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Scope on the hip Labrale letsesl Zeist 24 april 2013

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Presentation on theme: "Scope on the hip Labrale letsesl Zeist 24 april 2013"— Presentation transcript:

1 Scope on the hip Labrale letsesl Zeist 24 april 2013
Dr J De Schepper AZ Nikolaas – Sint-Niklaas

2 Groin pain in athletes J Am Acad Orthop Surg. 2007 Aug;15(8):507-14
Sports hernia Imbalance in trunk stabilizers and adductor muscles Soccer, hockey, hurdling, running

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4 Groin pain in athletes Activity related Normal X-rays
All investigations negative Long conservative treatment Hernia repair Longterm absence on the field

5 Groin pain in athletes Extra-articular Intra-articular Cause for pain

6 Intra-articular causes for groin pain
Acute injury Torn ligamentum teres Loose body, cartilage lesion Gradual onset Concept of impingement

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8 Heup arthroscopie

9 Anatomie Centraal compartiment Perifeer compartiment

10 Heup arthroscopie INDICATIES : LOOSE BODIES Oorzaken: Posttraumatisch
Synoviale chondromatose Andere kraakbeenaantastingen Investigaties: CT – Arthro CT

11 Heup arthroscopie

12 Heup arthroscopie INDICATIES : KRAAKBEENLETSELS Traumatische letsels
Impactietrauma

13 Concept of femoro-acetabular impingement FAI
dynamic concept Developed by R. Ganz (Bern) 1. cam - impingement 2. pincer - impingement

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16 Concept of femoro-acetabular impingement FAI
cam - impingement Probleem situeert zich op de nek, gevolgen acetabulair Anterior offset Notzli’s angle

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18 cam - impingement Notzli’s angle ????

19 delaminated cartilage
Consequences labral tears wave sign delaminated cartilage early arthritis

20 cam - impingement Osseous bump Femoral retroversion Coxa vara
“variant” Idiopathic old LCP subclinical slipping Femoral retroversion Coxa vara

21 cam - impingement Bone Marrow Edema Labral tear Cartilage lesions
Subchondral cyst formation (Bump-cyst complex; herniation pit) Os acetabuli

22 cam - impingement CAM FAI: intact labrum + wave sign

23 cam - impingement

24 Concept of femoro-acetabular impingement FAI
pincer - impingement acetabular retroversion cross-over sign

25 pincer - impingement

26 pincer - impingement Pincer FAI Acetabular origin
Acetabular overcoverage Coxa profunda Protrusio acetabuli

27 Abutment nek tegen anterior wall
Consequences Abutment nek tegen anterior wall Mainly labral tears Contre-coup lesions

28 Often combined impingement

29 Clinical features of FAI
Click, locking of the hip Limited internal rotation Pain in ADduction, Flexion and internal rotation Gondolière sign + McCarthy + C-sign + Pain during sport, may aggrevate afterwards

30 Clinical features of FAI
Testen Faber

31 Clinical features of FAI
Testen Mc Carthy

32 Radiological findings of FAI
Standard X-ray Arthro MRI 3D CT-scan In doubt : Injection of the joint

33 Standard X-Rays Standard radiography: standing AP pelvis
Comparison of contralateral hip Leg length Pelvic rotation Pelvic tilt Correct evaluation acetabular retroversion Coccyx must be centered over the pubic symphysis and should be not separated more than 2 cm

34 Standard X-rays Value of correct positioning tilt rotatie

35 Standard X-rays Standard radiography: 3/4 Lateral neck

36 Standard X-rays Other valuable radiographs Lequesne (faux profile)
Profile of acetabulum: anteversion, retroversion Dunn view 90° flexion/ abduction 20° Anterior femoral neck

37 Standard X-rays Other valuable radiographs Lequesne (faux profile)
Profile of acetabulum: anteversion, retroversion Dunn view 90° flexion/ abduction 20° Anterior femoral neck

38 Standard X-rays Pincer FAI Acetabular origin Acetabular overcoverage
Coxo profunda Protrusio acetabuli

39 Arthro-MRI findings MR Imaging Cor (FS)TSE pd/T2 both hips
Evaluation BME/ tumors… Direct MR arthrography Evaluation labrum, cartilage, hip and actebulum morphology

40 Arthro-MRI findings CAM FAI Bone Marrow Edema Labral tear
Cartilage lesions Subchondral cyst formation (Bump-cyst complex; herniation pit)

41 Arthro-MRI findings Pincer FAI Acetabular origin - Acetabular depth
Distance of center of the femoral neck to line that connected the anterior and posterior acetabular rim Pfirrmann C. et al. Radiology 2006;240:778.

42 Treatment of FAI Behandeling : ARTHROSCOPISCH Philippon, Buly, Dienst
Centraal Compartiment : - gevolgen van het impingement - rimtrimming en labrumrefixatie - resectie tot stabiele kraakbeenrand Perifeer Compartiment : - Oorzaak wegnemen

43 Treatment of FAI Resectie door surgical dislocation (Ganz)

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45 Treatment of FAI

46 Heup arthroscopie COMPLICATIES Villar, Clin Orthop, Jan 2003
1054 gevallen 1,4 % Neuropraxie, skin necrosis Bloeding portals of hematoomvorming Trochanter bursitis Breuk instrumentarium Infectie

47 Scope on the hip Scope in the hip


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