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Zusammenfassung: Das femoroazetabuläre Impingement (FAI) ist häufig, die geschätzte Prävalenz liegt bei 10-15%. Unsere bisher 10-jährige Erfahrung bestätigt das FAI als eine wesentliche, wenn auch nicht einzige Ursache der Koxarthrose. Isolierte azetabuläre oder femorale Fehlformen sind selten, obwohl bei Frauen die azetabuläre und bei Männern die femorale Pathomorphologie dominiert. Normalbefunde im Standardröntgen schließen ein FAI nicht aus. Symptome treten umso früher auf, je größer die Deformität und je intensiver hohe Bewegungsanforderungen gestellt werden. Die überwiegende Mehrzahl der Patienten ist

The aim of treatment of slipped capital femoral epiphysis is an anatomically aligned epiphysis with normal blood supply. This result can be achieved by open subcapital reorientation of the epiphysis or by a wedge osteotomy of the femoral neck. Other procedures have, so far, not gained optimal control over the risk of avascular necrosis.Acute epiphyseolysis. Chronic epiphyseolysis for which trimming of the metaphyseal overhang to permit free flexion and internal rotation without impingement would leave less than two thirds of the femoral neck diameter intact.Ankylosis of the hip joint at an advanced stage. Destruction of the femoral head.The blood supply to the epiphysis from the medial femoral circumflex artery can be preserved by surgical hip dislocation and a soft-tissue flap derived subperiosteally from the retinaculum and external rotators. This soft-tissue flap permits not only the detachment of the epiphysis, but also complete callus resection from the femoral neck without causing tension in the retinaculum. Dislocation of the femoral head ensures its manual protection during curettage of the epiphyseal plate and, ultimately, allows anatomic reduction under visual control of the retinaculum. With the head dislocated there is less risk to the integrity of the retinaculum due to unintentional manipulation of the leg than there would be, if the head remained in the socket.From 1996 to 2005, 30 hips with a diagnosis of slipped capital femoral epiphysis were treated according to the technique described. The average follow-up time was 55 months (24-96 months). Femoral head necrosis did not occur. Distribution across sexes was well balanced. Girls were 12 years old at the time of the operation and boys were 14 years old on average. Posterior displacement was measured at 30-70 degrees. In six hips there was a so-called acute on chronic slip. Two hips required revision due to screw failure, a difficulty that was addressed by the introduction of fully threaded wires. One hip had to be revised because the fully threaded wire bent. After reoperation, shortening of maximum 1 cm was seen in these three cases. In one patient with ectopic bone formation at the anteroinferior femoral neck, internal rotation in flexion is reduced by half.

To describe anterior femoroacetabular Impingement (AFAI) as a cause of persistent painful loss of motion and progressive joint-destruction in patients with a healed femoral neck fracture, and to evaluate results after its surgical treatment.Eleven patients with groin pain elicited by motion and exertion following a healed femoral neck fracture were diagnosed clinically, by conventional radiographs and radial Arthro MRI with AFAI. During surgical subluxation or dislocation of the hip joint the impingement was visually verified and eliminated by re-shaping the anterior contour of the head-neck-junction.All patients presented a flat contour of the anterior head-neck-junction causing a cam-type impingement with subsequent damage of the anterior-superior acetabular cartilage adjacent to the rim. These chondral changes result from the repetitive compression and shear forces between the flattened head-neck junction and the acetabular cartilage in flexion and internal rotation. At five year follow-up a clear improvement of the symptoms was observed without any signs of progressive joint destruction.When chronic pain after a healed femoral neck fracture without necrosis of the femoral head occurs, the possibility of an AFAI caused by retrotorsion of the proximal fragment should be taken into consideration. The symptoms of AFAI can be relieved by surgical correction of the femoral head-neck-offset. The existing damage of the acetabular cartilage originated by the impingement at the time of surgery can hardly be improved. Therefore anatomical fracture reduction should be performed in order to prevent the development of osteoarthritis. Pre-existing deformities of the joint should be treated at the time of operative fracture treatment.