共查询到20条相似文献,搜索用时 31 毫秒
1.
2.
Background
The authors report the results of femoroacetabular impingement (FAI) treated with a surgical dislocation.Methods
From April 2005 to May 2007, 15 FAI hips were treated with a surgical dislocation. The male/female ratio, mean age and mean symptom duration was 12/2, 35.8 years and 2.3 years, respectively. Radiographs and MR arthrograms were taken. The clinical evaluation involved changes in the pre- and postoperative Harris hip score (HHS).Results
There were 12 hips (80%) with at least one structural abnormality in the radiographs, with 11 (79%) labral tears and 8 (73%) abnormally high angles in the MR arthrograms. We performed 15 osteochondroplasties, 12 labral repairs, 12 acetabuloplasty, and 3 debridements. The mean HHS improved from 76 to 93 points. Three non-unions of the trochanteric osteotomy sites were encountered as complications.Conclusions
Radiographs and MR arthrograms are important for making a proper diagnosis of FAI and planning treatment. A surgical dislocation can be used to treat FAI but further technical improvements will be needed for fixation of the greater trochanteric osteotomy sites. 相似文献3.
Ira Zaltz MD 《Clinical orthopaedics and related research》2012,470(12):3398-3405
Background
Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair.Questions/Purposes
The questions raised in this review were: (1) does labral repair restore normal histologic structure, tissue permeability, hip hydrodynamics, load transfer, and in vivo kinematics; and (2) does labral repair favorably alter the natural course of femoroacetabular impingement (FAI) treatment or age-related degeneration of the acetabular labrum?Methods
An electronic literature search for the keywords acetabular labrum was performed. Three hundred fifty-five abstracts were reviewed and 52 selected for full-text review that described information concerning pertinent aspects of labral formation, development, degeneration, biomechanics, and clinical results of labral repair or resection.Results
Several clinical studies support labral repair when performed in conjunction with acetabular rim trimming. Little data support or refute the use of routine labral repair for all patients with symptomatic labral damage associated with FAI. It is not known whether or how labral repair affects the natural course of FAI.Conclusions
Based on the current understanding of labral degenerative changes associated with mechanical hip abnormalities, the low biologic likelihood of restoring normal tissue characteristics, and mechanical data suggesting minimal consequence from small labral resections, routine labral repair over labral débridement is not supported. 相似文献4.
K. C. Geoffrey Ng MASc Gholamreza Rouhi PhD Mario Lamontagne PhD Paul E. Beaulé MD 《HSS journal》2012,8(3):206-212
Background:
Cam femoroacetabular impingement (FAI) can impose elevated mechanical loading in the hip, potentially leading to an eventual mechanical failure of the joint. Since in vivo data on the pathomechanisms of FAI are limited, it is still unclear how this deformity leads to osteoarthritis.Purpose:
The purpose of this study was to examine the effects of cam FAI on hip joint mechanical loading using finite element analysis, by incorporating subject-specific geometries, kinematics, and kinetics.Questions:
The research objectives were to address and determine: (1) if hips with cam FAI demonstrate higher maximum shear stresses, in comparison with control hips; (2) the magnitude of the peak maximum shear stresses; and (3) the locations of the peak maximum shear stresses.Methods:
Using finite element analysis, two patient models were control-matched and simulated during quasi-static positions from standing to squatting. Intersegmental hip forces, from a previous study, were applied to the subject-specific hip geometries, segmented from CT data, to evaluate the maximum shear stresses on the acetabular cartilage and underlying bone.Results:
Peak maximum shear stresses were found at the anterosuperior region of the underlying bone during squatting. The peaks at the anterosuperior acetabulum were substantially higher for the patients (15.2 ± 1.8 MPa) in comparison with the controls (4.5 ± 0.1 MPa).Conclusions:
Peaks were not situated on the cartilage, but instead located on the underlying bone. The results correspond with the locations of initial cartilage degradation observed during surgical treatment and from MRI.Clinical Relevance:
These findings support the pathomechanism of cam FAI. Changes may originate from the underlying subchondral bone properties rather than direct shear stresses to the articular cartilage. 相似文献5.
6.
