Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup
Background Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincer-type femoroacetabular impingement (FAI); however, to our knowledg...
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| Veröffentlicht in: | Clinical orthopaedics and related research 2016-10, Vol.474 (10), p.2168-2180 |
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| creator | Hanke, Markus S. Steppacher, Simon D. Zurmühle, Corinne A. Siebenrock, Klaus A. Tannast, Moritz |
| description | Background
Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincer-type femoroacetabular impingement (FAI); however, to our knowledge, there are no published mid- or long-term studies on results of circumferential acetabular rim trimming through a surgical hip dislocation for patients with this condition.
Questions/purposes
(1) What is the 10-year survivorship of the hips treated with circumferential rim trimming through a surgical hip dislocation compared with a control group of hips that underwent surgery for pincer FAI but that did not have protrusio acetabuli? (2) What are the factors that were associated with a decreased likelihood of survivorship in those hips with the following endpoints: total hip arthroplasty, Merle d’Aubigné score of less than 15, and/or radiographic progression of osteoarthritis (OA)? (3) Does the radiographic pattern of degeneration differ between the two groups?
Methods
We performed a case-control study comparing two groups: a protrusio group (32 patients [39 hips]) and a control group (66 patients [86 hips]). The control group consisted of hips treated with a surgical hip dislocation for pincer FAI and did not include hips with a positive protrusio sign or a lateral center-edge angle > 39°. The study group did not differ from the control group regarding the preoperative Tönnis OA score, age, and body mass index. However, the study group had more women, decreased mean height and weight, and lower preoperative Merle d’Aubigné-Postel scores, which were inherent differences at the time of first presentation. During the period in question, the indication for performing these procedures was a painfully restricted range of motion in flexion and internal rotation (positive impingement sign). The mean followup of the protrusio group (9 ± 5 years [range, 2–18 years]) did not differ from the control group (11 ± 1 years [range, 10–13 years], p = 0.109). At the respective minimum followup intervals in the underlying database from which cases and control subjects were drawn, followup was 100% for patients with protrusion who underwent FAI surgery and 97% for patients with FAI who underwent surgery for other anatomic patterns (three of 86 hips). We assessed the Merle d’Aubigné-Postel score, Harris hip score, WOMAC, and UCLA activity score at latest followup. A Kaplan-Meier su |
| doi_str_mv | 10.1007/s11999-016-4918-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5014816</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1827934568</sourcerecordid><originalsourceid>FETCH-LOGICAL-c503t-a262a65be3f704f09b0f1dc0c9f3bb983c80b0b77b0613868d358cb02a75a0763</originalsourceid><addsrcrecordid>eNqNkl-L1DAUxYMo7uzqB_BFAr74Us1N2ibxQSiL4w4sKP5B30KSSWeztk1NWpd58bObMuOyCoJP4XJ-Obm59yD0BMgLIIS_TABSyoJAXZQSRCHvoRVUVBQAjN5HK0KILCSFryfoNKXrXLKyog_RCeWUi5rzFfp54ceEv_jpCr-PYYpz8gE31k3azJ3HTXRYT3gz2Oh0clv8wadvuA0Rr7Xv5qw27eRy5foQgz7e0xFv-tEPO9e7YcIf57hzcf8KNxhIsXdZXoeuCzfz-Ag9aHWX3OPjeYY-r998Or8oLt-93Zw3l4WtCJsKTWuq68o41nJStkQa0sLWEitbZowUzApiiOHckBqYqMWWVcIaQjWvNOE1O0OvD77jbHq3tbmtqDs1Rt_ruFdBe_WnMvgrtQs_VEWgFLAYPD8axPB9dmlSvU_WdZ0eXJiTAkG5zNOtxX-gIBjjwGRGn_2FXoc5DnkSC8VLWZeCZgoOlI0hpeja276BqCUI6hAElYOgliCoxfnp3Q_f3vi9-QzQA5CylDcV7zz9T9dfiSm-qw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1817496482</pqid></control><display><type>article</type><title>Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Hanke, Markus S. ; Steppacher, Simon D. ; Zurmühle, Corinne A. ; Siebenrock, Klaus A. ; Tannast, Moritz</creator><creatorcontrib>Hanke, Markus S. ; Steppacher, Simon D. ; Zurmühle, Corinne A. ; Siebenrock, Klaus A. ; Tannast, Moritz</creatorcontrib><description>Background
Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincer-type femoroacetabular impingement (FAI); however, to our knowledge, there are no published mid- or long-term studies on results of circumferential acetabular rim trimming through a surgical hip dislocation for patients with this condition.
