Hip preservation

Abstract

■ Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extraarticular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. ■ Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. ■ Two main mechanisms of intra-articular impingement have been described: (1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’). ■ Either arthroscopic or open treatment can be performed depending on the severity of deformity. ■ Slipped capital femoral epiphysis often results in a camlike deformity of the hip. In acute cases a subcapital realignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. ■ Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. ■ Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results.