Acetabular Rim Disorders/Pincer-type Femoroacetabular Impingement and Hip Arthroscopy.

Femoroacetabular impingement (FAI) can lead to acetabular impaction, chondral injury, and labral pathology secondary to deformities of the proximal femur (CAM-type FAI), acetabulum (pincer-type FAI), or with combined FAI. While the majority of cases are of the combined type, this paper focuses on acetabular overcoverage/pincer-type deformities. Various pincer subtypes include focal anterior overcoverage, global retroversion, global overcoverage/profunda, protrusio, subspine impingement, and os acetabuli/rim fracture variants. A thorough history and physical examination, plain radiographs, magnetic resonance imaging, 3-dimensional computerized tomography, and diagnostic injections can lead to an accurate assessment of pincer-type variants. Appropriately indicated arthroscopic management techniques and pearls for the various pincer subtypes can lead to improved patient-related outcome measures and a high rate of return to athletic activity for the majority of these patients.

Management of Ankle Arthritis After Severe Ankle Trauma.

OBJECTIVES: There are still unanswered questions about the best treatment options for ankle arthritis after severe lower leg trauma. This study compared results in outcomes and complications for 3 groups. DESIGN: Retrospective cohort study case-control study. SETTING: Single institution. PATIENTS: Three groups of 100 surgeries. INTERVENTION: Patients underwent an ankle fusion using anterior plate, total ankle arthroplasty (TAA) for primary osteoarthritis (OA), or a TAA for post-traumatic arthritis (PTA). MAIN OUTCOME MEASUREMENTS: Veterans Rand 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale, Visual Analog Pain Scale, and the American Orthopaedic Foot and Ankle Society Hindfoot score were collected preoperatively and at subsequent postoperative appointments. A patient satisfaction survey was also distributed to each patient postoperatively. RESULTS: Although all scores improved from preoperative to latest postoperative, the total ankle for PTA consistently resulted in the best postoperative outcomes. Patient satisfaction survey indicated 26% of fusion, 55% of TAA-OA, and 63% of TAA-PTA experienced very good to excellent pain relief. The overall satisfaction was found to be 92.5% for the TAA-PTA patients, 90.5% for the TAA-OA patients, and 84% for the fusion patients. Revision surgeries included 2 from the TAA-OA group, 2 from the TAA-PTA group, and 1 fusion patient. CONCLUSIONS: Results of comparing 3 groups who underwent an ankle fusion or a TAA demonstrate improvement in pain (P < 0.001), physical quality of life (P < 0.001), and activity (P < 0.001) and resulted in a high level of patient satisfaction. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.