Examination Of Hip Research Articles

IMPLANT MOVEMENT ANALYSIS: A CT-BASED TECHNIQUE TO DIAGNOSE EARLY LOOSENING IN TOTAL HIP ARTHROPLASTY

The painful hip without obvious clinical or radiographic signs of complications is a well-known scenario for surgeons. The clinical tools we have access to currently lack a dynamic test for detecting early signs of motion between implant and bone.A new software, Sectra IMA, has a potential to facilitate diagnosis of early implant loosening by analysis of paired CT exams. In clinical practise the two scans are acquired by endpoint of a possible motion, “a provocation CT”, for example maximal external and internal rotation in a CT hip examination. 20 years of research by Olivecrona and Weidenhielm is the scientific background for the technique. Early results are presented by Sandberg et al 2022.To further validate and create clinical evidence more extensive clinical studies is needed. A proposal for a multicentric, global clinical study will be presented for further discussion.A new technique for diagnosis of acetabular cup loosening using computed tomography: preliminary experience in 10 patients. Henrik Olivecrona, Lotta Olivecrona, Lars Weidenhielm, Marilyn E Noz, Jocelyn Kardos, Gerald Q Maguire Jr, Michael P Zeleznik, Peter Aspelin. Acta Orthop. 2008 Jun;79(3):346-53. doi: 10.1080/17453670710015247.Inducible displacement CT increases the diagnostic accuracy of aseptic loosening in primary total hip arthroplasty. Sandberg O, Carlsson S, Harbom E, Cappelen V, Tholén S, Olivecrona H, Wretenberg P. Acta Orthop. 2022 Oct 31;93:831-836. doi: 10.2340/17453674.2022.5240.PMID: 36314542

Using an Innovative Model to Improve Performance of the Infant Hip Examination.

Determine if a new teaching bundle targeting developmental dysplasia of the hip screening improved interns' examination skills across multiple pediatric residency programs. This multicenter prospective cohort study included interns across 6 pediatric residency sites within the Academic Pediatric Association's Better Outcomes through Research for Newborns Network in 2022. Participants underwent a baseline hip examination assessment on models using a checklist derived from textbook descriptions of Galeazzi, Ortolani, and Barlow maneuvers before receiving a teaching bundle. Repeat testing occurred after instruction. Data were analyzed using t-test for continuous and χ2 test for categorical variables. Semistructured focus groups provided qualitative feedback regarding the teaching bundle. We enrolled 117 of 155 interns across 6 sites (76%) for participation in the teaching bundle. Only 2% of participants (n = 2) identified a positive Galeazzi sign at baseline, whereas 88% (n = 103, P < .001) did so on the postinstructional assessment. Although 27% of participants (n = 32) correctly identified a positive Barlow sign at baseline, 69% (n = 81, P < .001) did so on the postinstructional assessment. The ability to correctly detect a positive Ortolani sign increased from 22% (n = 26) to 92% (n = 108, P < .001). Fifteen interns participated in the semistructured focus groups, with resultant themes reinforcing the limited experience of the infant hip examination before this intervention and the positive impact of the teaching bundle. Most participants in this study did not have strong infant hip examination skills at entry into residency. A standardized teaching bundle significantly improved skills in examination technique and identifying abnormalities.

Utilization trends for MR arthrography of the hip and shoulder: a retrospective cross-sectional analysis of 20-year data from a tertiary care academic medical center.

The purpose of this study is to analyze changes in the utilization of MRA of the hip and shoulder at a large tertiary care academic medical center during a period of significant technological advancements over the last 20 years. This retrospective cross-sectional analysis identified MRA of the hip and shoulder performed at our institution over a 20-year period (2/2003-2/2023) in relation to the total number of MR hip and shoulder examinations during the same period. Patient characteristics and referring provider demographic information were extracted. Descriptive statistics and trend analysis were performed. The total number of MRIs of the hip and shoulder increased overall, with small dips in 2020 and 2022. MRA of the hip increased significantly over the first 10 years of the study period (p = 0.0005), while MRA of the shoulder did not change significantly (p = 0.33). The proportion of both MRA of the hip and shoulder declined over the last 10 years (hip, p = 0.0056; shoulder, p = 0.0017). Over the same period, there was significant increase in the proportion of examinations performed at 3 Tesla versus 1.5 (p < 0.0001). Overall, there was a downward trend in MR shoulder and hip arthrogram utilization in the second half of this 20-year study period. However, utilization varied somewhat by referring specialties and credentials. These changes are likely reflective of both improvements in image quality and evolving practice recommendations. Awareness of such trends may be valuable in ensuring appropriate patient care, as well as for anticipating the needs of a musculoskeletal radiology practice.