Questions/purposes
(1) What is the 10-year survivorship of the hips treated with circumferential rim trimming through a surgical hip dislocation compared with a control group of hips that underwent surgery for pincer FAI but that did not have protrusio acetabuli? (2) What are the factors that were associated with a decreased likelihood of survivorship in those hips with the following endpoints: total hip arthroplasty, Merle d’Aubigné score of less than 15, and/or radiographic progression of osteoarthritis (OA)? (3) Does the radiographic pattern of degeneration differ between the two groups?
Methods
We performed a case-control study comparing two groups: a protrusio group (32 patients [39 hips]) and a control group (66 patients [86 hips]). The control group consisted of hips treated with a surgical hip dislocation for pincer FAI and did not include hips with a positive protrusio sign or a lateral center-edge angle > 39°. The study group did not differ from the control group regarding the preoperative Tönnis OA score, age, and body mass index. However, the study group had more women, decreased mean height and weight, and lower preoperative Merle d’Aubigné-Postel scores, which were inherent differences at the time of first presentation. During the period in question, the indication for performing these procedures was a painfully restricted range of motion in flexion and internal rotation (positive impingement sign). The mean followup of the protrusio group (9 ± 5 years [range, 2–18 years]) did not differ from the control group (11 ± 1 years [range, 10–13 years], p = 0.109). At the respective minimum followup intervals in the underlying database from which cases and control subjects were drawn, followup was 100% for patients with protrusion who underwent FAI surgery and 97% for patients with FAI who underwent surgery for other anatomic patterns (three of 86 hips). We assessed the Merle d’Aubigné-Postel score, Harris hip score, WOMAC, and UCLA activity score at latest followup. A Kaplan-Meier survivorship analysis of the hip was calculated if any of the following endpoints for both groups occurred: conversion to total hip arthroplasty, a Merle d’Aubigné-Postel score < 15, and/or radiographic progression of OA. Differences in survivorship were analyzed using the log-rank test.
Results
At 10-year followup, we found a decreased survivorship of the hip for the protrusio group (51% [95% confidence interval {CI}, 34%–67%]) compared with the control group (83% [95% CI, 75%–91%], p < 0.001) with one or more of the endpoints stated. We found four multivariate factors associated with a decreased likelihood of survival of the native hip according to the mentioned endpoints: body mass index > 25 kg/m
2
(adjusted hazard ratio, 6.4; 95% CI, 5.2–8.1; p = 0.009), a preoperative Tönnis OA score ≥ 1 (13.3; 95% CI, 11.8–14.9; p = 0.001), a postoperative lateral center-edge angle > 40° (4.2; 95% CI, 2.8–5.6; p = 0.042), and a postoperative posterior coverage > 56% (6.0; 95% CI, 4.3–7.6; p = 0.037). Preoperatively, joint space narrowing and osteophytes were more frequent posteroinferior (joint space narrowing 18% versus 2%, p = 0.008; osteophytes 21% versus 4%, p = 0.007), medial (joint space narrowing 33% versus 5%, p < 0.001) and anterior (osteophytes 15% versus 1%, p = 0.004) in the protrusio compared with the control group. After correction in hips with protrusio, progression of joint space narrowing (from 6% to 45%, p = 0.001) and osteophyte formation (from 15% to 52%, p = 0.002) was most pronounced laterally.
Conclusions
At 10 years, in 51% of all hips undergoing open acetabular rim trimming for protrusio acetabuli, the hip can be preserved without further radiographic degeneration and a Merle d’Aubigné score > 15. Even with the lack of a control group with nonoperative treatment, isolated rim trimming may not entirely resolve the pathomorphology in protrusio hips given the clearly inferior results compared with surgical hip dislocation for FAI without severe overcoverage.
