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Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 2, Plain Radiography.

ABSTRACT: The use of hip arthroscopy to treat various forms of hip pathology continues to grow. As part of a standard evaluation for eligibility for hip arthroscopy, we routinely obtain standard radiographs to assess the hip joint. These include orthogonal projections of the acetabulum and proximal femur, which can be obtained with a standing false profile, supine anteroposterior pelvis, and a lateral view of the proximal femur (either Dunn 45° or 90°, frog-leg lateral, or cross-table lateral). A comprehensive analysis of the radiographs is of utmost importance in order to indicate a patient for hip arthroscopy, for preoperative planning, and to determine prognosis. The purpose of this Technical Note is to provide a comprehensive guide of how our group performs qualitative and quantitative analysis of hip radiographs in a potential candidate for hip arthroscopy.

SUBMITTER: Mannava S

PROVIDER: S-EPMC5794674 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 2, Plain Radiography.

Mannava Sandeep S Geeslin Andrew G AG Frangiamore Salvatore J SJ Cinque Mark E ME Geeslin Matthew G MG Chahla Jorge J Philippon Marc J MJ

Arthroscopy techniques 20171030 5

The use of hip arthroscopy to treat various forms of hip pathology continues to grow. As part of a standard evaluation for eligibility for hip arthroscopy, we routinely obtain standard radiographs to assess the hip joint. These include orthogonal projections of the acetabulum and proximal femur, which can be obtained with a standing false profile, supine anteroposterior pelvis, and a lateral view of the proximal femur (either Dunn 45° or 90°, frog-leg lateral, or cross-table lateral). A comprehe ...[more]

PMID: 29399468

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Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 1, Physical Examination.

Project description:A thorough evaluation of the hip must include a comprehensive medical and surgical history focused on the hip joint, surrounding soft tissues, and the associated structures of the spine, pelvis, and lower extremities. These details can guide the physical examination and provide insight into the cause of the patient's chief complaints. A proper examination includes physical examination while the patient is in the upright, supine, prone, and lateral position, as well as an evaluation of gait. Guided by a thorough history, the physical examination enables the surgeon to distinguish between intra-articular and extra-articular contributors to hip pain, selection of appropriate imaging modalities, and ultimately supports medical decision making.

| S-EPMC5792748 | biostudies-literature

Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 3, Magnetic Resonance Imaging.

Project description:Radiologic imaging is an essential supplement to the physical examination in the evaluation of a patient with femoroacetabular impingement. Plain radiographs are the initial modality of choice for the evaluation of bony anatomy and pathology. Magnetic resonance imaging supplements the physical examination and standard radiographs by enabling qualitative and quantitative evaluation of both articular cartilage and soft tissues about the hip. Magnetic resonance imaging also provides improved 3-dimensional characterization of the bony anatomy owing to the multiplanar nature of this technique. This article describes a comprehensive approach to interpretation of magnetic resonance examination of the hip.

| S-EPMC5794495 | biostudies-literature

Etiology and Pathomechanics of Femoroacetabular Impingement.

Project description:PURPOSE OF REVIEW:Femoroacetabular impingement is a common cause of hip pain in young patients and has been shown to progress to osteoarthritis. The purpose of this review is to better understand the development of femoroacetabular impingement. RECENT FINDINGS:Recent literature shows little genetic transmission of FAI. However, molecular studies show strong similarities with the cartilage in osteoarthritis. The development of cam lesions has a strong association with sports participation, particularly at the time of physeal closure suggesting abnormal development. Lumbar, pelvis, and femoral biomechanics may also play an important role in dynamic impingement. In summary, femoroacetabular impingement is a dynamic process with many influences. Further research is needed to clarify the pathophysiology of FAI development in hopes of finding preventative options to reduce symptoms and progression to osteoarthritis.

| S-EPMC6684670 | biostudies-literature

Arthroscopic technique for treatment of femoroacetabular impingement.

Project description:With an increasing understanding of femoroacetabular impingement (FAI) and advancement of the surgical treatment in patients with FAI, various techniques have been published. Successful outcome after arthroscopic hip surgery depends on appropriately reshaping the bony architecture to allow for improved range of motion before impingement symptoms occur, with special attention to preserve the labrum and restore its function. We present our surgical technique for the arthroscopic treatment of FAI.

| S-EPMC3678601 | biostudies-literature

Computer-Assisted Hip Arthroscopic Surgery for Femoroacetabular Impingement.

