cadera / hip - Active Congress.......

MIÉRCOLES / WEDNESDAY
132
12.45 - 17.15 h
CADERA / HIP
Cadera difícil y complicaciones de las artroplastias
Diffi cult hip and complications
Moderadores / Moderators: Cecil Rorabeck, Wayne Paprosky
MANAGEMENT OF
THE PAINFUL HIP OF
THE YOUNG ADULT
R. Ganz
Orthopädische Universitätsklinik
Balgrist, Zürich, Switzerland
The vaste majority of hip symptoms in young
adults can be attributed to acetabular dysplasia
or femoroacetabular impingement.
The best treatment fort he hip with acetabular
dysplasia is a reorientation procedure.
Frequently the insuffi ciently shaped anterior
head-neck contour needs to be additionally
corrected to avoid secondary impingement
even with a perfectly corrected acetabulum.
This is even more importand in a borderline
dysplastic acetabulum which is symptomatic
from impingement even before surgery; Radial
arthro-MRI may be helpful in the precise
evaluation of such hips. The result of a reorientation
procedure depends on the achieved
spatial positioning of the acetabulum, on the
joint congruency but also on the amount of
joint damage at the time of surgery. Hips
without a labral lesion have a better longterm
prognosis.
The treatment of femoroacetabular impingement
focuses on improving the clearence for
hip motion. On the acetabular side local or
general overcoverage is trimmed. If possible
the labrum is refi xed for better lubrication and
early clinical and radiological results clearly
favor labrum refi xation over resection. On
the femoral side an osteochondroplasty is
performed resecting all nonspherical parts of
the head and reestablishing a normal offset
between head and neck. Experience has
shown that the results are better with early
surgical intervention. While complex morphological
abnormalities are best treated with
surgical dislocation, more isolated pathologies
are more and more treated arthroscopically.
Arthroscopy however needs advanced
experience to avoid collateral damage; for
a combined acetabular and femoral correction
the procedure takes longer than open
surgery.
HIP ARTHROSCOPY
FOR IMPINGEMENT
D. Griffi n
Warwick Medical School
Coventry, Great Britain