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Objective: To assess the mid-term effectiveness of arthroscopic surgery in treatment of femoroacetabular impingement (FAI).
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In order to prevent the dislocation of total hip arthroplasty (THA) and reduce the wear rate, the position of the acetabular component in THA is very important. However, due to the influence of many potential factors, the accurate implantation of the acetabular component in the operation is still a challenge. Lewinnek safety zone positioning the cup anteversion angle (15±10)°, abduction (40±10)°, has been regarded as acetabular prosthesis installation standards, in an attempt to reduce the risk of instability, but there are still reported a dislocation. Based on the Lewinnek safety zone, Ha proposed the use of acetabular anatomical landmarks. According to patient specific shape positioning the position of the acetabular component methods are used to determine the specificity of the target area, thereby reducing the impact of hip replacement, and to maintain a lower liner wear rate. Image navigation system can improve the positioning of acetabular cup, but it is affected by many factors, such as high cost, difficult operation and so on.
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BACKGROUND: Standard treatments may provide adequate containment in mild to moderate Legg-Calve-Perthes disease (LCPD), but they can be problematic in more severe cases. The purpose of this study was to report the results of combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD. METHODS: We reviewed 12 patients who had undergone combined shelf acetabuloplasty with femoral varus osteotomy. The indications for this type of operation were: (1) above 8 years of age at clinical onset; (2) massive femoral epiphysis involvement (Catterall group 4, lateral pillar C); (3) femoral head lateral subluxation on the anteroposterior radiograph; and (4) impending hinged abduction on preoperative magnetic resonance imaging or arthrography. The mean age was 9.3 years (range, 8 to 10.8 years). The patients were clinically evaluated with Iowa hip score and leg length discrepancy at the final follow-up. Radiographic outcome was assessed using the Stulberg classification to evaluate femoral head sphericity. The presence of osteoarthritis was evaluated by the Tonnis classification. Correlation analysis was conducted to analyze the preoperative factors that were strongly associated with patients' outcomes. RESULTS: The mean follow-up period was 10.1 years (range, 7.1 to 13.2 years). Functional grade was excellent in all patients at last follow-up (mean, 92; range, 82 to 99). The mean leg length discrepancy after skeletal maturity was 0.9 cm (range, 0 to 1.7 cm). There were no significant complications or need for additional surgery. Radiographically, 92% of patients reached satisfactory outcomes: Stulberg grade I, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7 cases (58%), Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. There was no osteoarthritis by Tonnis classification. CONCLUSIONS: The surgical outcomes for combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD patients over 8 years old are comparable with other advanced surgical methods. In the cases of severe disease that match our inclusion criteria, our containment method could be another treatment option.
Subject(s)
Child , Female , Humans , Male , Acetabuloplasty/adverse effects , Leg Length Inequality , Legg-Calve-Perthes Disease/diagnostic imaging , Osteotomy/adverse effects , Pain , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To report the clinical and radiological outcomes of a mid-term follow-up of patients with femoroacetabular impingement treated using an arthroscopic method. MATERIALS AND METHODS: Of the patients who underwent an arthroscopic labrectomy (91 cases), femoroplasty (82 cases) or acetabuloplasty (9 cases) after a diagnosis of femoroacetabular impingement, 82 patients (91 cases) who had been followed up were examined. The preoperative and postoperative clinical outcomes were evaluated using the Modified Harris hip score, Hip Outcome Score, pain score and patient's satisfaction. The radiological assessment was performed by measuring the alpha angle, femoral offset, and center edge angle using simple radiographs and computed tomography. RESULTS: The patients consisted of 63 men and 19 women, whose mean age was 33.5 years (range, 15-70 years). The mean follow-up period was 42.2 months (range, 25-60 months). On the clinical results, the mean pain score improved from 0.72 points preoperatively to 2.02 points at the final follow-up. The Modified Harris hip score improved from 61.4 preoperatively to 83.4 at the final follow-up. The median patient satisfaction was 8.2 (range,0-10 points). On the radiological assessment, the alpha angle decreased from 60.9degrees to 40.4degrees, and the femoral offset recovered from 4.9 mm to 10.0 mm. CONCLUSION: The arthroscopic treatment of femoroacetabular impingement could be an excellent modality to prevent osteoarthritis of the hip. However, recovery of clinical results by arthroscopic treatment is not expected in elderly patients or those with developed osteoarthritis, a low preoperative Modified Harris hip score and concurrent degenerative disease.
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Aged , Female , Humans , Male , Arthroscopy , Femoracetabular Impingement , Follow-Up Studies , Hip , Osteoarthritis , Patient SatisfactionABSTRACT
A technique to restore acetabular anatomy by deepening the acetabular cavity and reconstructing the femoral head ligament and the joint capsule was tested on nine large breed dogs with severe hip dysplasia and acute subdislocation or dislocation. The technique consisted of two phases. First, all dogs were submitted to bilateral pectinotomy. In a second surgical intervention on the same dogs the acetabulum was approached and deepened, and the femoral head ligament and the joint capsule were reconstructed. In general, within 30 days of the surgery dogs could stand on the operated member to walk. Except for two dogs, all the others recovered pelvic member locomotive ability within 60-90 days after surgery. It is concluded that acetabuloplasty is a good alternative for treatment of severe canine hip dysplasia.
Uma técnica para restituir a anatomia acetabular com aprofundamento da cavidade acetabular e reconstrução do ligamento da cabeça do fêmur e da cápsula articular, foi testada em nove cães, de raças de grande porte, portadores de displasia coxofemoral grave com subluxação acentuada ou luxação. O procedimento cirúrgico foi constituído de duas fases. Inicialmente, foi realizada a pectineotomia bilateral em todos os cães. A segunda intervenção nos mesmos cães incluiu abordagem e aprofundamento do acetábulo, reconstrução do ligamento da cabeça do fêmur e da cápsula. Em geral, 30 dias após a cirurgia, os cães apoiavam o membro operado para se locomover. Com exceção de dois cães, todos os outros recuperaram a função locomotora do membro pélvico dentro de 60-90 dias. É concluído que a técnica de acetabuloplastia é uma boa alternativa para o tratamento da displasia coxofemoral grave.
Subject(s)
Animals , Acetabulum , Dogs , Hip Dysplasia, Canine , Surgery, VeterinaryABSTRACT
Objective To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study.A total of 19 lesions were detected. The lesions were 13 - 25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5 - 13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1 - 12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software.Results The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P < 0.01 ), which further decreased to 2.5 in one month (P < 0.01 ), while walking state score increased from a mean of 1.5before surgery to a mean of 2.5 in 24 hours after surgery (P < 0.01 ). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into paraacetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can markedlyimprove the patient's walking ability and the quality of life.