Parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement / Lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular

Abstract Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle.

Resumo Objetivo: Descrever casos de lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular, correlacionando dados clínicos e de imagem. Materiais e Métodos: Esta foi uma série de casos descritiva retrospectiva de lesão condral parafoveal da cabeça femoral em 21 pacientes submetidos a tomografia computadorizada e artrorressonância magnética do quadril e que receberam diagnóstico por imagem de impacto femoroacetabular. Resultados: Dos 21 pacientes avaliados, 15 (71%) tiveram impacto femoroacetabular do tipo cam, enquanto cinco (24%) tiveram impacto do tipo misto e um (5%) teve impacto do tipo pincer. Doze pacientes (57%) apresentaram baixa frequência de atividade física, sendo esta significativamente associada a impacto do tipo cam (p = 0,015). Houve correlação significativa entre a extensão da lesão e o ângulo de cobertura acetabular (p = 0,04), porém, não se correlacionou significativamente com o ângulo alfa ou com o valor do deslocamento cabeça-colo femoral (p = 0,08 e p = 0,06, respectivamente). Também não encontramos correlação entre a extensão da lesão e os outros principais parâmetros que definem os tipos de impacto femoroacetabular. Conclusão: Esta foi uma das maiores casuísticas de lesão condral parafoveal da cabeça femoral em pacientes com achados de imagem de impacto femoroacetabular. A extensão dessas lesões não parece se correlacionar com os parâmetros do impacto femoroacetabular, com exceção do ângulo de cobertura acetabular.

Distal femoral fractures from high-energy trauma: a retrospective review of complication rate and risk factors / Fraturas distais do fêmur por trauma de alta energia: uma revisão retrospectiva da taxa de complicações e fatores de risco

ABSTRACT Objective Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study.

RESUMO Objetivos Determinar a incidência e os fatores de risco de complicações nas fraturas de alta energia das fraturas distais do fêmur fixadas com placa bloqueada lateral. Métodos Foram incluídos 47 pacientes, sendo 87,2% homens e idade média de 38,9 anos. Os principais parâmetros radiográficos coletados foram o ângulo femoral distal lateral (AFDL), ângulo femoral distal posterior (AFDP), comprimento da cominuição, comprimento da placa, comprimento de trabalho dos parafusos, perda óssea, contato medial após a redução e contato placa-osso, localização da formação do calo e falha do implante. As complicações registradas foram não união, falha do implante e infecção. Resultados Fraturas complexas C2 e C3 representaram 85,1% dos casos. As fraturas expostas corresponderam a 63,8% dos casos. O AFDL e AFDP médios foram 79,8° ± 4,0° e 79,3°± 6,0°, respectivamente. Os comprimentos de trabalho total, proximal e distal médios foram 133,3 ± 42,7, 60,4 ± 33,4 e 29,5 ± 21,8 mm, respectivamente. A taxa de infecção foi de 29,8% e o único fator de risco foi a fratura exposta (p = 0,005). A taxa de não união foi de 19,1%, com maior comprimento de trabalho (p = 0,035) e maior PDFA (p = 0,001) como fatores de risco. O local de formação do calo também influenciou na pseudoartrose (p = 0,034). Conclusões Fraturas distais do fêmur de alta energia apresentam maior incidência de pseudoartrose e infecção. A não união tem como fatores de risco maior comprimento de trabalho, maior AFDL e ausência de formação de calo nos lados medial e posterior. O fator de risco para infecção foi a fratura exposta. Nível de evidência III; Estudo de Coorte Retrospectivo.

