Mitchell McDowell, DO**, Daljeet Sagoo, DO*, Michael P. Muldoon, MD*, Richard Santore, MD*

Transcription

1 Mitchell McDowell, DO**, Daljeet Sagoo, DO*, Michael P. Muldoon, MD*, Richard Santore, MD* *Orthopedic Medical Group,7910 Frost St. #200 San Diego, California 92123, USA **Riverside County Regional Medical Center,26520 Cactus Ave, Moreno Valley, California, 92555

2 Introduction Retroversion of the acetabulum is a recognized but infrequent cause of femoroacetabular impingement (FAI) and may lead to early osteoarthritis (1-4). There is limited data available on the optimum treatment of acetabular retroversion in FAI cases (5-12). The purpose of this study is to compare arthroscopic management versus periacetabular osteotomy reorientation with regards to acetabular retroversion

3 Methods A retrospective chart review study was performed based on patients with global acetabular retroversion defined as having a crossover sign on a standing antero-posterior radiograph with a posterior wall sign and absence of acetabulae protrusio. Diagnosis was confirmed by computed tomography(ct) which also allowed for assessment of volumetric deficiency, presence of rim fractures and subtle radiographic signs of arthrosis.

4 Methods All patients with global retroversion were recommended for reverse PAO. Patients with mechanical symptoms of locking and catching or MRI positve for chondral labral disruption were recommended for adjunctive arthroscopy. Patients or parents who strongly desired arthroscopic management alone were consented for all arthroscopic procedure including femoroplasty, chondroplasty, labral repair with limited acetabuloplasty and in one case ORIF of a large acetabular rim fracture Pre-operative and post-operative patient results were evaluated using the Modified Harris Hip Score in the arthroscopic managed group, the periacetabular osteotomy (PAO) group and the combined group. Ordinary, one-way Analysis of Variance (ANOVA) was utilized to compare continuous data.

5 Case Example 18 yo male RP lbs Retroversion with CAM and large acetabular rim fracture extending into weight bearing dome

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7 Pre-Op: 8/11/2010 Post-Op: 6/13/2012

8 Results The average age was 26 years old for the arthroscopic managed group, 22.8 years old for the PAO group and 23.5 for the combined group. The average follow up was 21 months for the arthroscopically managed group, 9 months for the PAO group and 32 months for the combined group

9 Results Sixteen patients (seventeen hips) were managed with Arthroscopy, Reverse PAO or a Combined Approach. Arthroscopy performed by a single experienced surgeon (MM) and PAO by a separate, experienced surgeon (RS). There were five patients (five hips) in the arthroscopic managed group, four patients (five hips) in the PAO group and seven patients (seven hips) in the combined group.

10 Results The Pre-operative Modified Harris hip scores: Arthroscopic: 57 Range: PAO: 66 Range : Combined: 57 Range: 25-75

11 Results The Post-Operative Modified Harris hip scores: No significant difference in mean Post-op MHHS (p<0.52). Significant difference in standard deviation Post-op MHHS (p<0.001) No significant difference improvement, mean or standard deviation, in post-op score (p<0.39) Arthroscopic: 92 (range: ) Mean Improvement 35 (range 14-67) PAO: All results 100 Mean Improvement 35 (range 21-60) Combined 92 (range ) Mean Improvement 35 (range 7-75)

12 Discussion/Conclusion Surgical methods (osteotomy, arthroscopic and combined) techniques improve patient outcomes with respect to global acetabular retroversion. In the all- arthroscopic patients, impingement was addressed on the femoral side only so as to not compromise a future reverse PAO if needed. The ability to ameliorate symptoms of global retroversion arthroscopically may be attractive but longer follow-up and greater patient numbers will be needed to strengthen and validate our findings.

13 References 1. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417: Fujii M, Nakashima Y, Yamamoto T, Mawatari T, Motomura G, Matsushita A, Matsuda S, Jingushi S, Iwamoto Y. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg Am Apr;92(4): Reikeras O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand. 1983;54: Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81: SiebenrockKA, SchoenigerR, GanzR: Anterior femoro-acetabular impingement due to acetabular retroversion: Treatment with periacetabular osteotomy. J Bone Joint Surg Am 2003; 85: Wettstein M, Dienst M. Hip arthroscopy for femoroacetabular impingement [in German]. Orthopade. 2006; 35(1): Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular impingement. Arthroscopy. 2006; 22(1): Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med. 2006; 25(2): Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010; 468(2): Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010; 468(2): Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004; (418): Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006; 88(5):