Impact of bone deformities and labral and cartilage lesions on early functional results of arthroscopic treatment of femoroacetabular impingement

Introduction. Perforation of the tympanic membrane in children may be the cause of recurrent middle ear infection and loss of hearing. Objective. The aim of this study was to analyze the application of different reconstructive materials in surgical technique myringoplasty. Methods. We performed 88 myringoplasties due to auricular tragus perforation in 76 children (aged 4 to 16 years, mean 11.9 years) from July 2001 to July 2009. Age, gender, size and the site of perforation, status of the contra lateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels and postoperative complications were recorded and analyzed. In performing myringoplasty we used fascia of the temporal muscle and cartilage of the auricular tragus. Results. In 43 (48%) patients we used fascia of the temporal muscle and in 45 (52%) cartilage of the auricular tragus. Graft success was defined as an intact eardrum at 12 months postoperatively and improvement in the perception of air-bone gap of 10 dB, which we recorded in 73 (83%) cases. Re-perforations were recorded in 12 (13%) patients, of whom in 8 (18.6%) cases we used the temporal fascia and in 4 (9.3%) cases a tragal cartilage. Retraction of the tympanic membrane was recorded in 3 (4%) cases with the temporal fascia. Conclusion. Myringoplasty is a reasonably successful method with good functional results in pediatric patients. Risk factors of surgical failure are young age, the size of auricular tragus perforation and pathological conditions of the contra lateral ear. The tragal cartilage gives better results in cases with bilateral perforations because the possibility of retractions and re-perforations is lower. Relatively small number of patients is probably the reason that, except for young age, differences between the two groups did not reach the level of statistical significance.

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Treatment of cam-type femoroacetabular impingement

Joints ◽

10.11138/jts/2015.3.2.067 ◽

2015 ◽

Vol 03 (02) ◽

pp. 67-71 ◽

Cited By ~ 5

Author(s):

Gennaro Fiorentino ◽

Alberto Fontanarosa ◽

Riccardo Cepparulo ◽

Alberto Guardoli ◽

Luca Berni ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Case Series ◽

Arthroscopic Treatment ◽

Correct Selection ◽

Harris Hip Score ◽

Radiographic Examination ◽

Level Of Evidence

Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

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