Arthroscopic treatment for patients with borderline developmental dysplasia of the hip and cam-type femoroacetabular impingement syndrome / 中华骨科杂志

Objective:To evaluate the clinical outcomes of patients with borderline developmental dysplasia of the hip (BDDH) and cam-type femoroacetabular impingement syndrome (FAIS) after hip arthroscopy.Methods:Data were retrospectively reviewed for patients with BDDH and cam-type FAIS who underwent hip arthroscopy surgery from June 2017 to December 2019. A total of 32 patients were enrolled, with a mean age of 36.13±8.67 years (range, 20-50 years), including 15 males and 17 females. The preoperative lateral center-edge angle was 22.3°±1.6° (range 20.1°-24.7°), while the preoperative α angle was 64.1°±4.6° (range, 56.0°-69.8°). All patients were treated with arthroscopic limited acetabular plasty, labral repair, femoral osteoplasty, and capsular plication after excluding from external hip diseases by ultrasound-guided hip blocking test. The visual analogue scale (VAS), modified Harris Hip Scores (mHHS) and International Hip Outcome Tool-12 (iHOT-12) scores were used to evaluate the clinical effects.Results:All patients were followed up, and the mean follow-up time was 2.5±0.8 years (range, 2.0-4.7 years). The VAS score decreased from 6.07±1.56 to 1.96±0.92 at 1 year and to 1.86±1.01 at 2 years after operation ( F=112.64, P<0.001); the mHHS score increased from 53.87±13.04 to 86.12±8.64 at 1 year and to 88.71±8.15 at 2 years after operation ( F=101.70, P<0.001); the iHOT-12 score was improved from 40.00±7.33 to 76.27±9.50 at 1 year and to 78.67±10.31 at 2 years after operation ( F=134.91, P<0.001). The α angle improved to 40.27°±4.52° (range, 34.8°-49.7°) with significant difference ( t=9.24, P<0.001). Conclusion:Hip arthroscopy can achieve satisfied short-term outcomes in treating BDDH and cam-type FAIS with few complications and less trauma.

Epidemiology of hip pain in brazilian bodybuilders / Epidemiologia da dor no quadril em fisiculturistas brasileiros

ABSTRACT Objective: To determine the frequency of hip pain in competitive bodybuilders over three different bodybuilding competitions. Methods: This study evaluated bodybuilders recruited from three competitions during the year of 2016. All participants provided their informed consent and the study received IRB approval. Training routine, health condition, level of success on competitions, history of hip pain and physical examination of the hip were evaluated. Results: 113 bodybuilders were evaluated, mean age was 30.5 ± 8.65 years and mean BMI was 25.2 ± 3.65 kg/m2. Mean values for hip flexion, adduction, abduction, internal rotation, external rotation and distance between the knee and the table (FABER distance) were 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 and 19 ± 4, respectively. Eight (7%) participants presented hip pain within the week prior to examination and only 2 (1,7%) presented with anterior impingement sign. None of the athletes who reported hip pain interrupted their physical training or performance. Conclusion: Symptomatic athletes continued their training program under the presence of hip pain. The frequency of hip pain among bodybuilders is high and may be underestimated in this study. Level of Evidence IV, Case series.

RESUMO Objetivo: Determinar a frequência de dor no quadril em atletas fisiculturistas durante três competições de fisiculturismo. Métodos: Este estudo avaliou fisiculturistas recrutados em três competições de fisiculturismo durante o ano de 2016. Termo de consentimento foi obtido de todos os participantes, e também foi obtido a aprovação do CEP. Rotina de treinos, condição de saúde, nível de sucesso nas competições, antecedente de dor no quadril ao exame físico foram avaliados. Resultados: Um total de 113 fisiculturistas foram avaliados, com idade e IMC médio de 30.5 ± 8.65 anos e 25.2 ± 3.65 kg/m2, respectivamente. O valor médio de flexão, adução, abdução, rotação interna, rotação externa do quadril, e distância entre o joelho e a mesa de exame (distância FABERE) foi de 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 e 19 ± 4, respectivamente. Oito (7%) participantes apresentavam dor no quadril dentro da última semana antes de serem examinados, e apenas dois (1.7%) apresentavam sinal do impacto anterior do quadril à manobra de flexão adução e rotação interna. A dor no quadril não afetou o treinamento físico e a performance dos atletas que reportaram dor no quadril. Conclusão: Atletas sintomáticos continuaram o programa de treinamento mesmo na presença de dor no quadril. A frequência de dor no quadril de atletas fisiculturistas é alta e pode ter sido subestimada neste estudo. Nível de Evidência IV, Série de casos.

