Postoperative Imaging in the Setting of Hip Preservation Surgery

Osteoarthritis of the hip remains a prevalent disease condition that influences ever-changing treatment options. Procedures performed to correct anatomic variations, and, in turn, prevent or slow the progression of osteoarthritis, are aptly referred to as types of hip preservation surgery (HPS). Conditions that predispose individuals to femoroacetabular impingement (FAI), including pincer- and cam-type morphology, and hip dysplasia are specifically targeted in HPS. Common surgical interventions include acetabuloplasty, osteochondroplasty, periacetabular osteotomy (PAO), and derotational femoral osteotomy (DFO). The radiologist's understanding of the surgical approach, pre- and postoperative imaging findings, and common complications of HPS are paramount to providing value to the patient and surgeon. Acetabuloplasty and osteochondroplasty are performed to address pincer- and cam-type morphology in patients with FAI. With both of these HPS techniques, the goal is to restore the normal morphology by resecting excess bone in the acetabulum or femoral head or neck. As a result, a frequently encountered complication is incomplete or excessive resection. Excessive resection can predispose the patient to dislocation in the case of acetabuloplasty and fracture in the case of osteochondroplasty. Iatrogenic injury to adjacent structures such as the ischiofemoral ligament and acetabular cartilage also may occur. Although rare, especially when an arthroscopic approach is used, avascular necrosis remains a risk. Femoral head undercoverage in hip dysplasia is corrected by using PAO, which may be performed as the sole procedure or in conjunction with DFO. Incomplete or excessive rotation during surgery can result in postprocedural complications. As with any orthopedic procedure involving osteotomy, nonhealing is a risk. Iatrogenic injury in the form of fracture or hardware failure also may be seen. ^©RSNA, 2016.