Level of Evidence
Level III, therapeutic study.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-016-4918-9</identifier><identifier>PMID: 27278677</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Biomechanical Phenomena ; Conservative Orthopedics ; Disease Progression ; Female ; Femoracetabular Impingement - diagnostic imaging ; Femoracetabular Impingement - etiology ; Femoracetabular Impingement - physiopathology ; Femoracetabular Impingement - surgery ; Femur Head - abnormalities ; Femur Head - diagnostic imaging ; Femur Head - physiopathology ; Femur Head - surgery ; Follow-Up Studies ; Hip Dislocation ; Hip Joint - abnormalities ; Hip Joint - diagnostic imaging ; Hip Joint - physiopathology ; Hip Joint - surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Orthopedic Procedures - adverse effects ; Orthopedics ; Osteoarthritis - diagnostic imaging ; Osteoarthritis - etiology ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Risk Factors ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Symposium: 2015 International Hip Society Proceedings ; Time Factors ; Treatment Failure ; Young Adult</subject><ispartof>Clinical orthopaedics and related research, 2016-10, Vol.474 (10), p.2168-2180</ispartof><rights>The Association of Bone and Joint Surgeons® 2016</rights><rights>The Association of Bone and Joint Surgeons 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-a262a65be3f704f09b0f1dc0c9f3bb983c80b0b77b0613868d358cb02a75a0763</citedby><cites>FETCH-LOGICAL-c503t-a262a65be3f704f09b0f1dc0c9f3bb983c80b0b77b0613868d358cb02a75a0763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014816/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014816/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27278677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hanke, Markus S.</creatorcontrib><creatorcontrib>Steppacher, Simon D.</creatorcontrib><creatorcontrib>Zurmühle, Corinne A.</creatorcontrib><creatorcontrib>Siebenrock, Klaus A.</creatorcontrib><creatorcontrib>Tannast, Moritz</creatorcontrib><title>Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincer-type femoroacetabular impingement (FAI); however, to our knowledge, there are no published mid- or long-term studies on results of circumferential acetabular rim trimming through a surgical hip dislocation for patients with this condition.
Questions/purposes
(1) What is the 10-year survivorship of the hips treated with circumferential rim trimming through a surgical hip dislocation compared with a control group of hips that underwent surgery for pincer FAI but that did not have protrusio acetabuli? (2) What are the factors that were associated with a decreased likelihood of survivorship in those hips with the following endpoints: total hip arthroplasty, Merle d’Aubigné score of less than 15, and/or radiographic progression of osteoarthritis (OA)? (3) Does the radiographic pattern of degeneration differ between the two groups?
Methods
We performed a case-control study comparing two groups: a protrusio group (32 patients [39 hips]) and a control group (66 patients [86 hips]). The control group consisted of hips treated with a surgical hip dislocation for pincer FAI and did not include hips with a positive protrusio sign or a lateral center-edge angle > 39°. The study group did not differ from the control group regarding the preoperative Tönnis OA score, age, and body mass index. However, the study group had more women, decreased mean height and weight, and lower preoperative Merle d’Aubigné-Postel scores, which were inherent differences at the time of first presentation. During the period in question, the indication for performing these procedures was a painfully restricted range of motion in flexion and internal rotation (positive impingement sign). The mean followup of the protrusio group (9 ± 5 years [range, 2–18 years]) did not differ from the control group (11 ± 1 years [range, 10–13 years], p = 0.109). At the respective minimum followup intervals in the underlying database from which cases and control subjects were drawn, followup was 100% for patients with protrusion who underwent FAI surgery and 97% for patients with FAI who underwent surgery for other anatomic patterns (three of 86 hips). We assessed the Merle d’Aubigné-Postel score, Harris hip score, WOMAC, and UCLA activity score at latest followup. A Kaplan-Meier survivorship analysis of the hip was calculated if any of the following endpoints for both groups occurred: conversion to total hip arthroplasty, a Merle d’Aubigné-Postel score < 15, and/or radiographic progression of OA. Differences in survivorship were analyzed using the log-rank test.
