Why Is There a Range in Time Returning to Preoperative Activity Habits After Femoroacetabular Impingement Treatment in Recreational Athletes?

CONTEXT: Professional athletes showed excellent results after hip preserving procedures. However, there is still a lack of knowledge regarding the rate of return to activity and the rehabilitation time of recreational athletes. Thus, the aim of this study was to investigate factors that were associated with an extended return-to-activity time in nonprofessional athletes. DESIGN: Retrospective, quantitative case-control study. METHODS: This study included 47 cases (45 nonprofessional athletes), which were divided according to return-to-activity time (short term: 0.0-7.0 mo vs long term: >7.0 mo). The clinical outcome were evaluated with the modified Harris hip score, the nonarthritic hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the University of California, Los Angeles activity score. For statistical analysis between both groups, an unpaired student t test and a paired Wilcoxon test were used. In addition, the sports behavior, intraoperative findings, and surgical procedures were also assessed. RESULTS: After a mean follow-up of 4.3 years (±0.6; 3.4-5.6), the overall postoperative modified Harris hip score was 81.8 points, the nonarthritic hip score was 75.8 points, the Western Ontario and McMaster Universities Osteoarthritis Index was 36.7 points, and the University of California, Los Angeles activity score was 7.9. Compared with the preoperative results, all scores improved significantly (P < .001). Patients of the short-term return-to-activity group showed a higher preoperative activity diversity and, postoperatively, a higher rate in high-impact sports (P = .024). CONCLUSIONS: After mini-open arthrotomy for femoroacetabular impingement syndrome treatment, 92.5% of the recreational athletes returned to sports activity. The findings did not detect factors influencing the return-to-activity time. However, a higher preoperative diversity of activities and a shift to high-level impact sport activities might support a shorter rehabilitation.

The lateral joint space width is essential for the outcome after arthroscopically assisted mini-open arthrotomy for treatment of a femoroacetabular impingement: an analysis of prognostic factors for the success of this hip-preserving technique.

PURPOSE: The purpose of this study was to analyze predicting factors for a conversion to a total hip replacement (THR) after mini-open arthrotomy for treatment of femoroacetabular impingement (FAI). METHODS: Between 2011 and 2016, we identified 32 patients, who were treated for FAI with a mini-open arthrotomy and received after mean time of 2.1 ± 1.4 years a THR. These patients were compared to 47 cases who did not receive a THR (mean follow-up: 4.3 ± 0.7 years) to explore pre- and intra-operative factors associated with a conversion to THR. The results were presented in separated Kaplan-Meier curves with log rank test for significance and hazard ratios. RESULTS: A lateral joint space width of > 4 mm showed a higher THR-free survival rate compared to < 4 mm (p = 0.001); analogously one-sided (acetabular/femoral) 3-4° cartilage damage had a comparable THR-free survival rate than 1-2° kissing lesions (p = 0.001). Furthermore, an intact labrum without treatment and good cartilage status, a refixed labrum after rim resection in case of a pincer type FAI, or a refixed teared labrum were associated with a longer THR-free time than an untreated labrum accompanied by a poor cartilage status or an ossified labrum (p = 0.002). The strongest independent factor for a conversion to THR was femoral cartilage damage grade 1 and higher (p = 0.046). However, the rate of available patients was 53.0%. CONCLUSION: The success of a joint-preserving mini-open arthrotomy seems to be dependent on the status of the radiological joint space width and the intra-operative cartilage status of the lateral edge.

[Arthroscopically assisted minimally invasive symphysioplasty for the treatment of pubic related groin pain]. / Arthroskopisch assistierte minimal-invasive Symphysioplastik zur Behandlung des schambeinbezogenen Leistenschmerzes.

OBJECTIVE: Therapy of pubic related groin pain via minimally invasive symphysioplasty. INDICATIONS: Therapy of refractory pubic related groin pain based on osteitis pubis. CONTRAINDICATIONS: Groin pain from causes other than pubic related groin pain. SURGICAL TECHNIQUE: After a minimally invasive approach, an incision in the anterior capsule is made while protecting the dorsal capsule parts and the arcuate pubic ligament. The symphysis end plates are remodeled arthroscopically assisted using a surgical burr. The newly created pubic symphysis joint is filled with autogenous fibrin to support the formation of a new discus interpubicus. POSTOPERATIVE MANAGEMENT: Partial weight-bearing for 4 weeks with 20 kg using crutches is recommended. During the first 4 weeks the range of motion should be restricted. RESULTS: Since 2010, 10 athletes (7 men, 3 women; average age 34.1 ± 7.8 (23-47) years) have undergone arthroscopically assisted minimally invasive symphysioplasty and treatment of femoroacetabular impingement syndrome. The average follow-up time was 5.1 (2-9) years. All patients returned to their sport level. The mean preoperative Nonarthritic Hip Score (NAHS) of 64.4 ± 15.1 (32.1-86.5) points improved to a mean postoperative NAHS of 91.4 ± 9.8 (62.4-98.75) points (p < 0.0001). The average patient satisfaction (scale 0 to 10; 10 highest satisfaction) was 9.8 ± 0.4 (9-10).

