ABSTRACT
Introducción La displasia de la cadera en desarrollo (DCD) produce cambios anatómicos que dan lugar a artrosis precoz. Dentro de los procedimientos quirúrgicos indicados, se encuentra la osteotomía periacetabular de Ganz, diseñada para mejorar la arquitectura de la cadera, que por sí sola, no mejora el daño del cartílago articular, además de posibles lesiones del labrum. El objetivo fue describir hallazgos artroscópicos encontrados en caderas con displasia e indicación de osteotomía periacetabular de Ganz. Materiales & Métodos Estudio observacional tipo serie de casos, basado en la revisión de los registros clínicos (descripción quirúrgica y video de la artroscopia) de todos los casos con diagnóstico de displasia de cadera e indicación de osteotomía periacetabular de Ganz, en quienes se realizó artroscopia antes de la osteotomía. Resultados La artroscopia de cadera demostró compromiso intra-articular en 76,9% de los casos estudiados (10 de 13). Seis casos tenían compromiso del cartílago articular en las zonas geográficas 2, 3 y 4, adicionalmente se observó compromiso de la unión condrolabral en seis casos y el daño a nivel del labrum, se detectó en 5 casos; con respecto al offset cabeza-cuello femoral, se encontró disminuido en 5 casos. En una de las caderas, se contraindicó la osteotomía periacetabular por el grado de compromiso del cartílago articular. Discusión La DCD es una condición clínica que predispone al daño de estructuras articulares con alta frecuencia, que pueden ser tratadas de forma artroscópica con el fin de evitar la persistencia de síntomas después de una osteotomía periacetabular o incluso contraindicarla.
Background Dysplasia of the hip in development (DHD) produces anatomical changes that cause premature arthrosis. Within the surgical procedures indicated, Ganz periacetabular osteotomy has been described. It is designed to improve the architecture of the hip that, by itself, does not improve the damage to the articular cartilage, as well as possible lessions of the labrum. The objective was to describe the arthroscopic findings found in hips with dysplasia and indication of Ganz periacetabular osteotomy. Method Case series type observational retrospective study based on the review of surgical descriptions and videos of all cases with diagnosis of hip dysplasia and indication of Ganz periacetabular osteotomy where arthroscopy of the hip was performed prior to the osteotomy. Results Hip arthroscopy showed intra-articular compromise of 76.9% of the cases studied (10 of 13). Six cases had compromise of the articular cartilage in the 2, 3 and 4 geographic zones. In addition, compromise of the chondrolabral joint was observed in 6 cases and damage at the labrum level was detected in 5 cases. In regard to the femoral head-neck offset, it was found to be reduced in 5 cases. In one of the cases periacetabular osteotomy was contraindicated due to the level of compromise of the articular cartilage. Conclusions DHD is a clinical condition that is very frequently predisposed to damage of the articular structures; they can be treated with arthroscopy with the aim of avoiding persistence of sypmtoms after a periacetabluar osteotomy or even contraindicating it.
Subject(s)
Humans , Developmental Dysplasia of the Hip , Osteotomy , ArthroscopyABSTRACT
Abstract Objective To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger. Methods This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed. Results Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up (p > 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1st postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage. Conclusion In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.
Resumo Objetivo Avaliar os resultados funcionais de pacientes diagnosticados com impacto femoroacetabular (IFA) e com mais de 60 anos de idade em comparação aos resultados de pacientes com até 40 anos de idade. Métodos Esta é uma revisão retrospectiva de pacientes com IFA submetidos à artroscopia do quadril entre 2010 e 2015. Os pacientes eram adultos com mais de 60 anos de idade e Tönnis ≤ 1, alocados na proporção de 1:1 com adultos de até 40 anos de idade, de acordo com o tipo de deformidade (came, pincer, ou misto), sexo e data de realização da cirurgia. Resultados Trinta e quatro pacientes foram incluídos em cada grupo. A idade média foi de 30,6 ± 6,9 anos e 65,6 ± 4,6 anos nos grupos controle e de casos, respectivamente. Não houve diferenças significativas entre os grupos no acompanhamento de 1 ano (p > 0.05). No primeiro ano após a cirurgia, a pontuação Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) passou de 46,3 para 22,0 no grupo de pacientes mais velhos (casos) e de 38,1 para 7,2 no grupo controle em comparação ao estágio pré-operatório. Conclusão O grupo de pacientes com até 40 anos de idade apresentou uma mudança considerável na pontuação WOMAC, mas sem significado estatístico em comparação ao grupo de pacientes acima de 60 anos. Essa observação sugere que a artroscopia do quadril é benéfica quando a seleção de pacientes com IFA é apropriada, independentemente da idade dos indivíduos.