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Hip preservation

Markus S Hanke1, Florian Schmaranzer2, Simon D Steppacher1

  • 1Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland.

EFORT Open Reviews
|November 18, 2020
PubMed

Insights

Hip preserving surgery addresses conditions like femoro-acetabular impingement (FAI) and hip dysplasia. Accurate pre-operative imaging is vital for planning surgical interventions to correct deformities and improve hip joint function.

Area of Science:

  • Orthopedic Surgery
  • Hip Preservation
  • Sports Medicine

Background:

  • Classical indications for hip preserving surgery include femoro-acetabular impingement (FAI), hip dysplasia, slipped capital femoral epiphysis, and consequences of Perthes disease or avascular necrosis.
  • FAI presents with intra-articular ('cam') or extra-articular ('pincer') impingement mechanisms.
  • Developmental dysplasia of the hip can lead to osteoarthritis due to acetabular rim overload.

Purpose of the Study:

  • To review the classical indications for hip preserving surgery.
  • To emphasize the importance of pre-operative evaluation for surgical planning.
  • To outline diagnostic modalities and treatment approaches for various hip pathologies.

Main Methods:

  • Review of established indications for hip preserving surgery.
  • Discussion of pre-operative imaging techniques including radiographs, MRI, and CT.
  • Overview of surgical and non-surgical treatment strategies based on deformity severity.

Main Results:

  • Femoro-acetabular impingement (FAI) is categorized into 'cam' and 'pincer' types.
  • Slipped capital femoral epiphysis may necessitate subcapital re-alignment.
  • Periacetabular osteotomy is effective for developmental dysplasia of the hip, yielding good long-term outcomes.

Conclusions:

  • Comprehensive pre-operative assessment is crucial for successful hip preserving surgery.
  • Tailored surgical planning is essential for conditions like FAI, hip dysplasia, and post-Perthes deformities.
  • Hip preserving procedures aim to correct underlying pathomorphology, prevent further joint damage, and restore function.

Keywords:
femoro-acetabular impingementhip arthroscopyhip dysplasiaperiacetabular osteotomysurgical hip dislocation

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