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The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 831 - 838
1 Jul 2018
Ibrahim MM Poitras S Bunting AC Sandoval E Beaulé PE

Aims

What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI.

Patients and Methods

Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_1 | Pages 87 - 87
1 Jan 2018
Beaulé P Bunting A Ibrahim M Sandoval-Rodriguez E Kim J Poitras S Kreviazuk C
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The current study aimed to determine the influence of acetabular coverage and intraarticular pathology on post-operative functional outcomes of arthroscopy for cam type FAI.

Based on 762 hip scopes performed by a single surgeon between 2013 and 2016, we excluded patients with previous surgery on the hip, mixed FAI, surgical hip dislocation, and missing outcome scores. From this, 97 hips between the ages 17 and 48 that underwent arthroscopy for cam deformity were identified for analysis. Every patient received a partial capsulotomy, cam resection and either labral repair or resection. Measurements for acetabular coverage consisted of pre-operative lateral edge angle (LCEA) (mean 30°, range: 15.4°–40°) and three-dimensional anterior and posterior acetabular coverages. Intraoperative Beck scores were acquired from operative reports, and Hip Disability and Osteoarthritis Outcome Score (HOOS) was collected pre- and post-operatively.

Significant post-operative improvement was found in scores of all categories of the HOOS (p < 0.05). However, improvement in HOOS was not correlated with the LCEA, anterior coverage, or posterior coverage. There was a trend toward lower Beck grades (1–3) resulting in better HOOS outcomes than higher Beck grades (4–5). Also, lower Beck grades showed significantly lower alpha angle (mean = 55.86) than higher grades (mean = 73.48).

We showed that cam FAI arthroscopic resection improved patient outcome, and confirmed the relationship between the Beck score and functional outcome. However, functional improvement was not related to acetabular coverage suggesting that the so-called “borderline” dysplasia is not a useful radiographic indicator for surgical management.


The Bone & Joint Journal
Vol. 95-B, Issue 7 | Pages 1001 - 1006
1 Jul 2013
Esteban J Alvarez-Alvarez B Blanco A Fernández-Roblas R Gadea I Garcia-Cañete J Sandoval E Valdazo M

We have designed a prospective study to evaluate the usefulness of prolonged incubation of cultures from sonicated orthopaedic implants. During the study period 124 implants from 113 patients were processed (22 osteosynthetic implants, 46 hip prostheses, 54 knee prostheses, and two shoulder prostheses). Of these, 70 patients had clinical infection; 32 had received antibiotics at least seven days before removal of the implant. A total of 54 patients had sonicated samples that produced positive cultures (including four patients without infection). All of them were positive in the first seven days of incubation. No differences were found regarding previous antibiotic treatment when analysing colony counts or days of incubation in the case of a positive result. In our experience, extending incubation of the samples to 14 days does not add more positive results for sonicated orthopaedic implants (hip and knee prosthesis and osteosynthesis implants) compared with a conventional seven-day incubation period.

Cite this article: Bone Joint J 2013;95-B:1001–6.