30845 Suppl Giot.pdf - Giornale Italiano di Ortopedia e Traumatologia

Femoroacetabular impingement
OA, while hips with pincer FAI fail toward a postero-inferior or
central OA.
TrEaTMENT aSPECTS
While classic procedures to preserve the native hip, such as intertrochanteric
and pelvic osteotomies continue to have an indication,
new and powerful techniques have emerged. Increased knowledge
of the femoral head perfusion but also the new understanding about
the onset of OA of the hip played a pivotal role in the development
of such procedures. Beyond this, the impingement concept has
served as stimulus to move hip arthroscopy from a diagnostic to
a science based interventional procedure with increasing indication
20 . In contrast to the older, mostly extracapsular interventions,
the new approaches are intracapsular and allow at this level more
direct corrections. With regard to FAI the acetabular deformity is
treated with trimming of the overcoverage includine refixation of
the labrum whenever possibile; on the femoral side osteochondroplasty
of the deformed head neck junction is performed. While
today isolated impingements can be treated using arthroscopy, the
more complex deformities continue to be an indication for open
execution using sugical hip dislocation, eventually combining it
with additional osteotomies.
rEFErENCES
1 Bertaux Th-A. L’humérus et le fémur. Considérés dans les espèces, dans les
races humaines selon le sexe et selon l’age. Thèse, Bigot Frères, Lille 1891.
2 Poirier P. Traité d’anatomie humaine. Vol 1, Embryologie (Prenant A.)
Ostéologie et Arthologie (Poirier P) et al. Masson, Paris, 1899, p. 516-26.
3 Fick R. Handbuch der Anatomie und Mechanik der Gelenke. Erster Teil:
Anatomie der Gelenke. Gustav Fischer Verlag, Jena 1904; p. 318.
4 Von Mikulicz J. In: Von Bergmann E, Von Bruns P, Von Mikulicz J,
Handbuch der praktischen Chirurgie, Bd IV Chirurgie der Extremitäten.
Ferdinand Enke Verlag Stuttgart, 1903; p. 601.
S234
5 Vulpius O, Stoffel A. Orthopädische Operationslehre, 3. Aufl. Ferdinand
Enke Verlag Stuttgart 1924, p. 402.
6 Heyman CH, Herndon CH, Strong JM. Slipped femoral epiphysis with
severe displacement. J Bone Joint Surg 1957;39A:293-303.
7 Preiser G. Statische Gelenkerkrankungen. Ferdinand Enke Verlag, Stuttgart.
1911; p. 78.
8 Murray RO. The etiology of primary osteoarthritis of the hip. Br J Radiol
1965;38:810-24.
9 Solomon L, Beighton P. Osteoarthrosis of the hip and ist relationship
to preexisting deformity in an African population. J Bone Joint Surg
1973;55B: 216-7.
10 Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res
1986;213:20-33.
11 Stuhlberg SD. Unrecognized childhood hip disease: a major cause of
idiopathic osteoarthritis of the hip. In: Cordell LD, Harris WH, Ramsey
PL, McEwen GD, eds. The Hip: Proceedings of the third Open Scientific
Meeting of the Hip Society. St Louis, MO: CV Mosby 1975;212-8.
12 Goodman DA, Feighan JE, Smith AD, et al. Subclinical slipped capital
femoral epiphysis. Relationship to osteoarhrosis of the hip. J Bone Joint
Surg 1997;79A:1489-97.
13 Rab GT. The geometry of slipped capital femoral epiphysis: implications
for movement, impingement and corrective osteotomy. J Pediatr Orthop
1999;19:419-24.
14 Ganz R, Bamert P, Hausner P, et al. Zervikoazetabuläres Impingement nach
Schenkelhalsfraktur. Unfallchirurg 1991;94:172-5.
15 Ganz R, Parvizi J, Beck M, et al. Femoroacetabular Impingement. A Cause
for Osteoarthritis of the Hip. CORR 2003;417:112-20.
16 Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral
circumflex artery and its surgical implications. J Bone Joint Surg 2000;82-
B:679-83.
17 Ganz R, Gill TJ, Gautier E, et al. Safe Surgical dislocation of the adult hip.
J Bone Joint Surg 2001;83-B:1119-24.
18 Ganz R, Leunig M, Leunig-Ganz K, eta l. The Etiology of Osteoarthritis of
the Hip. An Integrated Concept. Clin Orthop Relat Res 2008;466:264-72.
19 Reichenbach S, Jüni P, Werlen S, et al. Prevalence of non-spherical
extension of femoral head on Hip MRI in a Swiss Male Population: A Crosssectional
study. Arthritis Care & Research. In press.
20 Philippon MJ, Stubbs AJ, Schenker ML, et al. Arthroscopic Management
of Femoroacetabular Impingement. Osteoplasty Technique and Literature
Review. Amer J Sports Med 2007;35:1571-80.