Young patients undergoing THA or hip used. HOS and iHOT33 have demonstrated to be useful in hip preservation surgery but never used in THA.

The aim of the study was to evaluate long-term clinical outcomes with HOS and iHOT33 in hip arthroscopy and THA

We conducted a retrospective study with prospective data collection of 118 consecutive young patients (<65 y.o.) between 2008 to 2012 who underwent hip arthroscopy or THA. The mean follow-up was 12.05 years. All surgeries were done by the same senior surgeon. PROMs used were iHOT-33 and HOS preoperatively, at one year and 10 years. SPSS Statistics Grad Pack 28.0 software was used for statistical analysis

Arthroscopy Group (57 patients): Mean age 35.36 years. 55.93% were male. iHOT33 mean differential improvement was 24.43 at 1 year, 70,17% exceed MCID and 49,1% SCB. HOS mean differential improvement was 16.26 at one year. 54,38 % patients exceed MCID and 49,36% SCB. At 10 years, iHOT33 mean differential improvement was 14,36 and 12.56 for HOS. Regarding complications, 3 patients underwent THA (5.26%) and 10 (17.54%) continued with groin pain.

THA Group (61 patients): Mean age 52,54 years. 55.73% were male. Cementless THA was used in all patients with ceramic on ceramic used in 77%. iHOT33 mean differential improvement was 41,57 at 1 year. 95,08% patients exceed MCID and 85,25% SCB. HOS mean differential improvement was 16.57 points at one year. 85,25% patients exceed MCID and 81,97% SCB. At 10 years, iHOT33 mean differential improvement was 20,15 and 14.12 for HOS. Regarding complications, 1 patient underwent DAIR for infection (1.64%) and 1 dislocation with close reduction (1.64%).

iHOT33 or HOS scores should be considered to be used in young active patients after hip preserving surgery or THA, with more predictable results at long-term in THA group.

Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI.

Cite this article: Bone Joint J 2013;95-B:893–9.

Introduction: Femoroacetabular impingement (FAI) has been recently recognized as the main cause of hip pain in sportsmen. We analyse if clinical and functional results of surgical treatment are influenced by preoperative degenerative hip changes.

Materials and Methods: A series of 117 consecutive Ribas mini open procedures (mini open femoroacetabular osteoplasty with labral refixation) were performed in 115 sportsmen with confirmed clinical, radiographic, and MR-arthrography diagnosis of FAI, and were evaluated with a minimum follow up of 4 years (range: 4 – 6,5). According to Tönnis Grade for preoperative radiological degenerative hip stage, the hips were divided into 3 groups: group A/Tönnis 0: 32 hips; group B/Tönnis 1: 61 hips; group C/Tönnis 2: 24 hips. A Combined Clinical Score (CCS), which includes Impingement test, Merle D’Aubigné and WOMAC scores, was used to evaluate the patients before surgery and at 6 weeks, 3 months, 6 months and every year after operation. Satisfactory and unsatisfactory results were obtained and collected. SPSS 10.0 software (SPSS INC, Chicago, Ill) was used for statistical analysis and comparisons were performed by means of chi-squared and Wilcoxon tests; p< 0,05 was considered to be significant.

Results: With CCS method, satisfactory results were obtained in group A (Tönnis 0) in 93,4% of the cases at 12 months, in 96,5% at 24 months, and in 97,8% at the latest follow up of 48 months; in group B (Tönnis 1) satisfactory results were observed in 91,3% of the cases at 12 months, in 91,2% at 24 months, and in 93,6% at 48 months; in group C (Tönnis 2) satisfactory results were obtained in 58,3% of the cases at 12 months, in 55,3% at 24 months, and in 50,1% at 48 months. Differences between groups A and C, as like between groups B and C, were significant (p< 0,001), but not between groups A and B (p> 0,05).

Conclusions: Midterm results of the Ribas mini open procedure for the treatment of femoroacetabular impingement are encouraging, expecially in hips not exceeding Tönnis Grade 1 osteoarthrosis, as results depend directly on degenerative state. If symptomatic patients are treated in early stages, excellent expectancies can be obtained with this procedure already at midterm. In addition, instruction of general physicians and specialists in the diagnosis of FAI is of paramount importance.

Purpose: To determine the incidence of anterior femoroacetabular impingement (AFAI) as a cause of idiopathic coxarthrosis in young adults.

Materials and methods: We carried out a retrospective study of 196 patients with total hip replacement (THR), selecting patients under 55 (51 cases, 26.02%). We recorded epidemiological, clinical and radiological data prior to the implantation of the THR. In all cases we used cementless stems and cups. The statistical analysis was done with SPSS software v10.0.

Results: The mean age was 50.7 (29–55). There was a predominance of men (31 cases, 61%) over women (20 cases, 39%). The mean BMI was 30.1 kg/m2 (20–42). The mean time with pain before hip arthroplasty was 8 years (2–20 years). Among the possible causes of the origin of coxarthrosis we found sequelae of acetabular fractures, hip growth dysplasias, rheumatoid arthritis, sequelae of Perthes disease and AFAI. 70.6% presented a “hump” in the head-neck junction on the axial projection, which appeared at the onset of symptoms; 10% presented frank deformity of the femoral head and 8% had protrusion of the head toward the acetabulum. The patients with AFAI presented less mean flexion (78.5°) and internal rotation (2.9°) (p< 0.05), and the predominant type of pain was inguinal irradiating to the thigh or greater trochanter (p< 0.05). The mean time from onset of symptoms to implantation of THR was less in this group (7.4 years) as compared to the rest (10.4 years) (p< 0.05).

Discussion: Murray (Br. J. Radiol 38:810–24, 1965) and Harris (CORR 213:20.23, 1986) had already mentioned AFAI as a predisposing factor in the degeneration of the coxofemoral joint. In recent years its importance has increased as the resection of the femoral hump in the initial degenerative stages has became more widespread (Tönnis 0 and I). This osteoplasty can be performed by hip arthroscopy (small humps), with dislocation of the femoral head (as described by R. Ganz) or by a very small anterior approach without dislocation of the femoral head as proposed by Ribas-Vilarubias (2004). Leunig (2005) speaks of an AFAI incidence of 15% in the general population and Tanzer (CORR 429:170-77, 2004) discovered “humps” in the femoral head-neck junction in 68–100% of patients with THR. Our study gives similar results, placing the incidence at 70.6% in patients under the age of 55 who have had a THR.

Conclusions: We think the incidence of femoroacetabular impingement is high and that this syndrome plays an important role in the onset of degeneration of the coxofemoral joint in young adults. These findings suggest the advisability of early surgery to attempt to delay the rapid progression toward primary arthroplasty at an early age.