Kyle MacIntyre Brendan Gomes Steven MacKenzie Kevin D’Angelo 《The Journal of the Canadian Chiropractic Association》2015,59(4):398-409
Objective:
To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender.Clinical Features:
A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented.Summary:
FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury. 相似文献7.
Ashley L. Kapron PhD Stephen K. Aoki MD Christopher L. Peters MD Andrew E. Anderson PhD 《Clinical orthopaedics and related research》2014,472(12):3912-3922
Background
Femoroacetabular impingement (FAI) may constrain hip articulation and cause chondrolabral damage, but to our knowledge, in vivo articulation and femur-labrum contact patterns have not been quantified.Purpose
In this exploratory study, we describe the use of high-speed dual-fluoroscopy and model-based tracking to dynamically measure in vivo hip articulation and estimate the location of femur-labrum contact in six asymptomatic hips and three hips with FAI during the impingement examination. We asked: (1) Does femur-labrum contact occur at the terminal position of impingement? (2) Could range of motion (ROM) during the impingement examination appear decreased in hips with FAI? (3) Does the location of femur-labrum contact coincide with that of minimum bone-to-bone distance? (4) In the patients with FAI, does the location of femur-labrum contact qualitatively correspond to the location of damage observed intraoperatively?Methods
High-speed dual-fluoroscopy images were acquired continuously as the impingement examination was performed. CT arthrogram images of all subjects were segmented to generate three-dimensional (3-D) surfaces for the pelvis, femur, and labrum. Model-based tracking of the fluoroscopy images enabled dynamic kinematic observation of the 3-D surfaces. At the terminal position of the examination, the region of minimal bone-to-bone distance was compared with the estimated location of femur-labrum contact. Each patient with FAI underwent hip arthroscopy; the location of femur-labrum contact was compared qualitatively with damage found during surgery. As an exploratory study, statistics were not performed.Results
Femur-labrum contact was observed in both groups, but patterns of contact were subject-specific. At the terminal position of the impingement examination, internal rotation and adduction angles for each of the patients with FAI were less than the 95% confidence intervals (CIs) for the asymptomatic control subjects. The location of minimum bone-to-bone distance agreed with the region of femur-labrum contact in two of nine hips. The locations of chondrolabral damage identified during surgery qualitatively coincided with the region of femur-labrum contact.Conclusions
Dual-fluoroscopy and model-based tracking provided the ability to assess hip kinematics in vivo during the entire impingement examination. The high variability in observed labrum-femur contact patterns at the terminal position of the examination provides evidence that subtle anatomic features could dictate underlying hip biomechanics. Although femur-labrum contact occurs in asymptomatic and symptomatic hips at the terminal position of the impingement examination, contact may occur at reduced adduction and internal rotation in patients with FAI. Use of minimum bone-to-bone distance may not appropriately identify the region of femur-labrum contact. Additional research, using a larger cohort and appropriate statistical tests, is required to confirm the findings of this exploratory study.Electronic supplementary material
The online version of this article (doi:10.1007/s11999-014-3919-9) contains supplementary material, which is available to authorized users. 相似文献8.
Peter Emary 《The Journal of the Canadian Chiropractic Association》2010,54(3):164-176
Objective:
To familiarize the chiropractic clinician with the clinical presentation, radiographic features, and conservative versus surgical treatment options for managing femoroacetabular impingement (FAI) syndrome.Background:
FAI syndrome is a relatively new clinical entity to be described in orthopedics, and has been strongly linked with pain and early osteoarthritis of the hip in young adults. Hip joint radiographs in these patients often appear normal at first—particularly if the clinician is unfamiliar with FAI. The role of conservative therapy in managing this disorder is questionable. Surgical treatment ultimately addresses any acetabular labral or articular cartilage damage, as well as the underlying osseous abnormalities associated with FAI. The most commonly used approach is open surgical hip dislocation; however, more recent surgical procedures also involve arthroscopy.Conclusion:
In FAI syndrome—a condition unknown to many clinicians (including medical)—chiropractors can play an important role in its diagnosis and referral for appropriate management. 相似文献9.
