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OBJECTIVES To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. METHODS Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. RESULTS Anterior cup visibility (P = .03), contact with the psoas tendon (P

The function of the abductor mechanism (AM) of the hip can be disturbed, or even compromised, following tumor resection in the hip area. The consequences are instability (limping, dislocation), pain and altered walking ability. Several reconstruction techniques can be used for the same AM sacrifice. After defining the AM, this lecture will discuss the best technique for a given type of bone and muscle resection. These reconstruction techniques depend on exactly where the AM was sacrificed. For zone 1 resections of the ilium and/or iliac gluteal insertions, reconstruction is often optional. When muscle from the AM is resected, especially when the gluteal tendon is detached from its trochanteric insertion, isolated reconstruction can be done or reconstruction in combination with a tendon allograft or an allograft and/or tendon transfer from the surrounding area. This sacrifice, whether followed by reconstruction or not, in most cases leads to a good functional outcome, except when a complete musculotendinous unit or the superior gluteal nerve is sacrificed. Isolated resection of the greater trochanter is rare; however, this completely disrupts the continuity of the AM and justifies reconstruction, often using a bone-tendon allograft. Proximal femur resection is the most common scenario. The extent of the trochanteric resection and the gluteal tendon attachments drives the type of prosthesis used. The two most used techniques consist in an allograft sleeve over a long cemented femoral stem (allograft prosthesis composite – APC) or a modular proximal femoral endoprosthesis (megaprosthesis) with a specific AM fixation system (small plate or wire cerclage, resorbable or metal wire, synthetic reattachment tube). These two techniques yield nearly identical long-term functional outcomes with complications specific to each: osteolysis and fracture for APC, failure of tendon reattachment for megaprosthesis. Beyond these technical considerations, one must consider the poor availability of massive bone allografts. This is a highly relevant issue in France, and partially explains the shift to reconstruction with a megaprosthesis. Lastly, we will look at the different clinical and diagnostic tests used to evaluate the function of the AM in an oncology context and the outcomes of the various types of reconstruction.

There are a variety of options for filling defects during revision total knee arthroplasty: cement with or without screws, structural or morselized allograft, highly porous cones and sleeves, massive bone allograft or megaprostheses. Our goal is to describe the techniques for these procedures and their indications. Any necrotic bone, fibrous tissue or granulomas must be excised, and the bone freshened. The height of the joint line must be restored using trial components stabilized by stems. The defect is the space between the bone and each of the two components. Whether contained or not, it can be evaluated using the AORI classification. Cement alone or supplemented with screws, which is pressurized to penetrate the bone, is now only used in small defects less than 10 mm in diameter, especially contained one. It is preferable to use morselized compacted bone graft instead. Augments are used to fill AORI type 2 defects less than 10 mm deep in a condyle. They can also be used to position the femoral component and sometimes the tibial one. For type 2 and 3 defects, bone allografts aim to reconstruct the skeleton. They can be used as trimmed fragments, as described by Engh who did hemispheric reaming to embed a femoral head into the defect. One can also compact or pack morselized bone graft around a stem. These reconstruction procedures are long and difficult. They are being done less and less since porous cones and sleeves were introduced, which are impacted after bone preparation. These sterile components are secured to the stem either mechanically or with cement, saving time. Once in place, bone grows into them. They provide metaphyseal anchoring that helps to reduce the stem's length. When the epiphysis is nearly all gone, the choices are a massive bone allograft or a megaprosthesis, although both have a high risk of infection and mechanical failure. The allograft must be trimmed to restore the height of the joint line and achieve a stable connection with the host bone. A long stem, always cemented into the allograft, is essential. In older patients, a megaprothesis is simpler to use and faster. The femur is better suited to massive reconstruction than the tibia, where coverage must be ensured along with extensor mechanism continuity. Level of evidence V; expert opinion.