Results
At 10-year followup, we found a decreased survivorship of the hip for the protrusio group (51% [95% confidence interval {CI}, 34%–67%]) compared with the control group (83% [95% CI, 75%–91%], p < 0.001) with one or more of the endpoints stated. We found four multivariate factors associated with a decreased likelihood of survival of the native hip according to the mentioned endpoints: body mass index > 25 kg/m
2
(adjusted hazard ratio, 6.4; 95% CI, 5.2–8.1; p = 0.009), a preoperative Tönnis OA score ≥ 1 (13.3; 95% CI, 11.8–14.9; p = 0.001), a postoperative lateral center-edge angle > 40° (4.2; 95% CI, 2.8–5.6; p = 0.042), and a postoperative posterior coverage > 56% (6.0; 95% CI, 4.3–7.6; p = 0.037). Preoperatively, joint space narrowing and osteophytes were more frequent posteroinferior (joint space narrowing 18% versus 2%, p = 0.008; osteophytes 21% versus 4%, p = 0.007), medial (joint space narrowing 33% versus 5%, p < 0.001) and anterior (osteophytes 15% versus 1%, p = 0.004) in the protrusio compared with the control group. After correction in hips with protrusio, progression of joint space narrowing (from 6% to 45%, p = 0.001) and osteophyte formation (from 15% to 52%, p = 0.002) was most pronounced laterally.
Conclusions
At 10 years, in 51% of all hips undergoing open acetabular rim trimming for protrusio acetabuli, the hip can be preserved without further radiographic degeneration and a Merle d’Aubigné score > 15. Even with the lack of a control group with nonoperative treatment, isolated rim trimming may not entirely resolve the pathomorphology in protrusio hips given the clearly inferior results compared with surgical hip dislocation for FAI without severe overcoverage.
Level of Evidence
Level III, therapeutic study.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biomechanical Phenomena</subject><subject>Conservative Orthopedics</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Femoracetabular Impingement - diagnostic imaging</subject><subject>Femoracetabular Impingement - etiology</subject><subject>Femoracetabular Impingement - physiopathology</subject><subject>Femoracetabular Impingement - surgery</subject><subject>Femur Head - abnormalities</subject><subject>Femur Head - diagnostic imaging</subject><subject>Femur Head - physiopathology</subject><subject>Femur Head - surgery</subject><subject>Follow-Up Studies</subject><subject>Hip Dislocation</subject><subject>Hip Joint - abnormalities</subject><subject>Hip Joint - diagnostic imaging</subject><subject>Hip Joint - physiopathology</subject><subject>Hip Joint - surgery</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Orthopedic Procedures - adverse effects</subject><subject>Orthopedics</subject><subject>Osteoarthritis - diagnostic imaging</subject><subject>Osteoarthritis - etiology</subject><subject>Range of Motion, Articular</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Symposium: 2015 International Hip Society Proceedings</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>Young Adult</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkl-L1DAUxYMo7uzqB_BFAr74Us1N2ibxQSiL4w4sKP5B30KSSWeztk1NWpd58bObMuOyCoJP4XJ-Obm59yD0BMgLIIS_TABSyoJAXZQSRCHvoRVUVBQAjN5HK0KILCSFryfoNKXrXLKyog_RCeWUi5rzFfp54ceEv_jpCr-PYYpz8gE31k3azJ3HTXRYT3gz2Oh0clv8wadvuA0Rr7Xv5qw27eRy5foQgz7e0xFv-tEPO9e7YcIf57hzcf8KNxhIsXdZXoeuCzfz-Ag9aHWX3OPjeYY-r998Or8oLt-93Zw3l4WtCJsKTWuq68o41nJStkQa0sLWEitbZowUzApiiOHckBqYqMWWVcIaQjWvNOE1O0OvD77jbHq3tbmtqDs1Rt_ruFdBe_WnMvgrtQs_VEWgFLAYPD8axPB9dmlSvU_WdZ0eXJiTAkG5zNOtxX-gIBjjwGRGn_2FXoc5DnkSC8VLWZeCZgoOlI0hpeja276BqCUI6hAElYOgliCoxfnp3Q_f3vi9-QzQA5CylDcV7zz9T9dfiSm-qw</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Hanke, Markus S.</creator><creator>Steppacher, Simon D.</creator><creator>Zurmühle, Corinne A.</creator><creator>Siebenrock, Klaus A.