scholarly journals The Femoral Head “Divot” Sign: A Useful Arthroscopic Sign of Hip Microinstability

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091791
Author(s):  
Philip J. Rosinsky ◽  
Ben C. Mayo ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Edge Angle ◽  
Ligamentous Laxity ◽  
Capsular Plication ◽  
Center Edge ◽  
The Mean ◽  
Center Edge Angle

Background: A femoral head “divot” is a rare finding during hip arthroscopy. A linear chondral indentation can be observed on the femoral head, just lateral and parallel to the acetabular labrum. Purpose/Hypothesis: The purpose of this study was to describe a novel arthroscopic sign and retrospectively review patients with this finding. We hypothesized that this sign would be found in patients with characteristics consistent with hip microinstability. Study Design: Case series; Level of evidence, 4. Methods: Intraoperative images of patients undergoing primary hip arthroscopy between July 2017 and July 2019 were reviewed for evidence of a femoral head divot. Preoperative characteristics, physical examination findings, radiographic measurements, and magnetic resonance imaging (MRI) findings were described. Results: Of 690 available cases, 14 cases (13 patients; 2.0%) had evidence of a femoral head divot. The mean patient age was 29.1 years, and all but 1 patient (92.3%) were female. Ligamentous laxity was present in 81.8% of patients, anterior apprehension test was positive in 78.6%, and painful internal snapping was present in 50.0%. The mean lateral center-edge angle, anterior center-edge angle, and Tönnis angle were 19.2°, 20.3°, and 12.4°, respectively. The divot was identified in 5 of 12 available MRI scans, most commonly on axial proton density sequence. Intraoperatively, all hips had labral tears, iliopsoas bursitis was demonstrated in 78.6%, and the ligamentum teres was damaged in 42.9%. Labral repair was performed in 12 of the 14 hips, with 2 patients undergoing labral reconstruction. Iliopsoas fractional lengthening was performed in 50.0%, capsular plication was performed in 78.6%, and capsular repair was performed in the remainder. Conclusion: The femoral head divot sign is a rare arthroscopic finding during hip arthroscopy. The results of this study demonstrated that patients who have a divot also present with characteristic radiographic or physical examination findings of hip microinstability due to either acetabular dysplasia or ligamentous laxity. Recognition of a femoral head divot may be valuable for the diagnosis of microinstability during hip arthroscopy and may help guide appropriate management, such as capsular plication. Further studies are needed to determine the exact prevalence of the femoral head divot in patients with microinstability and to evaluate the effect of this finding on patient outcomes.

Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

2017 ◽  
Vol 46 (3) ◽  
pp. 632-641 ◽  
Author(s):  
Omer Mei-Dan ◽  
Matthew J. Kraeutler ◽  
Tigran Garabekyan ◽  
Jesse A. Goodrich ◽  
David A. Young
Keyword(s):  
Soft Tissue ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Edge Angle ◽  
Center Edge ◽  
Hip Distraction ◽  
The Mean ◽  
Distraction Force ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Hip arthroscopy has traditionally been performed with a perineal post, resulting in various groin-related complications, including pudendal nerve neurapraxias, vaginal tears, and scrotal necrosis. Purpose: To assess the safety of a technique for hip distraction without the use of a perineal post. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed a consecutive cohort of 1000 hips presenting to a dedicated hip preservation clinic; all patients had hip pain and were subsequently treated with hip arthroscopy. Demographic variables, hip pathology, and lateral center edge angle were recorded for each case. In the operating room, the patient’s feet were placed in traction boots in a specifically designed distraction setup, and the operative table was placed in varying degrees of Trendelenburg. With this technique, enough resistance is created by gravity and friction between the patient’s body and the bed to allow for successful hip distraction without the need for a perineal post. In a subset of 309 hips (n = 281 patients), the degrees of Trendelenburg as well as the distraction force were analyzed. Results: The mean ± SD Trendelenburg angle used among the subset of 309 hips was 11° ± 2°. The mean initial distraction force necessary was 90 ± 28 lb, which decreased to 65 ± 24 lb by 30 minutes after traction initiation ( P < .0001). The most important variables in determining initial force for this cohort of patients were, in order of magnitude, sex ( P < .0001), weight ( P < .0001), and lateral center edge angle ( P < .01). No groin-related complications occurred among the entire cohort of patients, including soft tissue or nerve-related complications. The rate of deep venous thrombosis was 2 in 1000. Conclusion: The use of the Trendelenburg position and a specially designed distraction setup during hip arthroscopy allows for safe hip distraction without a perineal post, thereby eliminating groin-related soft tissue and nerve complications. Certain patient variables can be used to estimate the required distraction force and inclination angle with this method.