Resume Introduction La modularite a ete proposee dans les revisions femorales avec perte de substance osseuse (PSO) etendue. Elle expose a des complications mecaniques (demontage, rupture). Cette etude retrospective evaluait a 5 ans minimum de recul la prothese modulaire Extreme™ de 1re generation. Hypothese Un pivot sans ciment modulaire facilite les revisions avec PSO etendue et procure des resultats satisfaisants sans risque de defaillance de ses jonctions. Patients et methode Nous avons evalue au recul de 6,3 ans (5–9), 33 protheses chez 23 femmes et 9 hommes, âges de 65 ans (49–83), presentant un descellement aseptique dont 3 avec fracture peri-prothetique. La PSO a ete evaluee selon les classifications SOFCOT (17/33 stades 3 et 4) et de Paprosky (19/33 stades III et IV). Un patient est decede, un autre a ete perdu de vue, laissant 31 hanches. L’evaluation clinique comportait les scores de Merle d’Aubigne (PMA) et Harris (HHS) et l’evaluation radiologique le score de Engh et la mesure de l’index cortico-medullaire (ICM). Resultats Il y a eu 12 complications necessitant revision (36 %) : 15 complications necessitant revision : 9 (27 %) non liees a l’implant (1 hematome, 2 infections, 2 luxations, 1 pseudarthrose de volet femoral, 3 pseudarthroses trochanteriennes asymptomatiques) et 6 (18 %) non liees a l’implant (1 hematome, 2 infections, 2 luxations, 1 pseudarthrose de volet femoral) et 6 (18 %) en rapport avec lui (4 ruptures a 3 niveaux et 2 demontages epiphyso-metaphysaires ayant necessite 3 changements de la totalite de l’implant et 3 de sa partie proximale). Les scores PMA et HHS etaient significativement ameliores (PMA passant de 10,4 [6–18] a 14,4 [11–18], HHS de 50 [19–88] a 80,9 [52–100]). La rehabitation osseuse etait « certaine » selon Engh dans 11 cas (44 %). Aucune piece diaphysaire n’avait migre, y compris en cas de rupture ou dissociation. L’ICM a ete mesure aux 3 jonctions entre les 4 quarts de la tige, de proximal a distal. Il n’etait pas significativement modifie, passant de 32,9 a 32,7, 41,2 a 38,7 et 41,6 a 39,9 respectivement. La survie au recul de 6 ans etait de 81 % (IC a 95 % : 68 % a 94 %). Discussion Dans les autres series de prothese du meme type, les taux de rupture, toujours metaphyso-diaphysaire, sont tres inferieurs (0,8–3,8 %). Cette tige permet d’obtenir la fixation diaphysaire en cas de PSO grave mais expose a un risque trop eleve de demontages et de ruptures. Niveau de preuve Stade IV. Etude retrospective.

Purpose: To present a new method of arthroscopic measurement of the surface and location of condylar lesions. Methods: We propose measuring the height of the condylar lesion by using the lesion’s arc (Δ°) obtained from the difference between the angle of flexion at the beginning of the lesion and the angle of flexion at the end of the lesion. The first goal of the study was to determine the intra and inter reliability of the lesion’s arc. Experiment 1: 20 deep lesions were evaluated using the lesional arc by two arthroscopists. Experiment 2: In a second series of 20 lesions, the flexion angles of the knees were recorded using a goniometer. All 10 knees (5 in each series) were then disarticulated and the true lesion arc was checked with a goniometer to assess the validity of the scopic measurements. The second goal was to obtain the height of the lesion from the lesion’s arc. The lesion arc Δ° of the condylar is converted into height (millimeters) on the basis of a table obtained from 5 standard profiles of the lateral X-ray of the knee. Results: Experiment 1: The intra observer reliability was good but the inter observer reliability was poor. Experiment 2: The intra and inter observers’ reliability were good. On the anatomic control after disarticulating the knee, the confidence interval was narrower when using the goniometer. Conclusions: We propose a simple, reliable method to measure the height of a condylar lesion with the lesion’s arc during arthroscopy.