A Layered Approach to the History and Physical Exam of the Athlete's Hip

Hip pathology is a common source of pain and dysfunction in athletes. Taking a layered approach to the history and physical examination of the athlete's hip is imperative to deciphering the vast differential diagnoses for an athlete's hip pain. Systematic evaluation of the (1) osteochondral, (2) capsulolabral, (3) musculotendinous, (4) neurovascular, and (5) kinematic chain layers of the hip allow for the comprehensive consideration of hip pain etiologies, including femoroacetabular impingement syndrome, labral tears, osteoarthritis, Coxa Saltans, hamstring and gluteal tendinopathy, and sacroiliac joint dysfunction, among numerous other conditions. A thorough history, including the location, acuity, quality, radiation, and sport-specific limitations of the hip pain, followed by a methodologic physical examination, with ordered inspection, gait, palpation, range of motion, strength testing, and provocative maneuvers, allows clinicians to arrive at an early and accurate diagnosis of hip pain. Only after a thorough history and physical examination can more specific diagnostic and therapeutic modalities be applied.

X-ray, digital tomographic fusion, CT, and MRI in early ischemic necrosis of the femoral head.

To investigate the imaging performance of radiography, digital tomographic fusion (DTS), computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of early avascular necrosis of the femoral head (ANFH). A total of 220 patients with ANFH who visited our hospital from January 2020 to January 2022 were included in the study. X-ray, DTS, CT, and MRI examinations of both hips were performed for all patients. The trabecular structure, bone density changes, femoral head morphology, and joint space changes were observed using the aforementioned imaging modalities. The staging was performed according to the Association Research Circulation Osseous (ARCO) criteria. The diagnostic detection rate of each imaging modality, and the sensitivity, specificity, positive predictive value, and negative predictive value of each examination for diagnosing early ANFH were calculated and compared. Patients were diagnosed with stage I (n = 65), stage II (n = 85), stage III (n = 32), and stage IV (n = 38) ANFH. For MRI, the detection rate (97.7%), sensitivity (94.7%), specificity (88.6%), positive predictive value (95.9%), and negative predictive value (92.5%), for diagnosing early ANFH, were significantly higher than those of other imaging methods (P < .05). MRI is the most accurate and sensitive imaging method for diagnosing early ANFH and has important clinical applications.

Risk factors for a false negative Ortolani and Barlow examination in developmental dysplasia of the hip

IntroductionAlthough universal screening by neonatal clinical examination with Ortolani and Barlow manoeuvres is widely adopted, its role as a sole screening tool is controversial due to its poor sensitivity and failure in identifying hip joints that eventually require surgical intervention. HypothesisThis study aims to identify risk factors for a false negative Ortolani and Barlow examination in neonatal screening for DDH. The hypothesis is that risk factors for developmental dysplasia of the hips could similarly be risk factors for a false negative Ortolani and Barlow examination. Material and methodsIn the 14-year retrospective cohort study, all newborn infants born in a single institution from 1st January 1999 to 31st December 2013 were screened clinically with the Ortolani/Barlow manoeuvre by a neonatologist. Infants with positive risk factors, despite a normal clinical examination, were then scheduled for bilateral hip ultrasound in the first three months of life and evaluated according to the Graf's method, Harcke's method of dynamic ultrasound screening and Terjesen's method of evaluation for femoral head coverage. ResultsA total of 164 infants with normal Ortolani and Barlow examinations were scheduled for bilateral hip ultrasound due to the presence of risk factors. Amongst these, 32 (19.5%) infants were evaluated to have an abnormal hip on ultrasound. Breech position was the only statistically significant risk factor for a false negative Ortolani/Barlow examination (14/34, 41.2% vs. 18/112, 13.8%; p<0.001). DiscussionSonographic hip examinations are recommended for all infants with breech presentation even if they have a normal Ortolani and Barlow examination. Level of evidenceIII; case-control study.