Influences of structural changes after valgus impacted femoral neck fracture on hip range of motion: a 3D simulation test / 中华创伤骨科杂志

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Femoroacetabular Impingement - Factors Associated with the Presence of Deep Injuries of the Chondrolabral Junction / Impacto femoroacetabular - Fatores associados à presença de lesões profundas da junção condrolabral

Abstract Objective The purpose of the present study was to evaluate factors associated with the presence of deep chondral lesions (Konan/Haddad grades III and IV) in patients submitted to hip arthroscopy to treat femoroacetabular impingement (FAI). Method This was a prospective, cross-sectional study of a series of 125 consecutive hip arthroscopies performed between May 2016 and May 2017. After applying the exclusion criteria, 107 hips of 92 patients submitted to surgical treatment for mixed and CAM FAI were analyzed. For purposes of analysis, the present study considered groups with lesions considered mild and deep, which were associated with symptom score, lateral coverage angle, α angle, age, gender, and radiological classification of arthrosis. Results with a p-value < 0.05 were considered statistically significant. Results Patients whose hips had lesions considered deep had significantly higher nonarthritic hip scores (NAHSs) than those whose hips presented lesions considered mild or who did not present chondral lesions (67.9 ± 19.4 versus 57.0 ± 21.9, p= 0.027). The prevalence of deep lesions was higher in hipswith Tonnis 1 compared with hips with Tonnis 0: 15(55.6%) versus 10 (12.7%), respectively, p< 0.001.Men presented a higher prevalence of grades III and IV lesions than women, 23 (34.3%) versus 2 (5.0%), p= 0.001, and had significantly higher functional scores (65.6 ± 19.6 versus 49.3 ± 21.6, p< 0.001). Conclusion Men presented a higher prevalence of deep lesions. Hips classified as Tonnis 1 presented a 4.4-fold higher probability of presenting these lesions. Patients with deep chondrolabral lesions had a better preoperative functional score.

Resumo Objetivo Avaliar os fatores associados à presença de lesões condrais profundas (graus III e IV de Konan/Haddad) em pacientes submetidos à artroscopia do quadril para tratamento do impacto femoroacetabular (IFA). Método Estudo transversal, prospectivo, de uma série de 125 artroscopias consecutivas do quadril feitas entre maio de 2016 e maio de 2017. Depois de aplicados os critérios de exclusão, foram analisados 107 quadris de 92 pacientes submetidos a tratamento cirúrgico do IFA dos tipos misto e CAM. Para fins de análise, os grupos foram divididos entre lesões consideradas leves e profundas, e foi feita associação comescore de sintomas, ângulo de cobertura lateral, ângulo alfa, idade, gênero, e classificação radiológica de artrose. Foramconsiderados como estatisticamente significativos testes com valor de probabilidade < 0,05. Resultados Pacientes cujos quadris apresentaram lesões consideradas profundas tiveramescores de quadril não artrítico (NAHSs, na sigla em inglês) significativamentemaiores do que aqueles cujos quadris apresentavam lesões consideradas leves ou não apresentavamlesão condrolabral (67,9 ± 19,4 versus 57,0 ± 21,9; p= 0,027). Aprevalência de lesões profundas foi maior nos quadris Tonnis 1 do que nos que apresentaramTonnis 0: 15 (55,6%) versus 10 (12,7%), respectivamente; p< 0,001. Homens apresentaram melhores escores funcionais e maior prevalência de lesões graus III e IVdoque as mulheres: 65,6 ± 19,6 versus 49,3 ± 21,6; p< 0,001, e 23 (34,3%) versus 2 (5,0%), p= 0,001, respectivamente. Conclusão Homens apresentaram maior prevalência de lesões profundas. Quadris Tonnis 1 tiveram um risco 4,4 vezes maior de apresentar essas lesões. Pacientes com lesões condrolabrais profundas apresentaram melhor escore funcional pré-operatório.

