s Introduction Hip dysplasia is a disorder of abnormal development or dislocation of the hip secondary to capsular laxity and mechanical factors Adult and adolescent dysplasia can come in two forms dysplasia that was previously treated dysplasia that was not treated if left untreated it can progress to early arthritis Pathoanatomy acetabular retroversion is most common factor Epidemiology dysplasia is attributable to 1/3rd of all cases of hip osteoarthritis Classification Crowe Classfication Grade Proximal displacement Femoral head subluxation I <10% vertical height of pelvis proximal migration of head neck junction from inter-teardrop line <50% of femoral head vertical diameter II 10-15% 50-75% III 15-20% 75-100% IV > 20% >100% Hartofilakidis Classification Dysplasia (Type A) Femoral head within acetabulum despite some subluxation. Segmental deficiency of the superior wall. Inadequate true acetabulum depth. Low dislocation (Type B) Femoral head creates a false acetabulum superior to the true acetabulum. There is complete absence of the superior wall. Inadequate depth of the true acetabulum. High dislocation (Type C) Femoral head is completely uncovered by the true acetabulum and has migrated superiorly and posteriorly. There is a complete deficiency of the acetabulum and excessive anteversion of the true acetabulum. Presentation Symptoms hip or groin pain, especially in flexion activities often insidious onset Physical exam increased internal rotation before arthritis sets in due to increased femoral anteversion decreased internal rotation may represent osteoarthritis increased external rotation with ambulation positive anterior impingement test (pain with passive flexion, internal rotation and adduction) may have instability with extension, abduction and external rotation Imaging Radiographs recommended views AP lateral findings decreased femoral head sphericity crossover sign results from increased retroversion acetabular protrusio decreased lateral center-edge angle < 20° angle between vertical line + line from femoral head to lateral acetabulum assess on AP view normal 25-40° increased tonnis angle > 10° angle between horizontal line + line along superior acetabulum measures inclination of weightbearing zone assess on AP view normal 0-10° decreased head-neck offset ratio distance between line parallel to femoral neck through anterior femoral neck + anterior femoral head divided by diameter of femoral head assess on lateral view normal > 0.15 increased femoral neck-shaft angle angle created by anatomic axis of the femur and the femoral neck coxa valga decreased vertical center anterior margin angle (anterior center edge angle) obtained on false profile radiograph angle between the vertical line through the center of the femoral head to the lateral acetabulum assessment of anterior undercoverage CT useful in accessing structural abnormalities of the femoral head and neck Treatment Nonoperative supportive measures indicated as first line of treatment Operative periacetabular osteotomy +/- a femoral osteotomy indications symptomatic dysplasia in an adolescent or adult with concentrically reduced hip congruous joint with good joint space advantages provides hyaline cartilage coverage posterior column remains intact and patients can weight bear preserves external rotators delays need for arthroplasty salvage pelvic osteotomy (chiari, shelf) indications unreduced hip recommended for patients with inadequate femoral head coverage and an incongruous joint (a salvage procedure) hip resurfacing indications can be used for Crowe type I or II disease total hip arthroplasty (THA) indications treatment of last resort for those with severe arthritis preferred treatment for older patients (>50) and those with advanced structural changes in a patient with bilateral hip dysplasia, there are significant technical challenges that need to be addressed to ensure a successful total hip arthroplasty. Surgical Techniques PAO (Ganz, Bernese) technique involves multiple osteotomies in the pubis, ilium, and ischium near the acetabulum. This allows improved three-dimensional correction of the acetabulum configuration. It is technically the most challenging complication complication rate as high as 15% in experienced hands hip arthroplasty performed after PAO may lead to increased incidence of a retroverted acetabular cup Shelf Osteotomy goal to increase the weight bearing surface by placing extra-articular buttress of bone over the subluxed femoral head cover femoral head with fibrocartilage (NOT articular cartilage) technique add bone to the lateral aspect of acetabulum. Depends on metaplastic (fibrocartilage) for successful results. Chiari Osteotomy technique make cut above acetabulum to sciatic notch and shift ilium lateral beyond edge of acetabulum. Depends on metaplastic bone (fibrocartilge) for successful results. Total Hip Replacement technique may need trochanteric osteotomy to improve visualization in Crowe type III or IV patients in a patient with bilateral hip dysplasia, there are significant technical challenges that need to be addressed to ensure a successful total hip arthroplasty acetabular cup is ideally placed where the center of the true acetabulum would be restoring the center of the hip may cause significant lengthening and require femoral shortening. a high hip center can be used when there is inadequate bone stock in the acetabulum to achieve adequate host bone coverage. a modular femoral implant may be used for a dysplastic hip with significant rotational deformity. can use uncemented cup if there is less than 30% uncoverage Complications Sciatic nerve palsies 10 times increased incidence of sciatic nerve palsy (5-15%) lengthening of greater than 4 cm can lead to sciatic nerve palsy that will present clinically as a foot drop. Hip Dislocation increased risks of hip dislocation after arthroplasty (5-10%) Periprosthetic femur fx Infection
QUESTIONS 1 of 10 1 2 3 4 5 6 7 8 9 10 Previous Next This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.91) Figure 54 shows the preoperative radiograph of a 45-year-old woman who is considering total hip arthroplasty with her orthopaedic surgeon. What femoral characteristic is a typical concern in this patient? Review Topic QID: 6051 FIGURES: A 1 Osteopenia 4% (3/81) 2 Excessive anteversion 64% (52/81) 3 Excessive varus 12% (10/81) 4 Excessive bowing 1% (1/81) 5 Stove-pipe femur 12% (10/81) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 2 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.34) Figure 21 shows the radiograph of a 32-year-old patient with right hip pain that has failed to respond to nonsurgical management. What is the most appropriate surgical treatment at this time? Review Topic QID: 5994 FIGURES: A 1 Femoral derotational osteotomy 8% (8/105) 2 Total hip arthroplasty 11% (12/105) 3 Arthrodesis 0% (0/105) 4 Surgical dislocation of the hip 2% (2/105) 5 Periacetabular osteotomy 77% (81/105) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 5 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.32) A 42-year-old man undergoes right total hip arthroplasty for hip dysplasia. Postoperatively, he has a significant limb-length increase with a foot drop. A preoperative radiograph is shown in Figure 19. Which of the following should have been considered preoperatively to avoid this complication? Review Topic QID: 5992 FIGURES: A 1 Medialization of the acetabular component 6% (6/102) 2 Use of a modular femoral implant 15% (15/102) 3 Anterolateral approach to the hip 3% (3/102) 4 Femoral shortening 75% (76/102) 5 Electromyography 1% (1/102) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.8) Based on the radiograph shown in Figure 4, the innervation of what muscle is most at risk with total hip arthroplasty? Review Topic QID: 5968 FIGURES: A 1 Quadriceps 6% (8/132) 2 Extensor hallucis longus 66% (87/132) 3 Lateral gastrocnemius 8% (10/132) 4 Adductor magnus 8% (10/132) 5 Semitendinosus 12% (16/132) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Upgrade to View Premium Videos Upgrade to View Premium Videos Hip anterior femoroacetabular impingement test Chad Krueger Recon - Adult Dysplasia of the Hip 10/8/2012 930 views
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