scholarly journals Superior Clinical Outcomes with Capsular Closure versus Non-Closure in Patients Undergoing Arthroscopic Hip Labral Repair

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000 ◽  
Author(s):  
Ioanna Bolia ◽  
Karen K. Briggs ◽  
Marc J. Philippon
Keyword(s):  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Secondary Outcome ◽  
Edge Angle ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Closure Group ◽  
Center Edge Angle

Objectives: Controversy still exists on closing the capsule following hip arthroscopy. It is unclear if capsular closure at the end of hip arthroscopy results in better clinical outcomes compared to non-closure. The purpose of this study was to compare the clinical outcomes in patients who had a closed capsule to those without a closed capsule following hip arthroscopic labral repair by a single surgeon. Methods: Patients who did not have capsular closure were identified by reviewing arthroscopy video (non-closure group). Fifty consecutive patients without capsular closure were matched with fifty patients who had capsular closure. All patients underwent primary hip arthroscopy and labral repair. The primary patient-reported outcome measure was Hip Outcome Score(HOS)-ADL. Secondary outcome measures included the modified Harris hip score(MHHS), HOS-Sport, WOMAC, general health, and patient satisfaction with outcome. Patients with lateral center edge angle less than 25º were excluded. Results: There were 23 females and 27 males with an average age of 36 years (range:14 to 77) in each group. The average lateral center edge angle was 34º (range, 27 to 48) in both groups. The alpha angle was 68º (range, 40 to 134) in the non-closure group and 70º (range, 41 to 98) in the closure group. No patient had microfractures at the time of surgery. The average follow-up time was 5 years (non-closure group range: 3-10; closure group range 3-9). Eight patients (16%) in the non-closure group required total hip arthroplasty(THA), while 4 patients (8%) in the closure group required THA. Six patients in the non-closure group and 3 patients in the closure group required revision hip arthroscopy. Of those patients who did not require revision or THA, there was a significant difference in the HOS ADL score and the secondary outcome measures (see table). Capsular closure resulted in superior clinical outcomes compared to non-closure. Conclusion: There were twice as many conversion to THA and twice as many hip arthroscopy revisions in patients undergoing hip arthroscopic labral repair without capsular closure compared to those with closure. In addition, the closure group showed significantly higher outcomes scores compared to the non-closure at 5-year follow-up time. [Table: see text]

scholarly journals LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Clarabelle DeVries ◽  
Jeffrey J Nepple ◽  
Lucas Fowler ◽  
Sean Akers ◽  
Gail Pashos ◽  
...  
Keyword(s):  
Femoral Head ◽  
Normative Data ◽  
Low Dose ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Edge Angle ◽  
Center Edge ◽  
Two Sectors ◽  
Posterior Sector ◽  
Center Edge Angle

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

Prevalence of Generalized Ligamentous Laxity in Patients Undergoing Hip Arthroscopy: A Prospective Study of Patients’ Clinical Presentation, Physical Examination, Intraoperative Findings, and Surgical Procedures

2019 ◽  
Vol 47 (4) ◽  
pp. 885-893 ◽  
Author(s):  
Ardavan A. Saadat ◽  
Ajay C. Lall ◽  
Muriel R. Battaglia ◽  
Mitchell R. Mohr ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Relative Risk ◽  
Physical Examination ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Hip Arthroscopy ◽  
Clinical Presentation ◽  
External Rotation ◽  
Labral Repair ◽  
Ligamentous Laxity