Effects of capsular repair versus unrepaired capsulotomy during hip arthroscopy in treating femoracetabular impingement / 中华骨科杂志

Objective@#To investigate the effects of capsular repair versus that of unrepaired capsulotomy during hip arthroscopy in treating femoracetabular impingement (FAI).@*Methods@#A total of 102 cases with FAI who underwent hip arthroscopy from July 2014 to August 2017 were collected retrospectively. Patients were divided into unrepaired group (64 cases) and repair group (38 cases) according to capsular management strategies. In the repair group, in addition to the management of osteochondroplasty of pincer and cam deformity and labral repair, the capsulotomies were routinely repaired. Modified Harris hip score (mHHS), nonarthritic hip score (NAHS), and hip outcome score activity of daily living scale (HOS-ADL) were used to evaluate the clinical outcomes. The preoperative hip scores and those at 1 year postoperative follow up were collected. Operation duration and occurrence of complication were also collected.@*Results@#There were 28 males and 36 females in the unrepaired group, while 17 males and 21 females were in the repair group. The average age were 38.59±11.27 years and 37.64±11.10 years respectively. There were 18 pincer deformities, 12 cam deformities and 34 mixed deformities in the unrepaired group, while 7 pincer deformities, 7 cam deformities and 24 mixed deformities in the repair group. There was no difference in gender, average age and impingement type between two groups (P>0.05). The preoperative mHHS score, NAHS score and HOS-ADL score were 59.56±12.44, 58.79±12.90 and 64.11±14.43 in the unrepaired group. These scores elevated to 85.52±4.69, 80.76±5.27 and 86.08±5.85 at 1 year follow up. The preoperative mHHS score, NAHS score and HOS-ADL score were 61.68±12.41, 60.62±10.48 and 65.27±17.47 in the repair group. These scores elevated to 88.84±3.46, 89.24±3.94 and 91.03±3.97 at 1 year follow up. The scores in the repair group were higher than those in unrepaired group at 1 year follow up (P<0.05). The average operation duration was 137.62±31.21 minutes and 151.35±31.55 minutes (P<0.05), respectively. The complication occurrence rate in unrepaired group was 31% (20/64) and 24% (9/38) in repaired group with no statistical difference between two groups (P>0.05).@*Conclusion@#During hip arthroscopy in treating FAI, short-term clinical results could be achieved after routine repair of capsulotomy without increased risk of complication.

Effects of capsular repair versus unrepaired capsulotomy during hip arthroscopy in treating femoracetabular impingement / 中华骨科杂志

Objective To investigate the effects of capsular repair versus that of unrepaired capsulotomy during hip arthroscopy in treating femoracetabular impingement (FAI).Methods A total of 102 cases with FAI who underwent hip arthroscopy from July 2014 to August 2017 were collected retrospectively.Patients were divided into unrepaired group (64 cases) and repair group (38 cases) according to capsular management strategies.In the repair group,in addition to the management of osteochondroplasty of pincer and cam deformity and labral repair,the capsulotomies were routinely repaired.Modified Harris hip score (mHHS),nonarthritic hip score (NAHS),and hip outcome score activity of daily living scale (HOS-ADL) were used to evaluate the clinical outcomes.The preoperative hip scores and those at 1 year postoperative follow up were collected.Operation duration and occurrence of complication were also collected.Results There were 28 males and 36 females in the unrepaired group,while 17 males and 21 females were in the repair group.The average age were 38.59±11.27 years and 37.64±11.10 years respectively.There were 18 pincer deformities,12 cam deformities and 34 mixed deformities in the unrepaired group,while 7 pincer deformities,7 cam deformities and 24 mixed deformities in the repair group.There was no difference in gender,average age and impingement type between two groups (P＞0.05).The preoperative mHHS score,NAHS score and HOS-ADL score were 59.56±12.44,58.79±12.90 and 64.11±14.43 in the unrepaired group.These scores elevated to 85.52±4.69,80.76±5.27 and 86.08±5.85 at 1 year follow up.The preoperative mHHS score,NAHS score and HOS-ADL score were 61.68± 12.41,60.62± 10.48 and 65.27± 17.47 in the repair group.These scores elevated to 88.84±3.46,89.24±3.94 and 91.03±3.97 at 1 year follow up.The scores in the repair group were higher than those in unrepaired group at 1 year follow up (P＜0.05).The average operation duration was 137.62±31.21 minutes and 151.35±31.55 minutes (P＜0.05),respectively.The complication occurrence rate in unrepaired group was 31％ (20/64) and 24％ (9/38) in repaired group with no statistical difference between two groups (P＞0.05).Conclusion During hip arthroscopy in treating FAI,short-term clinical results could be achieved after routine repair of capsulotomy without increased risk of complication.

