methodsmentioning

confidence: 99%

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Ross

Tannenbaum

Nepple

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Often, anteroposterior (AP) pelvic radiographs are performed with the patient positioned supine. However, this may not represent the functional position of the pelvis and the acetabulum, and so when assessing patients for conditions like femoroacetabular impingement (FAI), it is possible that standing radiographs better incorporate the dynamic influences of periarticular musculature and sagittal balance. However, this thesis remains largely untested. Questions/purposes The purpose of this study was to determine the effect of supine and standing pelvic orientation on (1) measurements of acetabular version and common radiographic signs of FAI as assessed on two-and three-dimensional (3-D) imaging; and (2) on terminal hip range of motion (ROM). Methods Preoperative pelvic CT scans of 50 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI between July 2013 and October 2014 were analyzed. The mean age of the study population was 29 ± 10 years (range, 15-50 years) and 70% were male. All patients had a standing AP pelvis radiograph, a reconstructed supine radiograph from the CT data, and a 3-D model created to allow manipulation of pelvic tilt and simulate ROM to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign were recorded on simulated plain radiographs. Measurements of ROM to bony impingement were made during (1) simulated hip flexion; (2) simulated internal rotation in 90°of flexion (IRF); and (3) simulated internal rotation in 90°of flexion and 15°adduction (FADIR), and the location of bony One or more of the authors has received funding outside of submitted work from Smith & Nephew (Andover, MA, USA) (JJN); Smith & Nephew and A3 Surgical (La Tronche, France) (CML); and Smith & Nephew, A3 Surgical, and Pivot (Sunnyvale, CA, USA) (BTK, AB). During the study period, an amount less than USD 10,000 was received. One or more of the authors has stock/stock options in A3 Surgical (CML, AB) and A3 Surgical and Pivot (BTK Clin Orthop Relat Res (2015) 473:1267-1273 DOI 10.1007/s11999-014-4104-x Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®contact between the proximal femur and acetabular rim was defined. These measurements were calculated for supine and standing pelvic orientations. A paired Student's t-test was used for comparison of continuous variables, whereas chi square testing was used for categorical variables. A p value of \ 0.05 was considered significant. Results When changing from supine to the standing radiographs, both mean cranial and central version increased by 2°± 4°(95% confidence interval [CI], 1°-3°) and 2°± 3°(95% CI, 1°-3°), respectively (both p \ 0.001). However, with the numbers available, there were no changes in the proportion of positive crossover, posterior wall, and prominent ischial spine signs. Standing pelvic position tilt resulted in an increased hip flexion of 3°( 95% CI, 2°-4°) as well as an i...

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Section: Methodsmentioning

confidence: 99%

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Ross

Tannenbaum

Nepple

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The most common location of the cam lesion is anterosuperior, between 12 and 3 o'clock on the femoral neck [7,27,29], which contacts either the acetabular rim [3,4,10] or the base of the anterior inferior iliac spine [16]. Similarly, classic acetabular dysplasia involves lateral and anterior undercoverage, causing static overload on the anterior and superior rim in stance with resultant anterosuperior rim damage [15].…”

Section: Discussionmentioning

confidence: 99%

“…In up to 1 . 3 of patients with FAI, the pathoanatomy causing the impingement can only be visualized on radial MRI sequences or three-dimensional (3-D) CT reconstructions [6,7,29]. For some patients, 3-D simulations of hip motion are also helpful for elucidating the probable cause of the labral damage [3,4,16].…”

Section: Introductionmentioning

confidence: 99%

Case Reports: Anteroinferior Acetabular Rim Damage Due to Femoroacetabular Impingement

Tibor¹,

Ganz

Leunig

2013

Clinical Orthopaedics &Amp; Related Research

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Background The most common location of labral tears and chondral damage in the hip is the anterosuperior region of the acetabulum, which is associated with pain in flexion and rotation. We describe a case series of patients with labral tears, ganglion formation, and chondromalacia isolated to the anteroinferior acetabulum. Clinically, patients had pain in extension and internal rotation. Case Descriptions Isolated anteroinferior labral hypertrophy and ganglion were first observed in a patient with coxa valga. We retrospectively reviewed clinical and radiographic records and identified nine hips in seven patients with isolated anteroinferior damage. One patient with bilateral valgus femoral head tilt after slipped capital femoral epiphysis (SCFE) had impingement of the anteromedial metaphysis on the acetabulum from 3 to 6 o'clock.

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“…However, motion-capture alone cannot directly visualize the interactions of the internal structures. Computer modeling based on 3-D bone geometry has been used to better understand reduced ROM and potential locations of impingement [1,9], but these models do not include soft tissues. Additionally, outcome studies for FAI treatment generally include small numbers of patients and present shortterm followup results [3,10].…”

mentioning

confidence: 99%

CORR Insights®: Subject-specific Patterns of Femur-labrum Contact are Complex and Vary in Asymptomatic Hips and Hips With Femoroacetabular Impingement

Rylander

2014

Clin Orthop Relat Res

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Surgical Treatment of Femoroacetabular Impingement Improves Hip Kinematics

Cited by 143 publications

References 42 publications

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Case Reports: Anteroinferior Acetabular Rim Damage Due to Femoroacetabular Impingement

CORR Insights®: Subject-specific Patterns of Femur-labrum Contact are Complex and Vary in Asymptomatic Hips and Hips With Femoroacetabular Impingement

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