Background: Recent studies identified microinstability in the hip as a pathoetiology of painful hip conditions, and it was proposed that generalized ligamentous laxity conditions may predispose patients to such microinstability. Purpose: To study the relationship of generalized ligamentous laxity with patient characteristics, clinical presentation, intraoperative findings, and surgical treatments in a cohort of patients undergoing hip arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Registry data were prospectively collected and retrospectively reviewed between February 2014 and November 2017 for patients who underwent primary hip arthroscopy and had a documented Beighton score to assess generalized ligamentous laxity. Patients with a history of an ipsilateral hip condition or ipsilateral hip surgery, those with Tönnis grade >1, and those who had simultaneous arthroscopic and open procedures were excluded from the study. Two comparisons were made between patients with low and high Beighton scores: Beighton 0 vs ≥1 (B 0 vs B ≥1) and Beighton 0-3 vs ≥4 (B 0-3 vs B ≥4). Patient demographics, symptomatology, physical examination, and intraoperative findings were compared between these low and high Beighton groups. Results: A total of 1381 patients met our inclusion and exclusion criteria. Within this patient population, there were 882 with B 0, 499 with B ≥1, 1120 with B 0-3, and 261 with B ≥4. B 0 was 54.1% female, compared with 84.2% of B ≥1. Similarly, B 0-3 was 58.5% female, while B ≥4 was 92.7% female. The difference in sex makeup was significant between both sets of groups ( P < .0001). The relative risk of having B ≥1 for women versus men was 2.869, and the relative risk of having B ≥4 for women versus men was 6.873. The patients with higher Beighton scores in B ≥1 and B ≥4 had a younger mean age at onset of symptoms ( P < .0001) and lower mean body mass index ( P < .0001) than those in B 0 and B 0-3, respectively. The B ≥1 group had higher preoperative range of motion with internal rotation ( P = .05), external rotation ( P = .017), and flexion ( P < .0001) than B 0 patients, as well as a lower frequency of Trendelenburg gait pattern ( P = .0268). Similarly, the B ≥4 group had higher range of motion than the B 0-3 group with internal rotation ( P = .030), external rotation ( P = .003), flexion ( P < .0001), and abduction ( P = .002). As compared with the lower-score groups, the higher-score groups also had smaller labral size and tear dimension ( P < .0001), and a higher proportion of these patients underwent labral repair, capsular repair, and iliopsoas fractional lengthening. Conclusion: Patients undergoing hip arthroscopy who have generalized ligamentous laxity are overall younger, have a lower body mass index, and are more often female, as compared with patients who have lesser laxity. Patients with higher preoperative Beighton scores had greater hip range of motion and smaller intraoperative labral size and tear dimensions. Additionally, these patients were more likely to undergo labral repair, capsular plication, and iliopsoas fractional lengthening.

scholarly journals Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up

Medwave ◽  
2020 ◽  
Vol 20 (11) ◽  
pp. e8082-e8082
Author(s):  
Cristian Barrientos ◽  
Julián Brañes ◽  
Rodrigo Olivares ◽  
Rodrigo Wulf ◽  
Álvaro Martinez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hip Arthroscopy ◽  
Periacetabular Osteotomy ◽  
Case Series ◽  
Resonance Imaging ◽  
Edge Angle ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Purpose To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. Methods Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. Results A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. Conclusion To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

scholarly journals Is Hip Arthroscopy Effective in Patients With Combined Excessive Femoral Anteversion and Borderline Dysplasia? A Match-Controlled Study