Project description:Precise osteochondroplasty is key for success in hip arthroscopic surgery, especially for femoroacetabular impingement (FAI) caused by cam or pincer morphology. In this Technical Note, we present computer-assisted hip arthroscopic surgery for FAI, including preoperative planning by virtual osteochondroplasty and intraoperative computer navigation assistance. The important concept of this technique is that navigation assistance for osteochondroplasty is based on planning made by computer simulation analysis. The navigation assistance allows us to perform neither too much nor too little osteochondroplasty. Specifically, computer simulation was used to identify the impingement point. Virtual osteochondroplasty was then performed to determine the maneuvers that would improve range of motion. Thereafter, the planning data were transported to a computed tomography-based computer navigation system that directly provided intraoperative assistance. Thus, computer-assisted technology including preoperative simulation, virtual osteochondroplasty planning, and intraoperative navigation assistance may promote precise hip arthroscopic surgery for FAI.

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Evaluation of hip arthroscopy using a hip-specific distractor for the treatment of femoroacetabular impingement.

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| S-EPMC7877656 | biostudies-literature

Protocol for the Femoroacetabular Impingement Trial (FAIT): a multi-centre randomised controlled trial comparing surgical and non-surgical management of femoroacetabular impingement.

Project description:AimsFemoroacetabular Junction Impingement (FAI) describes abnormalities in the shape of the femoral head-neck junction, or abnormalities in the orientation of the acetabulum. In the short term, FAI can give rise to pain and disability, and in the long-term it significantly increases the risk of developing osteoarthritis. The Femoroacetabular Impingement Trial (FAIT) aims to determine whether operative or non-operative intervention is more effective at improving symptoms and preventing the development and progression of osteoarthritis.MethodsFAIT is a multicentre superiority parallel two-arm randomised controlled trial comparing physiotherapy and activity modification with arthroscopic surgery for the treatment of symptomatic FAI. Patients aged 18 to 60 with clinical and radiological evidence of FAI are eligible. Principal exclusion criteria include previous surgery to the index hip, established osteoarthritis (Kellgren-Lawrence ≥ 2), hip dysplasia (centre-edge angle < 20°), and completion of a physiotherapy programme targeting FAI within the previous 12 months. Recruitment will take place over 24 months and 120 patients will be randomised in a 1:1 ratio and followed up for three years. The two primary outcome measures are change in hip outcome score eight months post-randomisation (approximately six-months post-intervention initiation) and change in radiographic minimum joint space width 38 months post-randomisation. ClinicalTrials.gov: NCT01893034. Cite this article: Bone Joint Res 2014;3:321-7.

| S-EPMC4248299 | biostudies-literature

In-vivo hip arthrokinematics during supine clinical exams: Application to the study of femoroacetabular impingement.

Project description:Visualization of hip articulation relative to the underlying anatomy (i.e., arthrokinematics) is required to understand hip dysfunction in femoroacetabular (FAI) patients. In this exploratory study, we quantified in-vivo arthrokinematics of a small cohort of asymptomatic volunteers and three symptomatic patients with varying FAI deformities during the passive impingement, FABER, and rotational profile exams using dual fluoroscopy and model-based tracking. Joint angles, joint translations, and relative pelvic angles were calculated. Compared to the 95% confidence interval of the asymptomatic cohort, FAI patients appeared to have decreased adduction and internal rotation during the impingement exam and greater flexion and less abduction/external rotation in the FABER exam. During the rotational profile, only the FAI patient with the most severe deformities demonstrated considerable rotation deficits. In all participants, contact between the labrum and femoral head/neck limited motion during the impingement exam, but not the rotational profile. Substantial pelvic motion was measured during the impingement exam and FABER test in all participants. Femoral translation along any given anatomical direction ranged between 0.69 and 4.1mm. These results suggest that hip articulation during clinical exams is complex in asymptomatic hips and hips with FAI, incorporating pelvic motion and femur translation. Range of motion appears to be governed by femur-labrum contact and other soft tissue constraints, suggesting that current computer simulations that rely on direct bone contact to predict impingement may be unrealistic. Additional research is necessary to confirm these preliminary results. Still, dual fluoroscopy data may serve to validate existing software platforms or create new programs that better-represent hip arthrokinematics.

| S-EPMC4536131 | biostudies-literature

Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement.

Project description:Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zone-specific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35°, a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities.

| S-EPMC4044509 | biostudies-literature

Arthroscopic capsular repair in the treatment of femoroacetabular impingement.

Project description:The role of capsular repair in the arthroscopic treatment of femoroacetabular impingement remains poorly defined. Some surgeons rarely repair the capsule, whereas others perform repairs routinely. There is little direct clinical evidence to guide surgeon decision making. When capsular repairs are performed, the procedure requires adequate visualization and careful suture placement either to re-establish the patient's normal capsular volume or to plicate a redundant capsule in a hip with hyperlaxity preoperatively. We present our preferred technique for arthroscopic capsular repair.

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