Few epidemiological studies from Asian countries have addressed this issue and reported that
Introduction. Alpha angles have been used to identify the precise area on the femoral head/neck junction that causes cam-type
Aims. Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in
INTRODUCTION. Symptomatic hip disorders associated with cam deformities are routinely treated with surgery, during which the deformity is resected in an effort to restore joint range of motion, reduce pain, and protect the joint from further degeneration. This is a technically demanding procedure and the amount of correction is potentially critical to the success of the procedure: under-resection could lead to continued progression of the OA disease process in the joint, while over-resection puts the joint at risk for fracture. This study compares the accuracy of a new robotically assisted technique to a standard open technique. METHODS. Sixteen identical Sawbones models with a cam type impingement deformity were resected by a single surgeon simulating an open procedure. An ideal final resected shape was the surgical goal in all cases. 8 procedures were performed manually using a free-hand technique and 8 were performed using robotic assistance that created a 3-dimensional haptic volume defined by the desired post-operative morphology. All of 16 sawbones, including uncut one as well, were scanned by Roland LPX-600 Laser scanner with 1mm plane scanning pitch and 0.9 degree of rotary scanning. Post-resection measurements included arc of resection, volume of bone removed and resection depth and were compared to the pre-operative plan. RESULTS. The desired arc of resection was 117.7° starting at −1.8° and ending at 115.9°. Manual resection resulted in an average arc of resection error of 42.0 ± 8.5° with an average start error of −18.1 ± 5.6° and end error of 23.9 ± 9.9° compared to a robotic arc of resection error of 1.2 ± 0.7° (p<0.0001), an average start error of −1.1 ± 0.9° (p<0.0001) and end error of −0.1 ± 1.0° (p<0.0001). Over-resection occurred with every manual resection with an average volume error of 758.3 ± 477.1mm. 3. compared to an average robotic resection volume error of 31.3 ± 220.7mm. 3. (4 over- and 4 under-resected; p<0.01). CONCLUSION. Even using an approach that maximizes visualization, robotic assistance proved to be significantly more accurate and less variable than manual techniques. This is critical as the success of the surgical treatment of
Objectives. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) is a novel MRI-based technique with intravenous contrast agent that allows an objective quantification of biochemical cartilage properties. It enables a ‘monitoring' of the loss of cartilage glycosaminoglycan content which ultimately leads to osteoarthritis. Data regarding the longitudinal change of cartilage property after joint preserving hip surgery is sparse. We asked (1) if and how the dGEMRIC-index changes in patients undergoing open/arthroscopic treatment of femoroacetabular impingement (FAI) one year postoperatively compared to a control group of patients with non-operative treatment; (2) and if a change correlates with the clinical short term outcome. Methods. IRB-approved prospective comparative longitudinal study of two groups involving a total of 61 hips in 55 symptomatic patients with
Purpose: A growing body of literature confirms that idiopathic OA is frequently caused by subtle, and often radiographically occult, abnormalities at the femoral head-neck junction or acetabulum that result in abnormal contact between the femur and acetabulum. This condition, known as femoroacetabular impingement, is a widely accepted cause of early OA of the hip. MRI is the imaging modality that is most sensitive in detecting cam morphology. There is currently little published data regarding the prevalence of abnormalities of the femoral head-neck junction in patients without hip pain or previous hip pathology. The primary aim of this project is to examine the incidence of cam morphology in a population without hip pain or pre-existing hip disease using non-contrast MRI. Method: Two hundred asymptomatic volunteers underwent magnetic resonance imaging targeted to both hips. Subjects were examined at the time of MRI to document internal rotation of the hips at 90 degrees flexion and to assess for a positive impingement sign. The mean age was 29.4 years (range 21.4–50.6); 77.5% were Caucasian and 55.5% female. The Nötzli alpha angle was measured on oblique axial images through the middle of the femoral neck for each hip. A value greater than 50 degrees was considered consistent with cam morphology. Measurements were performed independently by two musculoskeletal radiologists. Results: Twenty-six percent of volunteers had at least one hip with cam morphology: 20% had an elevated alpha angle on either the right or the left side, and 6% had bilateral deformity. The average alpha angle was 42.6 degrees on the right (SD=7.9) and 42.4 degrees on the left (SD=7.7). Internal rotation was negatively correlated with alpha angle (p<
.05). Patients with an elevated alpha angle on at least one side tended to be male (p<
.01). Conclusion: The high prevalence of cam morphology in asymptomatic individuals is critical information in determining the natural history of