</creator><creator>Tannast, Moritz</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161001</creationdate><title>Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup</title><author>Hanke, Markus S. ; Steppacher, Simon D. ; Zurmühle, Corinne A. ; Siebenrock, Klaus A. ; Tannast, Moritz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-a262a65be3f704f09b0f1dc0c9f3bb983c80b0b77b0613868d358cb02a75a0763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biomechanical Phenomena</topic><topic>Conservative Orthopedics</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Femoracetabular Impingement - diagnostic imaging</topic><topic>Femoracetabular Impingement - etiology</topic><topic>Femoracetabular Impingement - physiopathology</topic><topic>Femoracetabular Impingement - surgery</topic><topic>Femur Head - abnormalities</topic><topic>Femur Head - diagnostic imaging</topic><topic>Femur Head - physiopathology</topic><topic>Femur Head - surgery</topic><topic>Follow-Up Studies</topic><topic>Hip Dislocation</topic><topic>Hip Joint - abnormalities</topic><topic>Hip Joint - diagnostic imaging</topic><topic>Hip Joint - physiopathology</topic><topic>Hip Joint - surgery</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Orthopedic Procedures - adverse effects</topic><topic>Orthopedics</topic><topic>Osteoarthritis - diagnostic imaging</topic><topic>Osteoarthritis - etiology</topic><topic>Range of Motion, Articular</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Symposium: 2015 International Hip Society Proceedings</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hanke, Markus S.</creatorcontrib><creatorcontrib>Steppacher, Simon D.</creatorcontrib><creatorcontrib>Zurmühle, Corinne A.</creatorcontrib><creatorcontrib>Siebenrock, Klaus A.</creatorcontrib><creatorcontrib>Tannast, Moritz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hanke, Markus S.</au><au>Steppacher, Simon D.</au><au>Zurmühle, Corinne A.</au><au>Siebenrock, Klaus A.</au><au>Tannast, Moritz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>474</volume><issue>10</issue><spage>2168</spage><epage>2180</epage><pages>2168-2180</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Protrusio acetabuli is a rare anatomic pattern of the hip in which the femoral head protrudes into the true pelvis. The increased depth of the hip and the excessive size of the lunate surface typically lead to severe pincer-type femoroacetabular impingement (FAI); however, to our knowledge, there are no published mid- or long-term studies on results of circumferential acetabular rim trimming through a surgical hip dislocation for patients with this condition.
Questions/purposes
(1) What is the 10-year survivorship of the hips treated with circumferential rim trimming through a surgical hip dislocation compared with a control group of hips that underwent surgery for pincer FAI but that did not have protrusio acetabuli? (2) What are the factors that were associated with a decreased likelihood of survivorship in those hips with the following endpoints: total hip arthroplasty, Merle d’Aubigné score of less than 15, and/or radiographic progression of osteoarthritis (OA)? (3) Does the radiographic pattern of degeneration differ between the two groups?
Methods
We performed a case-control study comparing two groups: a protrusio group (32 patients [39 hips]) and a control group (66 patients [86 hips]). The control group consisted of hips treated with a surgical hip dislocation for pincer FAI and did not include hips with a positive protrusio sign or a lateral center-edge angle > 39°. The study group did not differ from the control group regarding the preoperative Tönnis OA score, age, and body mass index. However, the study group had more women, decreased mean height and weight, and lower preoperative Merle d’Aubigné-Postel scores, which were inherent differences at the time of first presentation. During the period in question, the indication for performing these procedures was a painfully restricted range of motion in flexion and internal rotation (positive impingement sign). The mean followup of the protrusio group (9 ± 5 years [range, 2–18 years]) did not differ from the control group (11 ± 1 years [range, 10–13 years], p = 0.109). At the respective minimum followup intervals in the underlying database from which cases and control subjects were drawn, followup was 100% for patients with protrusion who underwent FAI surgery and 97% for patients with FAI who underwent surgery for other anatomic patterns (three of 86 hips). We assessed the Merle d’Aubigné-Postel score, Harris hip score, WOMAC, and UCLA activity score at latest followup. A Kaplan-Meier survivorship analysis of the hip was calculated if any of the following endpoints for both groups occurred: conversion to total hip arthroplasty, a Merle d’Aubigné-Postel score < 15, and/or radiographic progression of OA. Differences in survivorship were analyzed using the log-rank test.
