Regional muscle changes in adult dysfunctional hip conditions of femoroacetabular impingement and hip dysplasia

Abstract Objectives To compare the prevalence of pre- and postoperative osseous deformities and intra-articular lesions in patients with persistent pain following arthroscopic femoroacetabular impingement (FAI) correction and to identify imaging findings associated with progressive cartilage damage. Methods Retrospective study evaluating patients with hip pain following arthroscopic FAI correction between 2010 and 2018. Pre- and postoperative imaging studies were analyzed independently by two blinded readers for osseous deformities (cam-deformity, hip dysplasia, acetabular overcoverage, femoral torsion) and intra-articular lesions (chondro-labral damage, capsular lesions). Prevalence of osseous deformities and intra-articular lesions was compared with paired t-tests/McNemar tests for continuous/dichotomous data. Association between imaging findings and progressive cartilage damage was assessed with logistic regression. Results Forty-six patients (mean age 29 ± 10 years; 30 female) were included. Postoperatively, 74% (34/46) of patients had any osseous deformity including 48% (22/46) acetabular and femoral deformities. Ninety-six percent (44/46) had an intra-articular lesion ranging from 20% (9/46) for femoral to 65% (30/46) for acetabular cartilage lesions. Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of cam-deformity decreased (83 to 28%, p < 0.001). Progressive cartilage damage was detected in 37% (17/46) of patients and was associated with extensive preoperative cartilage damage > 2 h, i.e., > 60° (OR 7.72; p = 0.02) and an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Conclusion Prevalence of osseous deformities secondary to over- or undercorrrection was high. Extensive preoperative cartilage damage and higher postoperative alpha angles increase the risk for progressive degeneration. Key Points • The majority of patients presented with osseous deformities of the acetabulum or femur (74%) and with intra-articular lesions (96%) on postoperative imaging. • Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of a cam deformity decreased (83 to 28%, p < 0.001). • Progressive cartilage damage was present in 37% of patients and was associated with extensive preoperative cartilage damage > 2 h (OR 7.72; p = 0.02) and with an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04).

Download Full-text

Prevalence and diagnostic accuracy of in-toeing and out-toeing of the foot for patients with abnormal femoral torsion and femoroacetabular impingement

The Bone & Joint Journal ◽

10.1302/0301-620x.101b10.bjj-2019-0248.r1 ◽

2019 ◽

Vol 101-B (10) ◽

pp. 1218-1229 ◽

Cited By ~ 10

Author(s):

Till D. Lerch ◽

Patric Eichelberger ◽

Heiner Baur ◽

Florian Schmaranzer ◽

Emanuel F. Liechti ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

False Positive Rate ◽

False Negative ◽

False Negative Rate ◽

Controlled Study ◽

Femoral Torsion ◽

Foot Position

Aims Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT. Patients and Methods A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed. Results We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified. Conclusion In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218–1229

Download Full-text

Patients with a high femoroepiphyseal roof (FEAR) with concomitant borderline hip dysplasia and femoroacetabular impingement syndrome do not demonstrate inferior outcomes following arthroscopic hip surgery

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.10.012 ◽

2021 ◽

Author(s):

Stephanie E. Wong ◽

Daniel M. Wichman ◽

Alexander C. Newhouse ◽

Felipe Bessa ◽

Joel Williams ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Impingement Syndrome ◽

Hip Surgery ◽

Femoroacetabular Impingement Syndrome

Download Full-text

Os acetabuli—a new arthroscopic treatment option for the acetabular rim fracture

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab036 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i46-i50

Author(s):

Bent Lund

Keyword(s):

Treatment Option ◽

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Groin Pain ◽

Arthroscopic Treatment ◽

Acetabular Coverage ◽

Suture Bridge ◽

Technical Article ◽

Suture Bridge Technique ◽

Acetabular Rim

Abstract Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.

Download Full-text

Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

Bone & Joint Open ◽

10.1302/2633-1462.210.bjo-2021-0069.r1 ◽

2021 ◽

Vol 2 (10) ◽

pp. 813-824

Author(s):

Till Dominic Lerch ◽

Adam Boschung ◽

Florian Schmaranzer ◽

Inga A. S. Todorski ◽

Jan Vanlommel ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Sagittal Balance ◽

Hip Dysplasia ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

External Rotation ◽

Acetabular Retroversion ◽

Control Group ◽

Acetabular Version ◽

Iliac Wing

Aims The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version? Methods A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction. Results PI and PT were significantly decreased comparing AR (PI 42° (SD 10°), PT 4° (SD 5°)) with dysplastic hips (PI 55° (SD 12°), PT 10° (SD 6°)) and with the control group (PI 51° (SD 9°) and PT 13° (SD 7°)) (p < 0.001). External rotation of the iliac wing was significantly increased comparing AR (29° (SD 4°)) with dysplastic hips (20°(SD 5°)) and with the control group (25° (SD 5°)) (p < 0.001). Correlation between external rotation of the iliac wing and acetabular version was significant and strong (r = 0.81; p < 0.001). Correlation between PT and acetabular version was significant and moderate (r = 0.58; p < 0.001). Conclusion These findings could contribute to a better understanding of hip pain in a sitting position and extra-articular subspine FAI of patients with AR. These patients have increased iliac external rotation, a rotational abnormality of the iliac wing. This has implications for surgical therapy with hip arthroscopy and acetabular rim trimming or anteverting periacetabular osteotomy (PAO). Cite this article: Bone Jt Open 2021;2(10):813–824.

Download Full-text