External Snapping Hip Syndrome Endoscopic Treatment: "Fan-like" Technique as a Stepwise, Tailor-made Solution.

Classically, external snapping hip syndrome (ESHS) is considered to be caused by friction of a tight iliotibial band (ITB) over the greater trochanter (GT), which leads to pain, inflammation, and palpable or audible snapping. Surgical treatment remains a gold standard in patients resistant to conservative measures. Many surgical procedures addressing ESHS exist in the literature, but the vast majority of them involve only plasties of the ITB. However, observations led us to the conclusion that friction of the ITB over the GT may not be the only cause of ESHS and other structures like gluteal fascias or an anterior scarred part of gluteus maximus may be involved. The aim of this article is to provide a detailed description and video demonstration of an endoscopic surgical procedure using a "fan-like" cut to treat the ESHS. Its greatest advantage is the ability to gradually increase the extent of surgery based on intraoperative observations. It turns the procedure into a tailor-made surgery, which offers good and reproducible results.

Foreword to Selected presentations from the 1st European Hip Sport Meeting.

Recent years have witnessed a growing number of people practising sports both at professional and amateur level. This trend led to a progressive rise in the incidence and prevalence of acute and chronic hip damage. The treatment of hip disease in subjects practising sports is a major challenge for the orthopaedic surgeon. The evaluation of patients, in particular those of young age with high functional demands, is inevitably complex and should be performed with a multidisciplinary approach; from a surgical point of view, it is essential to carefully assess whether the indication is towards conservative surgery or hip replacement surgery. The advent of arthroscopic surgery in recent years has allowed us to improve our knowledge of hip joint diseases, such as femoroacetabular impingement that is typical of sports and overuse activity. A correct and early diagnosis of the disease can direct the patient promptly to a conservative surgical treatment that could reduce the progression of degenerative pathology. However, when the joint is permanently damaged, the only reliable solution remains prosthetic surgery, leading to a series of issues that the orthopaedic surgeon should be able to master, leading to a thoughtful decision on, for example, which implant to use, which biomaterials, which surgical approach or which sport to practise after surgery. This supplement contains selected contributions stemming from the work performed by internationally recognised experts in the field and presented during the 1st European Hip Sport Meeting held in Bologna on May 19th, 20th, 2016 that we had the honour to co-chair. We hope that these contributions will help the orthopaedic surgeon, the sports physician and physiotherapist in their day-to-day practice, and will help in fulfilling our ultimate aim to improve the knowledge of the hip pathology related to sports and overuse activities.

Mini-open approach for femoroacetabular impingement: 10 years experience and evolved indications.

INTRODUCTION: Femoroacetabular impingement (FAI) has been proposed as a possible cause of early osteoarthritis of the hip. The treatment of this condition and its related lesions can be performed by 3 methods: surgical dislocation of the hip; pure arthroscopic; and anterior mini-open technique with or without arthroscopic assistance. METHODS: We describe the anterior mini-open technique and report our experience over the last decade in the treatment of FAI and different associated pathologies of the hip. RESULTS: This technique was found to be safe and reliable, allowing tissue preservation and providing a clinical improvement similar to the purely arthroscopic-treated patient, even in complex cases. DISCUSSIONS: According to our experience there are several presentations of FAI and associated hip conditions, where other authors advocate surgical dislocation, which can be conducted through a mini-open approach when increased surgical skills are reached. Moreover, this technique was found to be useful as an additional tool to consider, even for surgeons involved in the arthroscopic learning curve.

Reconstruction of nonrepairable acetabular labral tears with allografts: mid-term results.

BACKGROUND: Many labral tears are nonrepairable. For these cases, labral reconstruction procedures may be considered in order to restore the joint fluid seal and prolong hip longevity. AIMS: The aim of this study was to describe the clinical and functional outcomes of a series of cases with nonrepairable labral tears that underwent labral reconstruction with tendon allografts. The hypothesis was that labral reconstruction would provide good clinical outcomes. METHOD: A cohort of 20 patients with nonrepairable labral tears, which underwent to labral grafting mainly by means of arthroscopic assisted anterior mini-open approach, were included in this study. The study period was comprised between July 2008 and September 2013. RESULTS: DCS-score resulted in 17 satisfactory results, whereas Nonarthritic Hip Score (NAHS) resulted in mean improvement of 39 points. 1 retrieved allograft demonstrated 8 weeks after implantation new whole revascularisation. CONCLUSIONS: We concluded that labral reconstruction with tendon allograft provides relief of painful symptoms, and represents a reliable alternative for patients with nonrepairable labral tears that are not yet candidates for a joint replacement procedure.

