Introduction The complete resection of the femoral bump is essential in the treatment of cam-type femoroacetabular impingement (FAI). The lesion of the retinacular vessels is possible during the resection of the most lateral portion of the femoral bump. The purpose of this study is the measurement of the distance between the femoral bump resection and the entry point of the retinacular vessels into the femoral head. Methods During a one-year period (October 2007-2008) we performed a CTscan with 3-D reconstruction in 60 patients with Cam-type FAI (34 males, 26 females, mean age 36, 5 years) before and after arthroscopic resection of the femoral bump. We identified the foraminas, corresponding to the entry point of the retinacular vessels into the femoral head. During the arthroscopy the retinacular vessels were identified prior to the bump resection. One year after hip-arthroscopy a clinical evaluation was realized to exclude avascular necrosis (AVN) of the femoral head. Results The mean distance between the most anterior foramina to the lateral limit of the femoral bump was 6.1 mm (1.1mm-17 mm). In the clinical evaluation 1 year after arthroscopy no patient presented with clinical signs suggesting AVN of the femoral head. Conclusion A CTscan with 3-D reconstruction helps to identify the lateral limit of the femoral bump and the entry point of the retinacular vessels into the femoral head. Because the lateral limit of the femoral bump extends close to the retinacular vessels, we recommend arthroscopic visualization of these vessels prior to the resection of the lateral portion of the femoral bump.

Introduction: Femoroacetabular impingement (FAI) is one of the main causes of hip osteoarthritis. Femoral retroversion has been reported as a cause of FAI and it is well established that a retroverted femur produces hip pain and alterations in the external and internal rotation balance. However, no studies of femoral retroversion in patients with FAI have been reported. Furthermore, since the lack of internal rotation is a common feature in patients with FAI, it could be possible that femoral version abnormalities are present in these patients. The purpose of this study is to describe the femoral version in a group of patients with FAI and to assess its relation in the development of hip osteoarthritis. Methods: The history, x-rays and hip CT scans of 142 patients with FAI were reviewed. All patients presented persistent hip pain and were evaluated clinically between January 2006 and July 2008. We defined FAI when at least one of the following features were present: an abnormal alpha angle (>49°) measured on the elongated femoral neck x-ray, a positive cross-over sign or pro-trusio acetabuli in the AP pelvis x-ray, the presence of diminished anteversion in the femur ( We documented the type of FAI, the presence of acetabular dysplasia, coxa valga, coxa vara and the femoral version measured on the CT scan. The degree of osteoarthritis of the hip using the Tonnis classification was documented as well. Results: Two hundred and sixty-five FAI hips from 142 patients (73 females and 69 males) were analyzed. The average age was 36.7 years. The mean femoral version was 11.4 ° (−14.1° to 47°). We found 43 hips (16.6%) of the femora were retroverted and 133 hips (50%) had either diminished anteversion ( Conclusion: The presence of a retroverted femur seems to be a cofactor in the development of hip osteoarthritis in patients with FAI. The orthopedic surgeons should be aware of the high frequency of femoral retroversion when evaluating patients with hip impingement, in order to make the right diagnosis and treatment. It might be possible that this association between FAI and femoral retroversion is due to a common hip disease during skeletal maturation (i.e. SCFE) leading to two anatomical alterations at the proximal femur: reduced head-neck offset and retroverted femur.

Modularity in sleeved femoral components allows the exchange of the stem without disruption of the fixation between the sleeve and the surrounding bone at revision surgery. Failure to disengage the stem from the sleeve would represent an unnecessary compromise from the intended usefulness of the modular design. We report the results of an examination of 22 modular titanium alloy femoral components retrieved after 0.0 to 8.8 years in vivo. In 7 implants, the stem-sleeve interface could not be disengaged without cutting through the components or using mechanical force. Moderate to severe corrosion was detected in all 7 of these cases. Corrosive surface changes were observed in an additional 6 interfaces. There was no correlation with the length of time that the devices had been implanted. When only the stem is to be revised, orthopedic surgeons should be aware of difficulties in disengagement and anticipate alternative surgical procedures.

