Skip to main content
SpringerLink
Log in

Is acetabular osteoplasty always required in mixed impingement?

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Mixed femoroacetabular impingement (FAI) is typically managed with both femoral and acetabular rim osteoplasties, but it has not been reported if the rim osteoplasty is always required.

Hypothesis/purpose

We hypothesized that mixed FAI managed by femoral or combined femoral and acetabular osteoplasties will both attain satisfactory clinical results, provided intraoperative impingement-free functional motion is attained.

Methods

We retrospectively reviewed 30 hips (23 patients, mean age at surgery 24.3 years, mean follow-up time 1.6 years) with mixed FAI who underwent surgical dislocation of the hip and had femoral osteochondroplasty with rim trim (RT, n = 21) or no rim trim (NRT, n = 9). Physical examination results and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were evaluated.

Results

Mean (±SD) WOMAC pain scores improved from 6.56 (±2.96) to 2.33 (±3.64) in the NRT group (p = .002) and from 6.86 (±4.15) to 3.86 (±3.95) in the RT group (p = .014). Function improved in both groups, but the difference was significant only for the NRT group (p < .001). Over 50 % of patients in both groups had resolution of impingement sign. Internal rotation increased from 8.6° (±11.8) to 20.0° (±10.4) in the NRT group (p = .043) and from 4.0° (±12.1) to 18.6° (±14.0) in the RT group (p < .001). Both groups had increased flexion post-operatively to normal range, but the change was only significant for the RT group (p = .02). Both groups had insignificant decreases in external rotation.

Conclusion

Satisfactory clinical outcomes were seen in hips with mixed impingement, regardless of whether RT was performed, provided impingement-free functional motion was attained and no severe cartilage damage was seen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tanzer M, Noiseux N (2004) Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 429:170–177

    Article  PubMed  Google Scholar 

  2. Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA (2008) Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res 466(2):273–280. doi:10.1007/s11999-007-0061-y

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Johnston TL, Schenker ML, Briggs KK, Philippon MJ (2008) Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthrosc J Arthrosc Relat Surg 24(6):669–675. doi:10.1016/j.arthro.2008.01.010

    Article  Google Scholar 

  4. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120. doi:10.1097/01.blo.0000096804.78689.c2

    PubMed  Google Scholar 

  5. Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272. doi:10.1007/s11999-007-0060-z

    Article  PubMed Central  PubMed  Google Scholar 

  6. Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M (2006) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 88(5):925–935. doi:10.2106/JBJS.E.00290

    Article  PubMed  Google Scholar 

  7. Leunig M, Beaule PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 467(3):616–622. doi:10.1007/s11999-008-0646-0

    Article  PubMed Central  PubMed  Google Scholar 

  8. Anderson SE, Siebenrock KA, Tannast M (2010) Femoroacetabular impingement: evidence of an established hip abnormality. Radiology 257(1):8–13. doi:10.1148/radiol.10091480

    Article  PubMed  Google Scholar 

  9. Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head–neck offset. J Bone Joint Surg Br 83(2):171–176

    Article  CAS  PubMed  Google Scholar 

  10. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83(8):1119–1124

    Article  CAS  PubMed  Google Scholar 

  11. Naal FD, Miozzari HH, Schar M, Hesper T, Notzli HP (2012) Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med 40(7):1501–1510. doi:10.1177/0363546512445884

    Article  PubMed  Google Scholar 

  12. Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 88(8):1735–1741. doi:10.2106/JBJS.E.00514

    Article  PubMed  Google Scholar 

  13. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73

    Article  PubMed  Google Scholar 

  14. Clohisy JC, St John LC, Schutz AL (2010) Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res 468(2):555–564. doi:10.1007/s11999-009-1138-6

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M (2004) Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res 418:61–66

    Article  PubMed  Google Scholar 

  16. Leunig M, Beck M, Dora C, Ganz R (2005) Femoroacetabular impingement: etiology and surgical concept. Oper Tech Orthop 15(3):247–255. doi:10.1053/j.oto.2005.06.005

    Article  Google Scholar 

  17. Guanche CA, Bare AA (2006) Arthroscopic treatment of femoroacetabular impingement. Arthroscopy 22(1):95–106. doi:10.1016/j.arthro.2005.10.018

    Article  PubMed  Google Scholar 

  18. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head–neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560

    Article  CAS  PubMed  Google Scholar 

  19. Philippon MJ, Arnoczky SP, Torrie A (2007) Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy 23(4):376–380. doi:10.1016/j.arthro.2007.01.017

    Article  PubMed  Google Scholar 

  20. Ferguson S (2003) An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 36(2):171–178. doi:10.1016/s0021-9290(02)00365-2

    Article  CAS  PubMed  Google Scholar 

  21. Ferguson SJ, Bryant JT, Ganz R, Ito K (2000) The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon) 15(6):463–468

    Article  CAS  Google Scholar 

  22. Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 81(2):281–288

    Article  CAS  PubMed  Google Scholar 

  23. Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M (2008) Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res 466(3):677–683. doi:10.1007/s11999-007-0058-6

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wiberg G (1953) Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Joint Surg Am 35-A(1):65–80

    CAS  PubMed  Google Scholar 

  25. Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res 407:241–248

    Article  PubMed  Google Scholar 

  26. Siebenrock KA, Leunig M, Ganz R (2001) Periacetabular osteotomy: the Bernese experience. Instr Course Lect 50:239–245

    CAS  PubMed  Google Scholar 

  27. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    CAS  PubMed  Google Scholar 

  28. Peters CL, Schabel K, Anderson L, Erickson J (2010) Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res 468(2):504–510. doi:10.1007/s11999-009-1152-8

    Article  PubMed Central  PubMed  Google Scholar 

  29. Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 25(6):758–765. doi:10.1002/jor.20380

    Article  PubMed  Google Scholar 

  30. Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J (2009) Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. J Bone Joint Surg Br 91(8):1031–1036. doi:10.1302/0301-620X.91B8.22389

    Article  CAS  PubMed  Google Scholar 

  31. Zaltz I, Kelly BT, Hetsroni I, Bedi A (2012) The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. doi:10.1007/s11999-012-2689-5

    Google Scholar 

  32. Beaule PE, Le Duff MJ, Zaragoza E (2007) Quality of life following femoral head–neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am 89(4):773–779. doi:10.2106/JBJS.F.00681

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Andreas M. Hingsammer

  2. Department of Orthopaedic Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Cara Beth Lee

  3. Hinsdale Orthopaedic Associates, Hinsdale, IL, USA

    Justin LaReau

  4. Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Leslie A. Kalish

  5. Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Young-Jo Kim

Authors
  1. Andreas M. Hingsammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cara Beth Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin LaReau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leslie A. Kalish
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young-Jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas M. Hingsammer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hingsammer, A.M., Lee, C.B., LaReau, J. et al. Is acetabular osteoplasty always required in mixed impingement?. Eur J Orthop Surg Traumatol 25, 331–338 (2015). https://doi.org/10.1007/s00590-014-1507-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-014-1507-z

Keywords

Search

Navigation