G. R. Boone BS M. R. Pagnotto MD J. A. Walker MD R. T. Trousdale MD R. J. Sierra MD 《HSS journal》2012,8(3):230-234
Background
Open and arthroscopic procedures are treatment options for patients with femoroacetabular impingement (FAI). Age has been found to be a predictive factor in the outcome of patients undergoing periacetabular osteotomy (PAO) for hip dysplasia. It is unclear if older age contraindicates joint preservation through a surgical hip dislocation (SHD).Questions/Purpose
The purpose of this retrospective case series was to evaluate the short-term outcomes of patients over 40 years of age without radiographic evidence of end-stage arthritis who underwent SHD for the treatment of FAI and to determine whether older age should be a contraindication for joint-preserving procedures in these patients. Our specific aims included (1) documenting the intraoperative findings and procedures, (2) assessing pain relief provided, and (3) assessing treatment failures and postoperative complications, noting the number of patients that ultimately required total hip arthroplasty (THA).Patients and Methods
All patients at age 40 and older who had SHD for the treatment of FAI were identified from a series of patients treated with SHD. Clinical notes, radiographs, and operative reports were reviewed to determine clinical results, complications, and the need for additional procedures. The minimum follow-up was 1 year (mean 3.9 years; range 1–8 years).Results
At final follow-up, 11/22 (50%) of hips had pain relief, while 11/22 (50%) either continued having significant symptoms or required THA. Five (23%) reported nontrochanteric pain symptoms that were the same or worse than before surgery, and six hips (27%) underwent subsequent THA). The average time between SHD and THA was 1.9 years (0.9–6.2). The average age of patients who went on to require THA was 45 (42–50) years.Conclusions
Surgical hip dislocation can be used for the treatment of FAI in patients over age 40, but strict selection criteria should be adhered to, as only half of the patients experienced significant improvement in their hip pain. THA was required in one-third of hips for continued pain and radiographic progression of arthritis. SHD for treatment of pathology that is not amenable to hip arthroscopy should remain a surgical option in older patients with FAI only if joint degeneration is not present. 相似文献10.
Background
Acetabular labral tear is a main cause of hip pain and disability, often requiring surgical treatment. Improvements of hip arthroscopic technique have produced positive outcomes after labral repair with arthroscopy. The purpose of this study was to determine clinical outcomes and patient satisfaction after arthroscopic repair of acetabular labral tear.Methods
We interviewed 21 patients (10 men and 11 women; mean age, 36 years [range, 22 to 57 years]) with acetabular labral tears that had been repaired arthroscopically in terms of satisfaction of the procedure. In addition, clinical outcome was assessed using visual analog scale (VAS) score, University of California, Los Angeles (UCLA) activity, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, and Harris hip score, and radiologic outcome was assessed using serial radiography. The patients were followed for 24-50 months.Results
The mean Harris hip score was 73 points (range, 64 to 84 points) preoperatively and 83 points (range, 66 to 95 points) postoperatively. Fifteen hips (71%) were rated excellent and good. The mean WOMAC osteoarthritis index and VAS scores were improved at final follow-up. UCLA activity at the latest follow-up improved in 16 patients. The Tonnis grade of osteoarthritis at the latest follow-up did not change in all patients. Eighteen of the patients (86%) were satisfied with the procedure.Conclusions
High rate of satisfaction after arthroscopic repair of acetabular labral tears is an encouraging outcome. Arthroscopic treatment of labral tears might be a useful technique in patients with hip pathologies, such as femoroacetabular impingement with labral tears. 相似文献11.
