gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Anterior femoroacetabular impingement due to femoral retrotorsion in young and active patients

Meeting Abstract

  • presenting/speaker Till Lerch - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Simon Steppacher - Inselspital Universitätsspital, Bern, Switzerland
  • Guoyan Zheng - ISTB, Institute for Surgical Technologies and Biomechanis, Bern, Switzerland
  • Silvio Pflugi - ISTB, Institute for Surgical Technologies and Biomechanis, Bern, Switzerland
  • Inga Todorski - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Klaus Siebenrock - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Moritz Tannast - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO26-84

doi: 10.3205/17dkou830, urn:nbn:de:0183-17dkou8308

Veröffentlicht: 23. Oktober 2017

© 2017 Lerch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Femoroacetabular Impingement (FAI) typically include Cam- FAI and Pincer-FAI. Femoral Retrotorsion could theoretically influence FAI conflicts. Further understanding of this pathomorphology is needed to adapt surgical therapy. Current therapy of FAI include offset correction and/or acetabular rim trimming with Hip arthroscopy (HAS) or surgical hip dislocation. Patients with Femoral Retrotorsion present clinically with decreased internal rotation (IR) and this could influence anterior FAI in young and active patients. But location of hip impingement in hips with femoral Retrotorsion is unknown. We evaluated selected patients with validated 3D impingement simulation software and questioned

1.
What is the range of motion in hips?
2.
Is the impingement located extra- or intraarticular?
3.
Where is bony impingement collision zone located?
4.
In hips with femoral Retrotorsion?

Methods: We performed a retrospective comparative study of 55 hips (46 patients). 18 symptomatic FAI patients (29 hips )with femoral retrotorsion were selected and compared to 26 hips with no FAI morphology on the AP radiograph and no hip pain. All 18 patients with femoral Retrotorsion were recruited from our outpatient clinic and presented with hip pain. Inclusion criteria was femoral torsion below 5° (mean femoral torsion of -1.0° +/-4). All patients underwent CT scan including the entire pelvis and the distal femoral condyles. Surface 3D models based on CT scan reconstruction of all 55 hips were included. Validated 3D collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and femoral sides. 2/29 Hips with femoral Retrotorsion had an Alpha Angle above 60° Femoral torsion in the normal group was between 10-25° Femoral torsion was measured on CT scans according to Murphy et al.

Conclusion:

1.
For normal hips, hips with femoral Retrotorsion mean Flexion was 125° +/-13 and 119° +/-10. Mean IR in 90° Flexion was 32° +/-9 and 21 +/- 7 Mean Adduction was 38° +/- 10 and 46 +/-10
2.
In hips with femoral Retrotorsion 95% of the impingement locations were located intraarticular and 5% were extraarticular.
3.
In all hips with femoral Retrotorsion 57% of Impingement was located on 3 o clock on acetabular side and ranged from 2 to 4 o clock for femoral Retrotorsion. Hip Impingement in femoral Retrotorsion is mainly located anterior. Hip Impingement in femoral Retrotorsion combined with acetabular Retroversion is located anterioinferior on the femoral side. Surgical correction should be performed anterior in patients with FAI due to femoral Retrotorsion.