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.

Introduction: The anterior femoroacetabular impingement syndrome has so far been a great unknown in orthopedic surgery. It is typically characterized by pain when the hip is subjected to the flexion – adduction – internal rotation movement. This pain is provoked by the impaction of the head-neck interface on the anterior wall of the acetabulum. The reason for this may be a retroverted acetabulum, an excessively prominent anterosuperior femoral head-neck junction or a combination of both. For many years, patients have been diagnosed with “adductor tendinopathy” or “inguinal herniations”, when in fact they had a coxofemoral problem.

Materials and methods: The first 14 cases operated were analyzed; all of them were young patients who played sports regularly. Using the modified Smith-Petersen approach, an osteoplasty was made in order to resect in the anterior wall and the superior walls of the acetabulum – the latter only in part – and the prominent head-neck junction of the femur. The result was an improvement in the joint balance and the disappearance of impingement. Unlike other authors (Ganz, Trousdale), we avoided an osteotomy of the greater trochanter as a surgical approach.

Results: In 13 of the first 14 cases operated with the technique described, immediate pain relief was achieved on internal flexorotation. ROM went from −17 ° mean internal rotation (range: −14°–−28°) in one 80 ° flexion to +23° after one month postop (range: 14°–32°). After two months, there were no instances of Trendelemburg sign or osteonecrosis of the femoral head.

Conclusions: We should wait to assess the pre-osteoarthritic development of these patients, although their clinical and functional improvement is evident.

Introduction: Chiari osteotomy with capsuloplasty is an acetabulum-widening osteotomy which makes it possible to substantially correct dysplastic hips. This paper presents an overview of the results obtained after 25 years.

Materials and methods: Between 1983 and 2002, 127 Chiari osteotomies were carried out. 103 were revised (59 women, 40 men , 4 bilateral). Mean follow up: 11.2 years (range: 1 to 20 years). The endpoints were: operative time, VCA angles, acetabular inclination, pre-post-follow up CE angle, Merle d’Aubigne score, preop and postop Ahlbach score.

Results: Operative time: 1h 42′ (range: 57′ – 3h 10′). Ahlbach I – 26, II – 59, III – 18, IV – 0. Associated operations: Femoral osteotomy 77, varus-derotation osteotomy 36, Reconversion 31, Trochanteric retensioning. M 69. Angles measurement: preop: CE 5° (−34°−25°), VCA 18° (7°–26°), Tönnis 56° (43°–61°). Postop: CE 34° (10°–55°), VCA 31° (26°–39°), Tönnis 40° (38°–44°). Mean increase in acetabular inclination:16°. Merle d’Aubigné: preop 14.3(7–17), Follow-up 16.2(12–18). Excellent-good results 89(86.4%), Fair-poor results 14(14.6%) 2 went on to THA; Mean osteotomy displacement 26 mms (18–39). Invariability Ahlbach changes: If preop I 24/26(92.3%), if preop II 42/59(71.2%), if preop III 5 /18 (27.7%). Survival rate: 81.76% after 10 years.

Discussion and conclusions: Long term results seem satisfactory, with a survival rate of 81.76% after 10 years. This is a technique of choice in dysplasias with a new cup and in non-congruent hips, generally associated to a femoral osteotomy (77/103). It is crucial to perform the preop planning using Pawels test.