Lorenzo Nardo Neeta Parimi Felix Liu Sonia Lee Pia M. Jungmann Michael C. Nevitt Thomas M. Link Nancy E. Lane Osteoporotic Fractures in Men Research Group 《Clinical orthopaedics and related research》2015,473(8):2578-2586
Background
The epidemiology of femoroacetabular impingement (FAI) is important but incompletely understood, because most reports arise from symptomatic populations. Investigating the prevalence of FAI in a community-based cohort could help us better understand its epidemiology and in particular the degree to which it might or might not be associated with hip pain.Questions/purposes
The purposes of this study were (1) to evaluate the proportion of older (≥ 65 years of age) men with morphologic abnormalities consistent with FAI; and (2) to assess the association of the morphologic abnormalities with prevalent radiographic hip osteoarthritis (OA) and hip pain.Methods
Anteroposterior radiographs were obtained in 4140 subjects (mean age ± SD, 77 ± 5 years) from the Osteoporotic Fractures in Men study. We assessed each hip for cam, pincer, and mixed FAI types using validated radiographic definitions. Both intra- and interobserver reproducibility were > 0.9. Radiographic hip OA was assessed by an expert reader (intraobserver reproducibility, 0.7–0.8) using validated methods, and summary grades of 2 or greater (on a scale from 0 to 4) were used to define radiographic hip OA. Covariates including hip pain in the last 30 days were collected by questionnaires that were answered by all patients included in this report. Logistic regressions with generalized estimating equations were performed to evaluate the association of radiographic features of FAI and arthrosis.Results
Pincer, cam, or mixed types of radiographic FAI had a prevalence of 57% (1748 of 3053), 29% (886 of 3053), and 14% (419 of 3053), respectively, in this group of older men. Both pincer and mixed types of FAI were associated with arthrosis but not with hip pain (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.25–2.13; p < 0.001 for pincer and OR, 2.49; 95% CI, 1.65–3.76; p < 0.001 for mixed type). Patients with hips characterized by cam-type FAI had slightly reduced hip pain without the presence of arthrosis compared with hips without FAI (OR, 0.82; 95% CI, 0.68–0.99; p = 0.037). A center-edge angle > 39° and a caput-collum-diaphyseal angle < 125° were associated with arthrosis (OR, 1.53; 95% CI, 1.22–1.94; p < 0.001 and OR, 2.09; 95% CI, 1.24–3.51; p = 0.006, respectively), but not with hip pain (OR, 0.89; 95% CI, 0.77–1.03; p < 0.108 and OR, 0.99; 95% CI, 0.67–1.45; p = 0.945, respectively). An impingement angle < 70° was associated with less hip pain compared with hips with an impingement angle ≥ 70° (OR, 0.76; 95% CI, 0.61–0.95; p = 0.015).Conclusions
FAI is common in older men and represents more of an anatomic variant rather than a symptomatic disease. This finding should raise questions on how age, activities, and this anatomic variant each contribute to result in symptomatic disease.Level of Evidence
Level III, prognostic study. 相似文献12.
Harish S. Hosalkar Nirav K. Pandya James D. Bomar Dennis R. Wenger 《Journal of children's orthopaedics》2012,6(3):161-172
Background
Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement.Methods
The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered.Results
Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations.Conclusions
Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head–neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis.Level of evidence
V. 相似文献13.
Alessandro Aprato Narlaka Jayasekera Richard Villar 《International orthopaedics》2012,36(11):2231-2234
Purpose
To our knowledge, there is no report in the orthopaedic literature that correlates the duration of hip pain with the results of hip arthroscopic surgery. The aim of this study was to compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a two year period.Methods
We present a prospective single-surgeon series of 525 consecutive patients undergoing hip arthroscopy for a labral tear, femoroacetabular impingement (FAI), or a chondral lesion. Modified HHS was recorded for all patients at the time of surgery and at six weeks, six months and one, two and three years after hip arthroscopy. At the time of surgery, patients were divided into three groups based on duration of preoperative symptoms: group A, under 6 months; group B, six months to three years; group C, over three years.Results
Mean age was 39 years. There were significantly better outcomes for patients who underwent surgery within six months of symptom onset compared with those who waited longer. Patients who had symptoms for over 3 years by the time of surgery had a significantly poorer result than those with a shorter symptom duration and a higher chance of requiring revision surgery.Conclusions
We recommend that patients with a diagnosis of labral tear, FAI or a chondral lesion should undergo hip arthroscopic surgery within six months of symptom onset. Patients with persistent symptoms for over three years should be made aware of the poorer outcome after hip arthroscopy. 相似文献14.