Objective: To evaluate if the complete resection of the femoral bump, in cam-type FAI increases the postoperative flexion and internal rotation. Material and Method: We reviewed 24 consecutive pre-operative and postoperative hip CT scans in 24 patients with FAI (22 male and 2 female, mean age 36.9 years) who underwent arthroscopic hip surgery for the removal of a bony prominence on the femoral neck-head junction. We measured the alpha angle in two places: in the classical location, in the mid plane of the femoral neck axis and proximally, in the same plane but in first quarter of the femoral neck height. Then we compared these results with the presence of a residual prominence diagnosed in the 3 dimensionally reconstructed images of the postoperative CT scan and the virtual range of motion of the 3D models using impaction detection software. Results: We found 7 cases with a residual bony prominence at the femoral neck-head junction in the 3D model of the proximal femur after the surgery. In this group the mean mid femoral neck alpha angle was significantly improved from 69.7° before the surgery to 48.3° (p=0.028), however the proximal alpha angle was not significantly improved 71.1° preoperative versus 62.7 (p=0.176) after the surgery. In the 17 patients without a residual bump, both alpha angles were improved, the mid alpha angle from 64.9° before the surgery to 40.76° (p=0.000) after the surgery and the proximal alpha angle from 65.8° to 38.4° (p=0.000). The range of motion of hip in the impaction detection software was also significantly improved in both groups, from flexion of 103° to 116° (p=0.001) in the group without a residual bump and from 102 to 118 (p=0.046) in the group with a residual bony prominence after the surgery. The internal rotation at 90° of flexion was also improved in both groups with a statistically significant difference (p=0.001 versus p=0.028 respectively). Conclusion: The complete arthroscopic resection of the femoral bump improves significantly the ranges of flex-ion and internal rotation in patients with cam-type FAI.

IntroductionArthroscopic treatment of femoro-acetabular impingement is increasing in popularity as an alternative to surgical dislocation or arthrotomy. The goal of this retrospective study was to assess the efficacy of this procedure and the effect of perioperative factors on outcome.MethodsNinety-six hips (79 patients) were evaluated at a mean of 35 months (range 24-54) after arthroscopy with femoral neck osteochondroplasty of a “cam” impingement lesion. The Tönnis osteoarthritis classification and alpha-angle were assessed on pre- and post-operative xrays. On clinical followup, patients rated their improvement, pain relief, and functional status. Statistical analysis of perioperative factors were performed using Chi-Square, T-tests and multi-variable analysis.ResultsMean age was 35 years (range 16-63). Sixteen hips underwent subsequent surgery (including eight total hip replacements). Eighty percent of patients felt they had improved from the surgery and 71% rated the pain relief as excellent or good. The alpha angle improved a mean of 27 degrees (range 11 to 67), but was not associated with outcome (p>0.45). An intra-operative finding of Grade 4 cartilage loss was correlated with less pain relief (p=0.03) and improvement (p= 0.01). The presence of a Grade 4 defect was associated with a retroverted acetabulum (p=0.004), a higher alpha angle (p=0.04), Tönnis grade 2 or 3 (p=0.001), and older age (p<0.001).ConclusionsWith the arthroscopic treatment of femoro-acetabular impingement, the presence of a grade 4 articular cartilage lesion is the most significant predictor of pain relief and clinical success. Hips with less damage at the time of surgery are more likely to have a better outcome. IntroductionArthroscopic treatment of femoro-acetabular impingement is increasing in popularity as an alternative to surgical dislocation or arthrotomy. The goal of this retrospective study was to assess the efficacy of this procedure and the effect of perioperative factors on outcome.

Shindle, Michael K. MD; Voos, James E. MD; Heyworth, Benton E. MD; Mintz, Douglas N. MD; Moya, Luis E. MD; Buly, Robert L. MD; Kelly, Bryan T. MD Author Information

Shindle, Michael K. MD; Voos, James E. MD; Heyworth, Benton E. MD; Mintz, Douglas N. MD; Moya, Luis E. MD; Buly, Robert L. MD; Kelly, Bryan T. MD Author Information