Trends in the development of computed tomography in the Russian Federation in 2011–2021

The article presents the analysis of the structure of computed tomography diagnostics according to the forms of the federal state statistical observation (radiation-hygienic passports in 2011–2021, forms № 3-DOZ in 2011-2021 and forms № 30 in 2014–2020) in order to assess the status of CT diagnostics in the Russian Federation and identify the main trends in the development of this type of radiation diagnostics and patient doses. In 2011–2021, there was a sharp development of CT diagnostics in the Russian Federation – an increase in the number of CT examinations per 1000 people (up to a factor of 5.9 – from 32 CT examinations per 1000 people to 189 CT examinations per 1000 people) and the contribution of CT in the collective dose from medical diagnostic exposure (3 times from 26% to 77%). The number of CT examinations per 1 CT device from 2014 to 2019 increased by 2 thousand (52%), and in 2020 by another 1.85 thousand (32% compared to 2019) and reached 7.7 thousand. The increase in the number of CT examinations was mainly due to the increased use of CT equipment. The main contribution to the structure and collective dose of computed tomography in 2021 is made by examinations of chest (58%/65%), abdomen (8%/14%), pelvis and hips (3%/4%), skull and maxillofacial area (18%/7%). In 2011-2021 for chest CT examinations, the average effective dose was in the range from 4.2 to 5.9 mSv per examination, for abdomen – from 6.5 to 9.2 mSv, for pelvis and hips – 5 to 6.7 mSv, for skull and maxillofacial area – 1.5 to 2.4 mSv. The COVID-19 pandemic in 2020-2021 caused a change in the structure of CT examinations and collective dose in the Russian Federation – the chest CT examinations occupied the first place of the contribution to the number of examinations and the collective dose. The number of CT examinations per 1000 people and the contribution of CT to the collective dose from medical diagnostic exposure in the Russian Federation were significantly lower than those in foreign countries (up to a factor of 3.5 in the number of CT examinations per 1000 people and up to a factor of 1.6 of the contribution of CT to the collective dose).

The Role of Ultrasonography in Hip Impingement Syndromes: A Narrative Review.

Hip pain is indubitably a frequent clinical problem deriving from copious etiologies. Hip impingement syndromes are one of the most prevalent causes of persistent groin pain, especially in young and active patients. Diligent imaging of the hip region is indispensable to discern femoroacetabular impingement, as the differential diagnosis of hip pain can be exceedingly arduous. Despite hip radiography being plain and broadly attainable, it offers narrow information concerning soft tissue pathologies around the hip joint (extra-articular hip impingement syndromes). Magnetic resonance imaging and arthrography remain the gold standard examination for detecting intra-articular pathologies; however, they are widely considered expensive, time-consuming and characterized by confined. Consequently, ultrasonography has emerged as an alternative valuable diagnostic tool for distinguishing the underlying abnormalities that trigger femoroacetabular impingement. Proper hip ultrasound examination provides dynamic assessment, while also beneficial for guided intervention around the hip joint. Ultrasound hip examination is exacting due to its complex regional anatomy and deep location. It is capable of providing detailed information about various hip quadrants. An adept operator can identify both intra-articular and extra-articular pathologies. In addition, with ultrasonography, hip injections have been rendered relatively undemanding, aiding in therapeutic and diagnostic purposes. This paper aims to provide a succinct and compendious review of the existing literature, accentuating the crucial role of ultrasonography in diagnosing hip impingement syndromes and determining whether an additional examination is required regarding distinguishing between intra-articular and extra-articular syndromes.

Neonatal clinical examination and selective ultrasound screening are not reliable for the early diagnosis of hip dysplasia: A retrospective cohort study.

To compare the incidence, clinical features and timing of initial treatment of early- and later-presenting developmental dysplasia of the hip (DDH) in infancy in the context of a risk-based selective ultrasound screening programme. We conducted a retrospective observational study of infants born at a tertiary perinatal centre in Melbourne, Australia, between July 2016 and June 2020 and treated for DDH up to 18 months of age at a tertiary paediatric centre. The incidence of DDH was calculated for early- and later-presenting cases. Clinical features and ultrasound indications were analysed using multivariate logistic regression. There were 192 infants with DDH requiring treatment, 100 (52%) of which were not detected by universal neonatal hip examination and selective ultrasound screening based on risk factors (overall incidence 6.3 per 1000 livebirths). The median age at which treatment was commenced was delayed by 8 weeks for the later-presenting group compared to those detected through screening (16.7 vs. 7.9 weeks, P < 0.001). Skin crease asymmetry was associated with later presentation (adjusted odds ratio (aOR) 44.03, 95% confidence interval (CI) 9.99-333), whilst breech presentation (aOR 0.08, 95% CI 0.02-0.26) and Barlow/Ortolani test positivity (aOR 0.06, 95% CI 0.01-0.25) were associated with early presentation. Only 39 (1.45%) infants receiving a screening ultrasound had DDH. Approximately half of all infants with DDH were not detected by combining risk-based selective ultrasound screening with neonatal clinical findings, highlighting the failure of this screening method to reliably detect a significant proportion of dysplastic infant hips.