Caso Clínico: Luxación Controlada de Cadera. Epifisiólisis de Cabeza Femoral / Case Report: Controlled Hip Dislocation. Slipped Capital Femoral Epiphysis

INTRODUCCIÓN: La epifisiólisis de la cabeza femoral es el desplazamiento de la epífisis con respecto a la metáfisis, en dirección anterosuperior; su etiología es desconocida, frecuente en adolescentes, periodo peripuberal, y con índice de masa corporal elevado, edad promedio entre 12 y 18 años. Su incidencia es variable, 0.2 (Japón) a 10 (Estados Unidos) por 100 000 habitantes. Se caracteriza por dolor progresivo en cadera, con irradiación a la ingle o rodilla, se asocia a cojera; con la detección precoz se puede instaurar un tratamiento adecuado, el más aceptado es la fijación in situ con tornillos centrales. CASO CLÍNICO: Paciente de sexo femenino 14 años de edad sin antecedentes patológicos, acudió al servicio de ortopedia infantil por presentar dolor lancinante crónico de cadera derecha de nueve meses de evolución que aumenta con la deambulación, diagnosticada por clínica y exámenes complementarios de imagen de epifisiólisis de cabeza femoral. Se realizó luxación quirúrgica de la cadera y reducción abierta anatómica con colocación de tornillos esponjosos. EVOLUCIÓN: Al tercer día de la cirugía, se decide alta hospitalaria; deambulación con muletas y sin apoyo durante un mes posquirúrgico. La osteosíntesis permaneció durante un año con controles mensuales y fisioterapia correspondiente; se ha evidenciado evolución favorable; arcos de movilidad de cadera conservados, deambulación normal, sin complicaciones. CONCLUSIÓN: El tratamiento inicial de un paciente con epifisiólisis de cabeza femoral estable depende del tiempo de evolución y se realiza fijando con tornillos o agujas mediante la luxación anatómica de la cadera y osteoplastia de remodelación del cuello femoral. La mayoría de los pacientes no desarrollan necrosis ni condrolisis y los resultados a largo plazo con la fijación in situ suelen ser excelentes, a diferencia de los pacientes con diagnóstico tardío.

BACKGROUND: The epiphysiolysis of the femoral head is the displacement of the epiphysis with respect to the metaphysis, in anterosuperior direction; it is etiology is unknown, frequent in adolescents, peripubertal period, and with high body mass index, average age between 12 and 18 years. It is incidence is variable, 0.2 (Japan) to 10 (United States) per 100 000 inhabitants. It is characterized by progressive pain in the hip, with irradiation to the groin or knee, is associated with lameness; with the early detection, an adequate treatment can be established, the most accepted one is the in situ fixation with central screws. CASE REPORT: A 14-year-old female patient with no pathological history attended the Children's Orthopedic Service due to the chronic lancinating pain of the right hip, which increases with walking, it is diagnosed by clinical examination and complementary exams of femoral head epiphysiolysis. Surgical dislocation of the hip and anatomical open reduction with placement of spongy screws was performed. EVOLUTION: On the third day of surgery, hospital discharge is decided; walking with crutches and without support during a postoperative month. The osteosynthesis remained for a year with monthly controls and corresponding physiotherapy; it has been evidenced favorable evolution; hip mobility arches preserved, normal ambulation, without complications CONCLUSIONS: The initial treatment of a patient with epiphysiolysis of stable femoral head depends on the evolution time and is done by fixing with screws or needles with of anatomical dislocation of the hip and osteoplasty of femoral neck remodeling. Most patients do not develop necrosis or chondro- lysis and long-term results with in situ fixation are usually excellent, unlike patients with late diagnosis.

