gms | German Medical Science

Femoroacetabular Impignement had been until now an unknown pathology. It causes pain in the movements of flexion-adduction-internal rotation, due to a bump effect between the head-neck surface of the femur and the anterior acetabular rim. This effect can be produced either by a retroverted acetabulum or by a lesser femoral neck-offset , by combination of both phenomena or even by normal hips in sportsactive patients where speedy and wide hyperflexion-hyperextension movements are required, During many years this pathology was been confused with false "Adductor Tendinitis", "Pubis Osteopathy" and "Inguinal Hernia".

We analise our 14 first patients, 3 operated bilateral with 1 year F.U.. In these later the elapsed time between both operations ranged from 5 to 8 weeks. Mean Age: 36 years (27 to 48), all sportsactive patients.. The technique that we used was through our modified Hueter approach . The superoanterior rim of the acetabulum was excised as well as the deformity at the femoral side that causes a less femoral neck-offset. For that purpose we used special maxilofacial-reamers instead of chisels. In this way we avoid any bleeding from the femoral neck. With this technique any approach by means of Throcanter osteotomy, as performed by other authors (Ganz, Trousdale, and cols.) is avoided.

Pain relief was obtained 4 weeks after surgery in 13 from 14 patients. Mean hospitalization time was 2,6 days (2 - 5). Improvement in ROM was significative (p= 0,006): from -17 º mean internal rotation (-14º to -28º) at 80 º flexion to +23º mean one month postop internal rotation (14º to 32º).There was a significant improvement of hip score according to Merle d'Aubigne evaluation (p=0,017): 13,8 points preop (13 to 15) to 16,9 at F.U. (16-18). Neither trendelemburg nor osteonecrosis was observed in any patient, as eventual complication related to the approach. Mean time of rehabilitation was 3,8 weeks ( 3 - 5). All patients returned to their respective sportactivities.

The by the author Modified Femoroacetabular Osteoplasty allows rapid improvement of the normal hip motion , relatively short rehabilitation time and sportsresume as well. However midtherm new osteoarthritic changes had to be assessed, although clinical and functional improvement has been evident. This surgical procedure makes as to think about other alternatives to hip endoprosthesis in young adults.