Multifid Iliopsoas Tendons Are More Common in Patients With Painful Snapping Iliopsoas Tendons

To retrospectively determine the prevalence of multifid tendons in a population of patients who underwent iliopsoas release for painful snapping iliopsoas tendons. Patients who underwent iliopsoas release for painful snapping iliopsoas tendons were retrospectively identified from a database of patients who had undergone arthroscopic hip surgery performed by a single surgeon between 2011 and 2020. Patients who had incomplete data or who underwent prior fracture fixation, joint arthroplasty, pelvic surgery, or other interventions for snapping hip were excluded. Magnetic resonance imaging (MRI) and operative reports were reviewed and compared with those of an age-matched control group of patients who had undergone hip or pelvic MRI examinations in the past year for different indications. This study included 91 patients (78 female and 13 male patients; mean age, 23.3 years) who were treated operatively for painful snapping hip and 78 controls (54 female and 24 male patients; mean age, 28.4 years) who received hip or pelvic MRI for other indications. Among the patients who underwent iliopsoas release, there were 5 unifid iliopsoas tendons (5.5%) compared with 86 multifid iliopsoas tendons (94.5%) when classified with MRI whereas operative examination showed 19 unifid tendons (20.9%) compared with 72 multifid tendons (79.1%, P < .001). When the MRI scans of the operative group were compared with the MRI scans of the control group, the patients who underwent surgery for painful snapping hip had a higher rate of multifid tendons (94.5% of operative hips compared with 69.2% of control right hips [P< .001] and 74.4% of control left hips [P < .001]). However, when the operative reports were used to classify the iliopsoas tendon, there was no significance between the operative and control groups (79.1% of operative hips had multifid tendons compared with 69.2% of control right hips [P= .141] and 74.4% of control left hips [P= .464]). For patients with symptomatic snapping hip undergoing iliopsoas lengthening, multifid iliopsoas tendons are more prevalent than in a control population. Level IV, prognostic case series.

Telemedicine Evaluation of Hip Ailments.

Background During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has provided new means of patient care while still allowing for physical examination and history to be obtained. Hip ailments are a common musculoskeletal problem leading to limited function. Today, we lack a standardized telemedicine hip evaluation protocol. Aim The aim of this manuscript is to provide an efficient means of extracting relevant information while performing telemedicine examinations of the hip. Methods The authors have created a step-by-step evaluation guide for physicians to evaluate hip complaints, including inspection, palpation, range of motion, strength testing, functional assessment, gait analysis, and special testing, with images of each maneuver. Results We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitatehip examination via telemedicine. Conclusions This manuscript provides a structured template for performing a telehealth examination ofhip ailments.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

FokI polymorphism in the vitamin D receptor gene in patients with hip osteoarthritis: A case-control study.

This study aimed to examine whether there is an association between hip osteoarthritis and vitamin D receptor gene FokI polymorphisms. In this case-control study, a total of 162 volunteers (43 males, 119 females; mean age: 62.4±9.3; range, 50 to 80 years) were included between March 2011 and March 2012. The patient group included 80 individuals with a diagnosis of coxarthrosis. Eighty-two individuals with normal hip, low back, and sacroiliac joint examination were included in the control group. The American College of Rheumatology hip osteoarthritis classification criteria were used in the diagnosis of coxarthrosis. Analysis of FokI polymorphisms was performed with restriction fragment length polymorphisms. When the genotype and allele distributions of vitamin D receptor FokI polymorphisms were examined, no statistical difference was found in both groups. No significant association between the hip osteoarthritis and FokI polymorphisms could be obtained.

Four decades of the Graf method in screening for developmental dysplasia of the hip (part I): Rightly the gold standard or of dubious benefit?

The method of infant hip sonography according to Graf is used for general hip screening in Serbia, Austria, and Germany and is considered the gold standard. In other countries, such as the USA, however, it is not well accepted and is claimed to lead to high costs and overtreatment. The aim of this study was to investigate how many of the mentioned sources in a recent review article contained sonograms that met the quality criteria as taught in Graf's ultrasound courses. A systematic review published by Sakkers et al. was analyzed in terms of addressing the quality criteria of Graf's method. Studies that were suitable by title, abstract, manuscript, that contained an image of sonographic hip examination, and that were accessible were included into analysis. Within the described review, there were 22 papers on the Graf method. Of these, 10 contained hip sonograms and were applicable for final analysis. The quality criteria according to Graf were not fulfilled within 5 of these 10 papers. Within these papers, there are examples of schematic sonograms that do not correspond with the quality criteria either. Skepticism regarding the Graf method may be based on user errors and insufficient application of the Graf quality assessment algorithm, which results in high intra- and inter-observer variations. Based on these findings, a working group was initiated to evaluate further work according to the same procedure (currently approximately 130 papers).