Aims. The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version?. Methods. A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic
Femoroacetabular impingement (FAI) causes pain
and chondrolabral damage via mechanical overload during movement
of the hip. It is caused by many different types of pathoanatomy,
including the cam ‘bump’, decreased head–neck offset, acetabular
retroversion, global acetabular overcoverage, prominent anterior–inferior
iliac spine, slipped capital femoral epiphysis, and the sequelae
of childhood Perthes’ disease. Both evolutionary and developmental factors may cause
Objectives. The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. Methods. The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only. Results. A total of 29 articles were reviewed to obtain information on a number of variables. These comprised the type of device used for measurement, rater standardisation, the type of movements tested, body positioning and comparative studies of muscle strength in
Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoro-acetabular impingement (FAI) have a similar impact on labral function. This study was performed to determine the effect of natural labral damage secondary to abnormal femoral morphology on the labral seal. Ten intact hip specimens were obtained from male donors (47.8 ± 1.5 yrs) for use in this study. CT reconstructions demonstrated that 6 specimens were of normal morphology, while 4 displayed morphology typical of cam-FAI. Specimens were dissected free of the overlying soft tissue, leaving the capsule and labrum intact. Each specimen was potted and placed in a loading apparatus (0.5 BW). Pressures developed within the central and peripheral compartments were monitored with miniature pressure transducers. The sealing capacity of the labrum was measured by introducing fluid into the central compartment at a constant rate until transport was detected from the central to the peripheral compartment. These measurements were performed in 10 functional positions simulating sequential stages of gait, stooping, and pivoting. During testing, the 3D motion of the femoral head in the acetabulum was measured with motion analysis combined with computer visualization. Peak pressures were compared between specimens with and without labral damage for each of the three activities (p < 0.05).Objectives:
Methods:
Osteoarthritis is extremely common and many different causes for it have been described. One such cause is abnormal morphology of the affected joint, the hip being a good example of this. For those joints with femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH), a link with subsequent osteoarthritis seems clear. However, far from being abnormal, these variants may be explained by evolution, certainly so for
Aims. The frequency of severe femoral retroversion is unclear in patients with femoroacetabular impingement (FAI). This study aimed to investigate mean femoral version (FV), the frequency of absolute femoral retroversion, and the combination of decreased FV and acetabular retroversion (AR) in symptomatic patients with
Over recent years hip arthroscopic surgery has
evolved into one of the most rapidly expanding fields in orthopaedic surgery.
Complications are largely transient and incidences between 0.5%
and 6.4% have been reported. However, major complications can and
do occur. This article analyses the reported complications and makes recommendations
based on the literature review and personal experience on how to
minimise them.
Aims. Femoroacetabular impingement (FAI) describes abnormal bony contact of the proximal femur against the acetabulum. The term was first coined in 1999; however what is often overlooked is that descriptions of the morphology have existed in the literature for centuries. The aim of this paper is to delineate its origins and provide further clarity on
Hip Osteoarthritis (HOA) is the most common joint disorder and a major cause of disability in the adult population, leading to total hip replacement (THR). Recently, evidence has mounted for a prominent etiologic role of femoroacetabular impingement (FAI) in the development of early OA in the non-dysplastic hip.
Aims. Femoroacetabular impingement (FAI) is a potential cause of hip osteoarthritis (OA). The purpose of this study was to investigate the expression profile of matrix metalloproteinases (MMPs) in the labral tissue with FAI pathology. Methods. In this study, labral tissues were collected from four
Abstract. Introduction. Recent reports show that spinopelvic mobility influences outcome following total hip arthroplasty. This scoping review investigates the relationship between spinopelvic parameters (SPPs) and symptomatic femoroacetabular impingement (FAI). Methods. A systematic search of EMBASE, PubMed and Cochrane for literature related to SPPs and
Periacetabular osteotomy (PAO) is an established treatment for developmental hip dysplasia (DDH) in young adults and can also be utilised in the management of femoroacetabular impingement (FAI) with acetabular retroversion. This study used a national registry to assess the outcomes of PAO for DDH and
This study used a national registry to assess the outcomes of hip arthroscopy (HA) for the treatment femoroacetabular impingement (FAI). All HAs for