Avaliação da torção femoral por tomografia computadorizada em pacientes jovens sem artrose e com dor no quadril por impacto fêmoro-acetabular / Femoral torsion evaluation by computed tomography in young patients without arthrosis with hip pain and femoral-acetabular impingement

Com a descoberta do impacto fêmoro-acetabular (IFA) que corresponde a maior causa de artrose do quadril, a análise biomecânica do quadril tornou-se fundamental. O objetivo do trabalho foi avaliar por tomografia computadorizada a torção femoral em pacientes jovens sem artrose com dor no quadril por IFA. No período entre janeiro de 2017 e março de 2018 foram avaliados 26 pacientes (52 quadris) entre 18 a 45 anos com dor no quadril e sem artrose. Todos os pacientes apresentavam dor e IFA (9 bilaterais) totalizando 35 quadris, sendo a maioria homens (73%). A idade média foi de 35 anos para ambos os sexos. O índice de massa corporal médio foi de 19 kg/m2 para mulheres, 24 kg/m2 para homens e a escala de Harris média foi de 67 pontos. Foram encontradas alterações da torção femoral em 11 quadris com dor (31%). A torção média encontrada foi de 14,5 graus, variando 0 a 39 graus (coeficiente de variabilidade= 60%). Pacientes com dor no quadril, torção femoral alterada e impacto do tipo CAM não apresentaram diferença quando comparados aos quadris sem dor (controle) (p= 0,234), como também no impacto tipo Misto (p= 0,314). No impacto tipo Pincer, a torção média dos quadris dolorosos foi de 16,63 graus e a torção média dos controles foi de 11,77 graus (p= 0,045). A presença de alterações na torcionais em quase 1/3 dos pacientes com IFA e a alta variabilidade encontrada revelaram a importância da medida da torção femoral nesta doença

The aim of the study was to evaluate femoral torsion in young patients with hip pain and femoral acetabular impingement (FAI). After the discovery of impingement, the complete analysis from the hip biomechanics has become essential. Twenty-six patients from 18 to 45 years presenting hip pain without arthrosis (Tonnis< 2) were evaluated. All patients presented both pain and FAI (9 bilateral), mostly man (73%). The average age was 35 years for both genders. BMI was 19 kg/m2 for women and 24 kg/m2 for men and the mean modified Harris Hip Score was 67 points. We have found femoral torsion changes in 11 hips with pain (31%) and high variability (60%). The mean femoral torsion was 14,5 degrees, ranging from 0 to 39 degrees. Patients with hip pain, CAM impingement and altered femoral torsion had no correlation when compared to controls (without pain) (p= 0.234), neither Mixed impingement (p= 0,314). Patients with Pincer impingement and painful hips had higher femoral torsion (16,63 degrees) than controls (11,77) (p= 0.045). The presence of torsional alterations in almost 1/3 of the patients with FAI and the high variability reveal the importance of measuring femoral torsion at this disease

Femoroacetabular Impingement Syndrome / 대한정형외과학회잡지

Femoroacetabular impingement (FAI) results from abnormal anatomic relationship between acetabulum and femoral head-neck junction, which causes secondary chondrolabral injury. FAI is the common cause of hip joint pain in young adults who have nearly normal hip joint structure. The pain usually progresses on hip flexion and internal rotation. Although it is still controversial whether FAI is one of the reason of secondary hip osteoarthritis or the contrary, instruments and surgical technique for treating FAI is continuing to improve. When we initially diagnosed with FAI, conservative treatment is recommended. But if the conservative treatment has no response, we can consider surgical intervention. The arthroscopic technique is one of the promising options, and it is the fastest growing fields for the treatment FAI.

Quantitative evaluation of residual bony impingement lesions after arthroscopic treatment for isolated pincer-type femoroacetabular impingement using three-dimensional CT / 中华骨科杂志