ROLE OF MAGNETIC RESONANCE IMAGING IN EVALUATION OF PAINFUL HIP JOINT

This study aims to evaluate the diagnostic value of MRI in the assessment of painful hip joint. Background: Radiographic evaluation is an initial and crucial role in patients with painful hip joint. Hip pain has different aetiologies in adults and children. MRI is the investigation choice for characterizing the various disorders and assessing the full extent of bone, cartilage and soft tissue abnormality of the hip joint. Methods: This prospective study included 50 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 &amp; STIR WIs, axial T1&amp;T2WIs, and sagittal T1WI. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: Male patients ages ranged from 1 to 60 years with a mean age of 35 years. Conclusion: MRI of the hip joint is informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.

Four decades of developmental dysplastic hip screening according to Graf: What have we learned?

PurposeSonographic hip examination according to Graf is widely accepted standard for diagnosing developmental dysplastic hips (DDH) but it is criticized for alleged intra- and interobserver variations. This review was conducted to evaluate whether objective quality criteria according to the Graf method are fulfilled within scientific literature.MethodsA systematic literature search on Pubmed was performed using the search string: [(DDH) OR (Hip dysplasia)] AND (Graf). Studies suitable by title, abstract, manuscript, containing an image of sonographic hip examination and online accessibility were included into analysis.Results131 studies were included into final analysis. Only 68 (51.9%) presented correct sonographic images according Graf’s criteria. 98 (74.8%) studies plotted alpha-angles (angle between bony roof line and base line) but only 85 (64.8%) studies beta-angles (angle between cartilage roof line and base line). Studies were contributed from 25 countries.ConclusionAssumingly, skepticism regarding the Graf method is based on user errors and insufficient application of the Graf quality assessment algorithm resulting in high intra- and interobserver variations. When performed correctly, the Graf method is of high diagnostic value.

Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants.

The aim of the study is to (1) determine the incidence of developmental dysplasia of the hip (DDH) in preterm infants born prior to 35 completed weeks' gestation in a breech presentation, and (2) evaluate if the association between breech presentation and DDH in full-term infants holds for premature infants. This study design comprises retrospective review of infants born between January 1, 2008, and December 31, 2017, at <35 weeks' gestation and admitted to the NICU. Infants had hip ultrasounds at 4 to 6 weeks' corrected age if they were born in a breech presentation with a stable hip examination. We excluded infants born in a presentation other than breech or vertex, had no documentation of presentation at birth, or if they died within the first year. We included 1,533 infants. Preterm infants <35 weeks' gestation born in the breech versus vertex position had an incidence of DDH of 0.47% (2/428) and 0.36% (4/1,105), respectively. There was no significant difference in the incidence of DDH between infants born in the breech versus vertex position (Chi-square and Fisher's exact tests). The sensitivity, specificity, and positive and negative predictive values of breech presentation in detecting DDH were 33, 72, 0.47, and 99.6%, respectively. There is no association between breech presentation and DDH in preterm infants <35 weeks' gestation. Obtaining hip ultrasounds on preterm infants <35 weeks' gestation born in the breech presentation with a normal hip examination is not recommended. · Breech position is a risk factor for DDH in term newborns.. · Preterm infants are often in the breech position until 37 weeks' gestation.. · This study shows that breech presentation is not a risk factor for DDH in preterm infants..

Status quo of screening for hip dysplasia

Since the first description of the ultrasound examination of the infant hip by Graf in 1980 this technique has impressively demonstrated that it lives up to its promise very well. In the implementation of hip ultrasound in the German pediatric guidelines it was hoped that it would improve the sensitivity and specificity of the early detection of dislocated and dysplastic joints in comparison to ageneral clinical hip screening. Furthermore, it has been repeatedly shown that general newborn hip ultrasound screening according to Graf can significantly reduce not only the treatment rate but also the invasiveness. Consequentially, the cost of treatment as well as the rate of late presenting developmental dysplasia of the hip (DDH) can also be significantly reduced. Despite those proven merits the meaningfulness of general hip ultrasound screening in infancy is still questioned, especially in the Anglo-American world. This article reviews how this misconception came about.

