Limitations of arthroscopy for managing coxa profunda

Area of Science:

• Orthopedic Surgery
• Hip Preservation
• Radiology

Background:

• Coxa profunda is a complex hip condition characterized by acetabular overcoverage.
• This can lead to femoro-acetabular impingement (FAI), causing pain and limited mobility.
• Accurate diagnosis of acetabular overcoverage type is crucial for effective treatment.

Purpose of the Study:

• To outline treatment strategies for coxa profunda based on the type of acetabular overcoverage.
• To differentiate between focal and general overcoverage and their respective surgical indications.
• To discuss surgical options for protrusio acetabuli and associated femoral deformities.

Main Methods:

• Evaluation of acetabular overcoverage using imaging techniques.
• Surgical planning based on the specific type and location of overcoverage.
• Arthroscopic recontouring for focal acetabular overcoverage.
• Open surgical techniques for general overcoverage and protrusio acetabuli.
• Consideration of femoral osteotomies for associated deformities like coxa vara.

Main Results:

• Arthroscopic recontouring effectively addresses focal acetabular overcoverage without posterior impingement.
• Open surgery is necessary for general overcoverage with postero-inferior impingement, allowing rim resection.
• Reverse peri-acetabular osteotomy is indicated for protrusio acetabuli, especially with reversed acetabular roof angle.
• Valgus femoral osteotomy can be beneficial for coxa vara to reduce joint forces.

Conclusions:

• Tailored surgical approaches based on acetabular overcoverage type are essential for managing coxa profunda and FAI.
• Minimally invasive arthroscopic techniques are suitable for specific cases, while open surgery or osteotomy is required for more complex presentations.
• Addressing both acetabular and femoral deformities optimizes outcomes in coxa profunda treatment.