Sclerotic lesions of the femoral head-neck junction for diagnosis of femoroacetabular impingement.

The morphological characteristics associated with a diagnosis of femoroacetabular impingement (FAI) observed on plain radiographs can also be seen in subjects without hip joint symptoms. Therefore, the purpose of this study was to investigate whether sclerotic lesions on femoral head-neck junction (FHNJ) could be used as a supplemental diagnostic feature. A total of 128 hips from 119 patients (43 male and 76 female) diagnosed with FAI and 24 hips from 21 patients (2 male and 19 female) with other hip pathologies as control were compared in this study. Using standing frog-leg plain radiographs, the prevalence of sclerotic lesions on the FHNJ was established. Additionally, the pixel intensity (PI) of the sclerotic lesions between the FAI and the control groups were quantitatively compared. Sclerotic lesions were present in 96.1% of FAI hips (123 of 128) and only 37.5% of control hips (9 of 24) (p < 0.05). The ratio of PI in the FAI group was significantly higher (approximately 10%) than in the control group (p < 0.05). The evaluation of sclerotic lesions may be used as a supplement to aid in the diagnosis of FAI.

Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device.

BACKGROUND: Probing to assess conditions of hip capsule and acetabular labrum is performed by "surgeons' feeling". OBJECTIVE: We investigated the resistance of the labrum and the hip capsule quantitatively while they were pulled with a probing device. METHODS: With the probing device in which a strain gauge was embedded, ten fresh frozen specimens of the pelvis and proximal femur were measured in each three surgical steps, (1) closed, (2) open, (3) closured for the capsule, and (1) intact, (2) cut, (3) repaired for the labrum. RESULTS: The mean highest resistance levels for the capsule were 9.8 N at the closed capsule, 4.1 N at the open capsule, and 8.5 N at the closured capsule. The values at the three phases were statistically significant. The mean highest resistance levels for the hip labrum were 8.2 N at the labrum intact, 4.0 N at the labrum cut, and 7.9 N at the labrum repair. The values at the three phases were also statistically significant. CONCLUSIONS: Since the quantitatively measured values in each three steps were significantly different, the values with the probing device might be useful to evaluate whether the lesion of the soft tissue exists and whether some surgical intervention works well.

Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement: Outcomes May Be Depressing.

Hip arthroscopy can be an extremely effective treatment for femoroacetabular impingement syndrome. As with any surgery, our clinical outcomes are directly related to proper patient selection. As orthopaedic surgeons, we often focus on the functional and painful history complaints, the physical examination maneuvers, and radiographic studies to determine whether patients will respond well to surgical treatment. However, we oftentimes overlook the overall well-being of our patients and forget how psychosocial factors may limit surgical outcomes. Patients need to be counseled about the importance of medically maximizing their overall well-being and addressing any underlying stress, anxiety, or depression. Although psychosocial factors are not a contraindication to surgery, they certainly play a major role in our ultimate goal of improving our patients' quality of life and function.

Natural History of Structural Hip Abnormalities and the Potential for Hip Preservation.

Hip osteoarthritis (OA) exerts a significant burden on society, affecting 3% of Americans aged >30 years. Recent advances in the understanding of the pathoanatomy and pathomechanics of the hip have led to treatment options for young adults with hip pain. Femoroacetabular impingement, specifically cam-type femoroacetabular impingement, hip dysplasia, and the sequelae of pediatric hip disease can predispose the hip to early OA. However, many patients with abnormal anatomic findings do not develop early OA, suggesting that there exist other patient characteristics that are protective despite abnormal bony anatomy. Outcome studies show that arthroscopic and open hip procedures improve pain and function in patients with symptomatic hips. However, there is currently limited evidence that these procedures extend the life of the patient's natural hip. Additional studies are needed to determine protective or adaptive factors in patients with abnormal anatomy who do not develop early OA and to determine whether joint preserving hip surgery extends the life of the native hip joint.

Progressive osteoarthritis during pregnancy several years following hip arthroscopy for femoroacetabular impingement.

CASE: A 28-year-old with borderline left hip dysplasia who underwent arthroscopic acetabuloplasty, femoral osteochondroplasty, and labral repair for femoroacetabular impingement. She did well for 8 years, though required arthroscopic capsulolabral adhesion release 2 years after the initial procedure. After this period of stability, she developed left hip pain during pregnancy. Radiographs demonstrated progressive osteoarthritis that lead to total hip arthroplasty at age 37. CONCLUSION: The physiologic and hormonal changes during pregnancy leading to increased ligamentous laxity may put vulnerable patients with hip dysplasia and iatrogenic instability at increased risk for progression of osteoarthritis.

Hip arthroscopy and the anterolateral portal: avoiding labral penetration and femoral articular injuries.

Establishing the introductory viewing portal is a key step in hip arthroscopy. Most hip arthroscopists initially gain access to the central compartment of the hip through the anterolateral portal. Iatrogenic injury to the labrum or the femoral head chondral surface is a common yet under-reported complication of the procedure. Instead of directing the needle toward the clear space of the distracted joint, labral penetration can be minimized by directing the needle slightly anteroinferior to the clear space, overlapping the superior femoral head. Femoral head scuffing can be minimized by adjusting the position of the beveled needle and confirming a straight guidewire trajectory before trocar placement. This technical note addresses surgical pearls to minimize iatrogenic injury during initial central compartment access.