Objective To determine the clinical characteristics and its effect on the clinical efficacy of residual bony impingement lesion after hip arthroscopic osteoplasty for pincer-type femoroacetabular impingement.Methods There were 30 patients who underwent hip arthroscopic osteoplasty for isolated pincer-type femoroacetabular impingement from December 2010 to January 2012 and had a minimum follow-up period of 2 years,including 21 males and 9 females.The average age at surgery was 34.5 years (range from 28-42 years).All of the patients had no advanced hip arthritis and the T(o)nnis grade was 0-2.Radiological evaluation was performed by 3-dimensional CT.According to residual rate,these patients were divided into 3 groups:residual rate ＜10％ group,residual rate of 10％-20％ groups and residual rate ＞20％ group.Results The average follow-up period was 26.3 months (range,22-34 months) and nineteen cases had residual bony impingement lesion after surgery.Among them,84.2％ of the residual bony impingement lesion was posterior to the acetabular actual resection zone.The preoperative and postoperative bony impingement angle were 77.47°±21.31° and 12.94°±18.04°,respectively.The residual rate was 16.7％± 8.83％.The modified Harris hip score got significantly improved from 55.18±7.96 preoperatively to 94.71±4.39 postoperatively.The overall satisfactory rate was 76.7％,and the postoperative modified Harris hip score for these three groups was 95.86±1.71,95.23±1.99 and 85.52±6.41,respectively.The postoperative modified Harris hip score in residual rate ＞20％ group was significantly worse than those in other two groups.The satisfactory rate was 92.9％,80.0％ and 33.3％,respectively.The satisfactory rate in residual rate ＞20％ group was significantly worse than those in other two groups.There was a significant negative linear relationship between the residual rate and postoperative modified Harris hip score (R2=0.516,P=0.001).Conclusion The incidence of residual bony impingement lesion after hip arthroscopic osteoplasty for pincer-type femoroacetabular impingement was 63.3％.The residual rate was 16.7％.The residual impingement lesion was mainly at the posterior part of the acetabulum.The patients with residual rate ＞20％ got significantly worse clinical score and satisfactory rate.

Técnica quirúrgica: resección artroscópica del resalte o giba femoral en el pinzamiento femoroacetabular tipo leva / Surgical technique: arthroscopic resection of femoral bump in cam-type femoroacetabular impingement

Hip arthroscopy is a procedure which has significantly increased its frequency in recent years, especially due to the surgical treatment of femoroacetabular impingment. Cam type femoroacetabular impingement. Cam type femoroacetabular impingement results from abnormal head-neck junction, where a prominent anterior extension of the femoral head at the expected step off to the adjacent femoral neck can be seen. This femoral “bump” is typically located lateral to the physeal scar, causing damage of the acetabular rim, cartilage and labrum. The surgical treatment, also called osteochondroplasty of the femoral head-neck junction, consist of the complete resection of this femoral “bump”, in order to reduce pain, prevent further bone impaction and progressive articular damage. Prior to the arthroscopic resection of the femoral “bump”, it is recommended to identify important anatomic landmarks in the peripheral joint compartment (medial limit: medial synovial fold, central limit: acetabular labrum, lateral limit: synovial folds and retinacular vessels in the lateral limit of the peripheral joint compartment, a secure lateral bump resection can be performed, without risk of injuring these vessels. In this paper, we describe the detailed operative technique of an effective and secure arthroscopic femoral “bump” resection.

La artroscopía de cadera ha aumentado significativamente su frecuencia en los últimos años, especialmente debido al tratamiento quirúrgico del pinzamiento femoroacetabular (PFA). En el PFA tipo leva existe una anesfericidad de la cabeza femoral con la formación de una prominencia, resalte o giba ósea en la cara anterior de la unión cabeza-cuello femoral. El tratamiento quirúrgico consiste en la completa resección de esta giba para reducir el impacto óseo sobre el reborde y cartílago acetabular, prevenir un deterioro articular progresivo y lograr el alivio sintomático de los pacientes. Para realizar la completa resección artroscópica de la giba femoral se recomienda la identificación de los reparos anatómicos en el compartimiento articular periférico previo a la resección (límite medial: pliegue sinovial medial; límite central: labrum acetabular; límite lateral: pliegues sinoviales y vasos retinaculares; límite periférico y profundidad: cuello femoral). Más allá de la completa resección ésta debe ser segura sin lesionar los vasos retinaculares en la región lateral recomendándose la identificación de esos vasos previo a la resección de la giba en la región lateral. Se describen en este trabajo detalles de la técnica quirúrgica para una efectiva y segura resección artroscópica de la giba femoral en el pinzamiento femoroacetabular tipo leva.