Maureen K. Dwyer Hugh L. Jones Richard E. Field Joseph C. McCarthy Philip C. Noble 《Clinical orthopaedics and related research》2015,473(2):602-607
Background
Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function.Questions/purposes
Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal?Methods
Using 10 fresh cadaveric specimens (mean age 50 years, ± 8), we measured the capacity of the central compartment of the hip (the iliofemoral joint) to maintain a seal during fluid infusion, which may help elucidate the function of the labrum during weightbearing. Specimens with and without abnormal femoral morphology (six normal-appearing specimens and four whose geometry suggested cam-type FAI) were tested in postures observed during functional activities, including simulations of normal gait, stooping, and pivoting. Each specimen with FAI morphology exhibited secondary damage of the labrum and the adjacent chondral surface, whereas specimens of normal morphology were undamaged.Results
Average peak central compartment pressure was reduced during pivoting for specimens with the presence of labral damage secondary to FAI. When placed in pivoting positions, hips with FAI maintained lower fluid pressures within the central compartment compared with intact specimens (15 ± 3 versus 42 ± 8 kPa, respectively; effect size: 1.08 [−0.36 to 2.31]; p = 0.007). No differences in peak pressure were observed between groups (FAI versus normal) for postures simulating either gait (21 ± 6 versus 22 ± 4 kPa; p = 0.902) or stooping (9 ± 2 versus 8 ± 3 kPa; p = 0.775) with the numbers available.Conclusions
The acetabular seal, quantified by the maximum intraarticular pressure, was reduced during pivoting; however, the seal was maintained during simulated gait and stooping.Clinical Relevance
Because degeneration is progressive with repetitive impingement, loss of the labral seal starts to be seen during pivoting and may progress from there, but in this small-sample cadaver study that evaluated specimens in middle adulthood, the seal remains intact during simulated gait and stooping. Our study suggests that labral damage secondary to cam-type FAI may reduce the ability of the labral to provide an adequate seal of the central compartment of the hip during loading; however, the extent to which this is affected requires further investigation. 相似文献15.
Robert J Macfarlane Fares S Haddad 《Annals of the Royal College of Surgeons of England》2010,92(5):363-367
INTRODUCTION
Femoro-acetabular impingement (FAI) was first described in 1999 as abnormal abutment between the acetab-ulum and the femoral head and neck. Since then, it has been shown to be responsible for many acetabular labral tears and is implicated in the aetiology of osteoarthritis of the hip. This review introduces the concept of FAI and reports the key aspects of its diagnosis and management.MATERIALS AND METHODS
A comprehensive search of the literature was conducted using the Pubmed database. Articles relating to the aetiology, pathophysiology, clinical features, diagnosis and treatment of FAI were reviewed. Search terms included femoro-acetabular impingement, arthroscopic treatment, open treatment, aetiology, pathophysiology. The search was limited to articles published in English. All articles were read in full by the authors and selected for inclusion based on relevance to the article.RESULTS
An increasing number of studies relating to FAI have been produced in the 10 years since its recognition. A range of clinical and radiological features have been described. Surgical management can be performed using a number of techniques, with promising results from various studies. Early treatment with open surgery has paved the way for less invasive and arthroscopic approaches, with short-to-medium term data demonstrating favourable functional results for arthroscopic treatment of FAI.CONCLUSIONS
A greater awareness of the diagnostic features of FAI, and the various management options available, will allow timely diagnosis and treatment of a relatively newly recognised syndrome. Early treatment may then help to prevent progression to end-stage osteoarthritis of the hip. 相似文献16.
17.
18.
Pascal André Vendittoli David Alexander Young David J. Stitson Rory Wolfe Angelo Del Buono Nicola Maffulli 《International orthopaedics》2012,36(11):2235-2241
Purpose
The purpose of this study was to investigate whether acetabular morphology may influence both pathogenesis and prognosis of the acetabular rim lesions and to propose a new system to classify labral tears.Methods
We assessed radiographic and arthroscopic findings in 81 patients (40 male and 41 female patients, 86 hips) aged from 16 to 74 years (median, 31 years) who underwent hip arthroscopy.Results
Acetabular rim lesions were associated with four different hip morphologies. Eleven (32 %) of 34 patients with severe rim lesions underwent hip arthroplasty for progressive symptoms, whereas no patient with early rim lesion reported significant progression of symptoms. The strategy of treatment was changed in 33 % of the patients undergoing arthroscopy before undertaking peri-acetabular osteotomy.Conclusions
Hip arthroscopy avoids more invasive procedures in patients with early acetabular rim lesions. 相似文献19.