Hip Arthroscopy

Background: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in patients with femoroacetabular impingement syndrome. Purpose: To investigate whether demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage injury (modified Beck grade 0-2 vs 3-4) and femoral head cartilage injury (International Cartilage Repair Society grade 0-2 vs 3-4). Logistic regressions assessed the association with the following: age (<30 vs 30-50 years); sex; sport activity level (Hip Sports Activity Scale); alpha angle (AA) assessed as normal (AA <55°), cam (55°≤ AA <78°), or severe cam (AA ≥78°); lateral center-edge angle (LCEA) assessed as normal (25°≤ LCEA ≤ 39°), pincer (LCEA >39°), or borderline dysplasia (LCEA <25°); joint space w...

Background Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. Objective To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. Design The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. Participants Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. Intervention Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led progr...

Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH.

Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH.

Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS.

Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality.

Myasthenia Gravis leads to painless fatigable weakness of specific muscles in the body. It is often associated with comorbidities. A major surgery like total knee replacement in such a patient can lead to myasthenic crisis and many other complications. The success of this surgery depends upon the strength of various groups of muscles. A 66 years old, short, obese, female, with Myasthenia Gravis, Rheumatoid Arthritis and Hypothyroidism was operated for bilateral total knee replacement in single stage. A good preoperative evaluation of the case, anaesthesia and surgical procedure related intraoperative care and a careful postoperative pharmacological and physiotherapy protocol led to a satisfactory recovery during the hospital stay. A comprehensive perioperative care with a team-based approach can lead to a successful outcome after a total knee replacement surgery in a patient with Myasthenia Gravis and other comorbidities.

The aim of this study is to measure the ischiofemoral distance (IFD) in the normal hip with healthy surrounding soft tissues and describe its variations caused by gender, age and proximal femoral anatomy so that this could serve as a reference for future studies on this subject. This is a retrospective study in which we reviewed the CT scans of 149 patients (298 hips) who had a CT of their pelvis for non-orthopaedic (abdomino-pelvic) pathology. The images were reviewed by two independent observers and the IFD (the smallest distance between the lateral cortex of the ischial tuberosity and the posteromedial cortex of the lesser trochanter), offset (the perpendicular distance from the centre of the femoral head to a line running down the middle of the shaft of the femur) and the neck-shaft angle (the angle between the lines in the middle of the neck to the line forming the axis of the femoral shaft) were measured. The CT scans belonged to 71 males and 78 females (M: 48%, F: 52%), with an average age of 51 6 19 years (range 18–92). The mean IFD was 18.6 6 8 mm in the females and 23 6 7 mm in the males and this difference was statistically significant (P < 0.001). The IFD increased by 1.06 mm for each 1 mm of offset and dropped by 0.09 mm with each year of age. However, the neck-shaft angle did not show any significant correlation with the IFD.

INTRODUCTION Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has been reported to improve hip function and decrease pain. Only few midterm and long-term studies have been published. The objective of this study was to report midterm results in a consecutive cohort and to study the relation between cartilage lesions and the conversion rate to total hip arthroplasty (THA). METHODS Eighty-four FAI patients were followed retrospectively for 6-8 years. The conversion rate to THA, the peri-operative findings and the patient-reported outcome measures were reported. RESULTS Fifteen of 84 (18%) patients were converted to THA. The five-year hip survival rate was 83.9% (confidence interval (CI): 75.1-91.5%). The THA group was significantly older, with a mean age of 46.9 years (CI: 42.8-50.8 years) compared with 39.0 years (CI: 36.6-41.6 years) in the non-THA group (p = 0.011). In the THA group, 13 of 15 patients were 40 years or older (p = 0.005). A high-grade ac...