Arthroscopic assisted mini-open approach of the hip: Early multicentric experience.

BACKGROUND: Surgical treatment of femoroacetabular impingement is becoming accepted worldwide, owing to improvements in clinical results and quality of life. In addition to treatment by surgical dislocation or arthroscopy, arthroscopic assisted mini-open approach was postulated to treat this pathology. OBJECTIVE: The aim of this study was to analyze early results of the first consecutive 72 cases of femoroacetabular impingement treated using the arthroscopic assisted mini-open approach in two different centers by two surgeons trained by a senior surgeon experienced in the technique. METHODS: Seventy-two consecutive cases of femoroacetabular impingement were operated in arthroscopic assisted mini-open approach technique in two different centers. After a mean follow-up time of 15 months (range 6-24 months), the Western Ontario and McMaster Universities Arthritis Index, Hip disability and Osteoarthritis Outcome Score and University of California, Los Angeles activity score, alpha angle and Wiberg angle were obtained. RESULTS: In both centers, all three scores showed significantly better results at follow-up time than preoperatively. The Western Ontario and McMaster Universities Arthritis Index increased from 64.3 to 91.4 (A) and from 68.1 to 89 (B). The Hip disability and Osteoarthritis Outcome Score increased from 59.5 to 94.4 (A) and from 62.1 to 93.8 (B). The University of California, Los Angeles activity score increased from 5.2 to 8.1 (A) and from 5.3 to 8.4 (B). The alpha angle and the Wiberg angle were significantly reduced after osteoplasty. The overall complication rate was low. CONCLUSIONS: Early results of this study show a good clinical and radiological outcome; therefore, the arthroscopic assisted mini-open approach can be used as an alternative in treating femoroacetabular impingement.

Hip resurfacing arthroplasty: mid-term results in 486 cases and current indication in our institution.

In the previous decade, metal-on-metal hip resurfacing has been considered an attractive option and theoretically advantageous over conventional total hip arthroplasty, especially in young active patients. Different authors have reported favourable mid-term clinical and functional results with acceptable survival rates. Proper indication and planning, as accurate technical execution have been advocated to be crucial elements for success.Concerns regarding serum metal ion levels and possible clinical implications have led in the last years to a decline in the use of metal-on-metal hip resurfacing and metal-on-metal bearings in general.The aim of this study is to present the results of our first 486 cases of hybrid hip resurfacing arthroplasties with a second generation cementing technique, and to describe our current restricted indication of this type of prosthesis, in the light of recent findings in the literature about the possible complications related to metallosis or improper patient selection. Global survivorship of our series was 97.9% at a mean follow-up of 7.2 years.In the second season of our experience the indication is restrictive. The candidate for a resurfacing hip replacement is a young and active male patient, with good bone quality, that has been made aware of the risks and benefits of this type of prosthesis.

Radiographic findings of femoroacetabular impingement in capoeira players.

PURPOSE: Capoeira is a Brazilian martial art that requires extreme movements of the hip to perform jumps and kicks. This study evaluated a group of capoeira players to assess the prevalence of femoroacetabular impingement (FAI) in athletes practicing this martial art. METHODS: Twenty-four experienced capoeira players (14 men, 10 women) underwent a diagnostic assessment, including clinical examination and standard radiographs of the pelvis and hips. The α-angle, head-neck offset, crossover sign, acetabular index, lateral centre-edge angle, and the Tönnis grade were assessed using the radiographs. Clinical relationships for any radiographic abnormalities indicating FAI were also evaluated. RESULTS: Four subjects (17 %) reported pain in their hips. Forty-four hips (91.7 %) had at least one radiographic sign of CAM impingement, and 22 (45.8 %) had an α-angle of more than 60°. Eighteen hips (37.5 %) had at least one sign of pincer impingement and 16 (33.3 %) a positive crossover sign. Sixteen hips (33.3 %) had mixed impingement. There was a significant positive association between having an α-angle of more than 60° and the presence of groin pain (P = 0.002). A reduced femoral head-neck offset (P < 0.001) and an increased α-angle on the anteroposterior radiograph (P = 0.008) were independently associated with a higher Tönnis grade. CONCLUSION: High prevalence of radiographic CAM-type FAI among these skilled capoeira players was found. In these subjects, a negative clinical correlation for an increased α-angle was also detected. Additional caution should be exercised whenever subjects with past or present hip pain engage in capoeira.

Allogenic labral transplantation in hip instability following arthroscopic labrectomy.

The acetabular labrum augments femoral head coverage within the acetabulum and contributes to hip joint stability. This has led to an increasing interest in procedures dedicated to preservation of the labrum. An allogenic labral transplantation performed in a patient who had previously undergone a partial labral resection is presented.

Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage.

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

Atrapamiento o choque femoroacetabular: Concepto, diagnóstico y tratamiento (parte I) / Femoroacetabular Impingement: Concept, diagnosis and treatment (partI)

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