Results
At 10-year followup, we found a decreased survivorship of the hip for the protrusio group (51% [95% confidence interval {CI}, 34%–67%]) compared with the control group (83% [95% CI, 75%–91%], p < 0.001) with one or more of the endpoints stated. We found four multivariate factors associated with a decreased likelihood of survival of the native hip according to the mentioned endpoints: body mass index > 25 kg/m
2
(adjusted hazard ratio, 6.4; 95% CI, 5.2–8.1; p = 0.009), a preoperative Tönnis OA score ≥ 1 (13.3; 95% CI, 11.8–14.9; p = 0.001), a postoperative lateral center-edge angle > 40° (4.2; 95% CI, 2.8–5.6; p = 0.042), and a postoperative posterior coverage > 56% (6.0; 95% CI, 4.3–7.6; p = 0.037). Preoperatively, joint space narrowing and osteophytes were more frequent posteroinferior (joint space narrowing 18% versus 2%, p = 0.008; osteophytes 21% versus 4%, p = 0.007), medial (joint space narrowing 33% versus 5%, p < 0.001) and anterior (osteophytes 15% versus 1%, p = 0.004) in the protrusio compared with the control group. After correction in hips with protrusio, progression of joint space narrowing (from 6% to 45%, p = 0.001) and osteophyte formation (from 15% to 52%, p = 0.002) was most pronounced laterally.
Conclusions
At 10 years, in 51% of all hips undergoing open acetabular rim trimming for protrusio acetabuli, the hip can be preserved without further radiographic degeneration and a Merle d’Aubigné score > 15. Even with the lack of a control group with nonoperative treatment, isolated rim trimming may not entirely resolve the pathomorphology in protrusio hips given the clearly inferior results compared with surgical hip dislocation for FAI without severe overcoverage.
Level of Evidence
Level III, therapeutic study.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27278677</pmid><doi>10.1007/s11999-016-4918-9</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-921X |
| ispartof | Clinical orthopaedics and related research, 2016-10, Vol.474 (10), p.2168-2180 |
| issn | 0009-921X 1528-1132 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5014816 |
| source | MEDLINE; SpringerLink Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Adolescent Adult Biomechanical Phenomena Conservative Orthopedics Disease Progression Female Femoracetabular Impingement - diagnostic imaging Femoracetabular Impingement - etiology Femoracetabular Impingement - physiopathology Femoracetabular Impingement - surgery Femur Head - abnormalities Femur Head - diagnostic imaging Femur Head - physiopathology Femur Head - surgery Follow-Up Studies Hip Dislocation Hip Joint - abnormalities Hip Joint - diagnostic imaging Hip Joint - physiopathology Hip Joint - surgery Humans Kaplan-Meier Estimate Male Medicine Medicine & Public Health Middle Aged Multivariate Analysis Orthopedic Procedures - adverse effects Orthopedics Osteoarthritis - diagnostic imaging Osteoarthritis - etiology Range of Motion, Articular Recovery of Function Retrospective Studies Risk Factors Sports Medicine Surgery Surgical Orthopedics Symposium: 2015 International Hip Society Proceedings Time Factors Treatment Failure Young Adult |
| title | Hips With Protrusio Acetabuli Are at Increased Risk for Failure After Femoroacetabular Impingement Surgery: A 10-year Followup |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T02%3A11%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hips%20With%20Protrusio%20Acetabuli%20Are%20at%20Increased%20Risk%20for%20Failure%20After%20Femoroacetabular%20Impingement%20Surgery:%20A%2010-year%20Followup&rft.jtitle=Clinical%20orthopaedics%20and%20related%20research&rft.au=Hanke,%20Markus%20S.&rft.date=2016-10-01&rft.volume=474&rft.issue=10&rft.spage=2168&rft.epage=2180&rft.pages=2168-2180&rft.issn=0009-921X&rft.eissn=1528-1132&rft_id=info:doi/10.1007/s11999-016-4918-9&rft_dat=%3Cproquest_pubme%3E1827934568%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1817496482&rft_id=info:pmid/27278677&rfr_iscdi=true |