An Acute Hip Injury Correlated With An Exacerbation Of Urinary Symptoms In A Dancer

HISTORY23-year-old female dancer sustained an acute right hip/groin injury during a rond-de-jambe movement (requiring a combination of hip abduction, extension and external rotation). She had a sensation of a pop at the time of injury, followed by difficulty with external rotation as she attempted to continue to dance. Subsequent days were characterized by bruising to the inner groin and progressive medial thigh discomfort. She concurrently experienced a significant worsening of pre-existing urinary dysfunction characterized by episodes of urge incontinence and a sensation of incomplete voiding. She then developed secondary lateral hip, sacroiliac and low back discomfort. PHYSICAL EXAMShe presented to our office 6 weeks after the initial injury. She had a normal gait and symmetric hip range of motion. Right hip exam with pain at end range of passive hip flexion, and pain also with resisted testing of hip adduction, internal rotation and external rotation. She had tenderness over the anterior hip flexor tendons and at the proximal medial thigh just inferior to the pubic ramus. She was not tender to the pubic ramus. Thomas test was negative bilaterally, but she had significant tightness of quadriceps bilaterally noted on Ely’s test. An internal exam separately completed by her urogynecologist identified tightness of the pelvic floor musculature. DIFFERENTIAL DIAGNOSIS adductor muscle strain, strain of deep hip rotator muscles (obturator externus, obturator internus), hip flexor tendonitis (as primary or secondary diagnosis), labral tear, pelvic floor muscle strain/tear/dysfunction, primary or secondary tightness of pelvic floor musculature, hormonal and/or bladder irritants affecting urinary function TESTS AND RESULTS 1. Xray pelvis/hip series: Well-formed acetabula, slight predisposition to CAM type FAI 2. Hip MRI: Shallow right acetabulum with mild uncovering of lateral femoral head, signs of possible labral tear, small partial intramuscular tear of the R obturator externus, strain of R iliopsoas muscle 3. Dynamic hip ultrasound - pending FINAL WORKING DIAGNOSIS 1.Obturator externus strain with comorbid strain of iliopsoas muscle 2.Pelvic floor dysfunction TREATMENT AND OUTCOMES 1. Dance specific PT for core and peri-pelvic stabilization 2. Pelvic floor physical therapy 3. Gradual return to dance

Arthroscopic Treatment of Femoral Neck Impingement Cysts Using Biocomposite Anchors in the Setting of Femoroacetabular Impingement

Background: There is no established superior treatment for femoral neck impingement cysts, which may be symptomatic and can create a challenge in the arthroscopic treatment of femoroacetabular impingement. Isolated decompression of these cysts may lead to biomechanical compromise and an increased risk of femoral neck fracture similar to that associated with cortical perforation in osteoplasty of cam lesions, given the remaining focal osseous disruption and cortical discontinuity analogous to a burr perforation. Indications: In patients undergoing arthroscopic treatment of femoroacetabular impingement and found to have femoral neck impingement cyst warranting decompression, occlusion of the remaining defect with a biocomposite anchor may improve symptoms related to the impingement cyst as well as reduce the risk of femoral neck fracture. Technique Description: This surgical technique video demonstrates the filling of a femoral neck impingement cyst using a case example of a very active middle-aged woman undergoing arthroscopic treatment of femoroacetabular impingement. During cam osteoplasty in the peripheral compartment phase, the cyst is decompressed using a curette. An appropriately sized bioabsorbable suture anchor is secured into the defect and the sutures removed. The osteoplasty is resumed over the screw to achieve contouring of the femoral neck commensurate with an adequate head-neck offset confirmed by dynamic intraoperative hip examination. Results: Postoperative imaging from this procedure reveals bony in-fill with gradual dissolution of the biocomposite anchor. In our cohort of patients treated with biocomposite anchors concomitant to arthroscopic treatment of femoracetabular impingement with follow-up ranging from 2 to 12 years, there were no self-reported femoral neck fractures. Discussion/Conclusion: We expect that treatment of femoral neck impingement cysts with biocomposite anchors will stimulate bony in-fill of the defect stimulated by the anchor, with a decrease in the risk of femoral neck fracture as compared with an untreated cyst. Further research is needed to strengthen the evidence surrounding comparative treatment of impingement cysts as well as the optimal choice of material in the case of occlusion with a biocomposite anchor.