HIP International

Hip arthroscopy has allowed the diagnosis and treatment of chondral injuries.

We retrospectively analysed the intraoperative data of 359 patients treated with hip arthroscopy from January 2012 to December 2013. We estimated the frequency, location and extension of acetabular cartilage (AC) injuries and their correlation to femoroacetabular impingement (FAI).

Grade 1 and 2 acetabular chondral lesions were not statistically significant in incidence, location and extension. Chondral lesions were absent on the acetabulum in 3.9% of cases, significantly lower compared to the femoral head (32.0%). 101 (28.1%) were affected by an acetabular chondral lesion. In 244 (68.0%) the chondral lesion was located on both acetabulum and femoral head. On the acetabulum, peripheral superior and superior-posterior area were frequently involved. Grade 4 acetabular chondral defects showed a significant high location on the superior-anterior, superior and superior-posterior area, involving both the peripheral and central surface. Delamination was present in 113 (31.5%) patients. Patients affected by acetabular delamination showed a reduced injury extension if compared to grade 3 or 4. 81 patients (25%) revealed acetabular chondral lesions grade 2a, 3 and 4 without any radiological, clinical or arthroscopic sign of FAI.

Location, extension and degree of hip chondral lesions show a progression toward a progressive degeneration. The high percentage of chondral delamination in the hip must be taken in consideration. The presence of symptomatic chondral lesion in cases with no radiological evidence of FAI, suggests that their aetiopathogenesis could be related to biomechanical alterations.

To quantitatively describe the kinematic behaviour of the hip joint with particular interest in the contribution of the periarticular soft tissues to the stability. To quantitatively assess the sealing function of the acetabular labrum of an intact labrum, the effect of a labral-chondral separation and different surgical approaches. The biomechanics of the joint during specific clinical examinations was also assessed.

All the kinematics tests, manually performed, have been acquired using a navigation systems. For the first part of the study, 4 hemi-corpse specimens were evaluated with the hip in 36 different positions with all the soft tissues intact, after removal of skin and muscles and after partial capsulectomy. During the second and the third part of the analysis 8 fresh frozen hips were analysed. They were tested during 3 different positions used for femeroacetabular impingement (FAI) diagnosis, during pivoting motion and distraction test. Contact area between acetabulum and femoral head, range of movement (RoM) and hip joint centre (HJC) displacement were evaluated.

Femoral head displacement occured in all 3 directions and increased as more tissue was removed. Considering both pivoting motion and distraction test there was an increase of the HJC displacement after labral tear. Analogously, the tested surgical approaches showed different results compared to intact condition. Our analysis confirmed that the hip position with Hyperextension-External Rotation is specific for the analysis of the posteriorsuperior region of the acetabulum.

The study showed that hip joint does not act as a true ball-and-socket joint and the femoral head anatomical displacement is strongly affected by the removal of periarticular soft tissues, labral repair as well as labrectomy.

The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement.

Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique.

The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45.

Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.

There is widespread trend in total hip replacement to limit soft tissue damage. New approaches that respect the capsule and ligaments has been recently reported. The potential advantages of this approach is to improve short-term results in terms of stability, pain, length of stay, transfusions and complications.

From October 2015 to March 2016 the two senior authors performed 21 hips using the Superpath® technique, the measured variables included age, sex, operative time, acetabular inclination, pain assessment using visual analogue scale at 24 hours, need for transfusion, length of stay and complications. Surgical technique is described.

10 women and 11 men with a mean age of 56.57 (35-74) years. Average operating time was 102.85 (80-130) minutes. The mean acetabular inclination was 44.05 (26-60) degrees. The visual analogue scale (VAS) at 24 hours of the procedure was 2.38, standard deviation (SD) 0.9. The length of stay was on average 4.04 days 1.4 days shorter when compared with a cohort of patients treated using standard posterolateral. All patients were discharged to home. Two patients required transfusion, and in one patient with a calcar crack, crutches for 8 weeks were instructed. No patients were readmitted.

The new generation of hip approaches have a strong anatomical basis, hip capsule preservation is a revolutionary concept, it ensures anatomical restoration, length and offset near to native joint. The Superpath® potentially minimises morbidity, reducing transfusion rates, allowing rapid recovery, shortening hospital stay and could save a significant cost to the healthcare system.

Femoroacetabular impingement (FAI) has been proposed as a possible cause of early osteoarthritis of the hip. The treatment of this condition and its related lesions can be performed by 3 methods: surgical dislocation of the hip; pure arthroscopic; and anterior mini-open technique with or without arthroscopic assistance.

We describe the anterior mini-open technique and report our experience over the last decade in the treatment of FAI and different associated pathologies of the hip.

This technique was found to be safe and reliable, allowing tissue preservation and providing a clinical improvement similar to the purely arthroscopic-treated patient, even in complex cases.

According to our experience there are several presentations of FAI and associated hip conditions, where other authors advocate surgical dislocation, which can be conducted through a mini-open approach when increased surgical skills are reached. Moreover, this technique was found to be useful as an additional tool to consider, even for surgeons involved in the arthroscopic learning curve.

Many labral tears are nonrepairable. For these cases, labral reconstruction procedures may be considered in order to restore the joint fluid seal and prolong hip longevity.

The aim of this study was to describe the clinical and functional outcomes of a series of cases with nonrepairable labral tears that underwent labral reconstruction with tendon allografts. The hypothesis was that labral reconstruction would provide good clinical outcomes.

A cohort of 20 patients with nonrepairable labral tears, which underwent to labral grafting mainly by means of arthroscopic assisted anterior mini-open approach, were included in this study. The study period was comprised between July 2008 and September 2013.

DCS-score resulted in 17 satisfactory results, whereas Nonarthritic Hip Score (NAHS) resulted in mean improvement of 39 points. 1 retrieved allograft demonstrated 8 weeks after implantation new whole revascularisation.

We concluded that labral reconstruction with tendon allograft provides relief of painful symptoms, and represents a reliable alternative for patients with nonrepairable labral tears that are not yet candidates for a joint replacement procedure.

The aim of this study was to compare return to sport activity between a short femoral cementless stem and a conventional femoral cementless stem in total hip arthroplasty in patients 50 years old and younger.

We retrospectively reviewed 55 patients (61 hips) treated with a short femoral cementless stem and 28 patients (32 hips) treated with a conventional femoral cementless stem 50 years old and younger from December 2009 and December 2014. Their mean age was 39.86 (22-49) years and 38.68 (18-49) years, respectively. The mean follow-up was 54.1 (15-68) months and 52.7 (15-72) months, respectively. They were pre- and postoperatively evaluated by the clinical and radiological examination.

No patients with the short stem had intraoperative fracture, but 1 patient with the conventional stem had intraoperative fracture. At final follow-up, there was no statistically significant difference in Harris Hip Score, and radiographic review level between 2 stems. No hip with the short stem had thigh pain, but 6 hips with the conventional stem had thigh pain at the final follow-up. No component was revised for aseptic loosening in either group. There were no differences observed in the return to sports activity between the 2 groups.

Our study demonstrated that both short cementless stem and conventional cementless stem provided stable fixation and achieved a satisfactory result in patients 50 years old and younger. There is no difference in return to sports activity level after the procedure.