2018 ◽  
Vol 47 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Edwin O. Chaharbakhshi ◽  
David E. Hartigan ◽  
Itay Perets ◽  
Benjamin G. Domb
Keyword(s):  
Hip Arthroscopy ◽  
Femoral Anteversion ◽  
Harris Hip Score ◽  
Control Group ◽  
Edge Angle ◽  
Center Edge ◽  
Modified Harris Hip Score ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Appropriate patient selection is critical when hip arthroscopy is considered in the setting of borderline dysplasia (BD). It is presumable that excessive femoral anteversion (EFA) and BD may contraindicate arthroscopy. Hypothesis: Patients with combined EFA and BD (EFABD) demonstrate significantly inferior short-term outcomes after arthroscopic labral preservation and capsular closure when compared with a similar control group with normal lateral coverage and femoral anteversion. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on patients undergoing hip arthroscopy between April 2010 and November 2014. The EFABD group’s inclusion criteria were BD (lateral center-edge angle, 18°-25°), labral tear, capsular closure, and femoral version ≥20°, as well as preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale. Exclusion criteria were workers’ compensation, preoperative Tönnis grade >1, microfracture, abductor pathology, or previous ipsilateral hip surgery or conditions. Patients in the EFABD group were matched 1:2 to a similar control group with normal coverage and femoral anteversion by age at surgery ± 6 years, sex, body mass index ± 5, acetabular Outerbridge grade (0, 1 vs 2, 3, 4), and iliopsoas fractional lengthening. Results: Sixteen EFABD cases were eligible for inclusion, and 100% follow-up was obtained at ≥2 years postoperatively. Twelve EFABD cases were matched to 24 control cases. Mean femoral version was 22.4° in the EFABD group and 10.2° in the control group ( P = .01). Mean lateral center-edge angle was 22.1° in the EFABD group and 31.5° in the control group ( P < .0001). Acetabuloplasty was performed significantly more frequently in the control group ( P = .0006). No other significant differences were found regarding demographics, findings, procedures, or preoperative scores. At latest follow-up, the EFABD group demonstrated significantly lower mean modified Harris Hip Score (76.1 vs 85.9; P = .005), Nonarthritic Hip Score (74.8 vs 88.5; P < .0001), Hip Outcome Score–Sports Specific Subscale (58.3 vs 78.4; P = .02), and patient satisfaction (7.1 vs 8.3; P = .005). There were 4 secondary surgical procedures (33.3%) in the EFABD group and 1 (4.2%) in the control group ( P = .03). One patient in each group required arthroplasty. Conclusion: Patients treated with arthroscopic labral preservation and capsular closure in the setting of EFABD demonstrated significant improvements from presurgery to latest follow-up. However, their results are significantly inferior when compared with a matched-controlled group. Consideration of periacetabular osteotomy or femoral osteotomy may be warranted in the setting of EFABD to achieve optimal benefit.

scholarly journals One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Gerardo Zanotti ◽  
Fernando Comba ◽  
Eduardo Genovesi ◽  
Martin Buttaro ◽  
Francisco Piccaluga
Keyword(s):  
Surgical Technique ◽  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Combined Treatment ◽  
Radiographic Examination ◽  
Edge Angle ◽  
One Stage ◽  
Center Edge ◽  
Center Edge Angle

Aim: We purposed to describe the surgical technique and preliminary outcomes of combined arthroscopic and periacetabular osteotomy (PAO) for the treatment of non-arthritic hip dysplasia. Methods: Between May and August 2015, 4 patients (3 female, 1 male) with an average age of 29 years old (range; 22-33) had undergone one-stage hip arthroscopy and periacetabular osteotomy. Primary symptom was pain associated with instability. Upon radiographic examination, mean lateral center-edge angle of Wiberg was 12° (range; 7°-18°). Intra-articular findings were computed and primary outomes were as follows: radiographic angular correction; time to healing after pelvis osteotomy and functional results according to Merle D’Aubigné Score. Results: Minimum follow-up was 6 months whereas maximum was 9 months. Mean surgical time was 98 minutes for hip arthroscopy and 132 minutes for the osteotomy. In all cases, a lesion of the antero-superior labrum and the chondro-labral junction was found and repaired. After correction, overall postoperative center-edge angle was 29° (range; 25°-35°). Bone healing was certified in all cases at 6 months postoperatively. Overall Merle D’Aubigné Score was 17/18 points. Conclusion: Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. Former arthroscopy enables the diagnosis of cartilage lesions and intra-articular pathology as well as it aids in proceeding or not to an open correction.

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