International audience; Purpose: Our purpose was to assess medial unicompartmental knee arthroplasty with navigation alone for the tibial cut and limb alignment. We hypothesised that this technique could be used routinely in practice. Methods: Outcome measures were tibial cut orientation and residual varus. Six-month post-operative radiographs of 59 knees were assessed. Results: Tibial cut orientation was within 2° of planned in 70.2 and 76.3 % of knees in the coronal and sagittal planes, respectively (49.1 % in both), within 4° in 91.2 and 91.5 %, respectively (82.5 % in both). All coronal-plane errors were in varus. Excessive planed tibial slope was at risk of excessive varus of the tibial cut. The hip-knee-ankle angle was ≤179° in 81.4 % and the mechanical axis through Kennedy Zone 2 in 59.3 % of knees. Risk factors for inadequate varus were pre-operative hip-knee-ankle angle >176° and strictly articular varus. Conclusions: Our results are not as good as previously reported with this technique, but taking into account the factors of failure identified, we could enhance the results. © 2016, SICOT aisbl.

In the 20-50-year age group, hip pain usually indicates dysplasia. Chronic mechanical pain is the usual pattern, although acute pain caused by avulsion or degeneration of the labrum may occur. The morphological characteristics of the dysplastic hip should be evaluated, and the link between the dysplasia and the osteoarthritis should be confirmed. Three factors indicate a favorable prognosis: joint space preservation, age younger than 40 years, and correctable femoral and acetabular abnormalities. Reconstruction is highly desirable, as it delays the need for joint replacement by 20 years. After 15 years, good outcomes are seen in 87% of patients after shelf arthroplasty and 85% after femoral varus osteotomy with or without shelf arthroplasty. Chiari acetabular osteotomy can be performed in patients with osteoarthritis but is followed by prolonged limping. Periacetabular osteotomy should be reserved for patients with moderate dysplasia and no evidence of osteoarthritis. Shelf arthroplasty and femoral osteotomy require 5-8 months off work (compared to 5 months after hip replacement surgery) but subsequently permits a far more active lifestyle. Hip replacement, which is required 20 years or more after biologic reconstruction, carries the same prognosis as first-line hip replacement (good results in 80% of patients after 15 years). Acute sharp pain related to anterior hip derangement also occurs in primary femoroacetabular impingement (FAI). The most common pattern is cam impingement, which is due to a decrease in head-neck offset and manifests as pain during flexion and adduction of the hip. Cam impingement can be corrected by anterolateral osteoplasty, which is often performed arthroscopically. Pincer-type impingement is contact between the anterior acetabular rim and the femoral neck due to retroversion of the proximal acetabulum. The imaging study strategy is discussed. Coxometry, computed tomography, and arthrography can be used. Primary FAI, which occurs as a result of geometric abnormalities, should be distinguished from secondary impingement. Causes of secondary impingement include exaggerated lumbar lordosis with pelvic tilt and to hip osteophytosis (sports or posterior hip osteoarthritis). Osteoplasty is rarely appropriate in patients with secondary impingement. The features of acute anterior hip derangement are now better defined. They can be used to guide palliative treatment, which is effective, in the medium term at least. Experience acquired over the last two decades has established the efficacy of surgery for hip dysplasia.

Resume Les douleurs de hanche du sujet jeune (20 a 50 ans) traduisent le plus souvent la dysplasie de hanche. Parfois elles sont aigues par desinsertion ou degenerescence du labrum. Habituellement, elles sont mecaniques et chroniques. Les composantes morphologiques de la dysplasie doivent etre analysees, le rapport entre dysplasie et arthrose affirme, les trois facteurs de bon pronostic recherches (arthrose sans pincement ; âge inferieur a 40 ans ; correction possible des anomalies femorales et acetabulaires). La chirurgie biologique est vivement conseillee car elle permet de retarder de 20 ans la decompensation arthrosique et la chirurgie prothetique. La butee donne 87 % de bons resultats a 15 ans, l'osteotomie femorale de varisation plus ou moins butee 85 % de bons resultats a 15 ans. Les osteotomies acetabulaires sont moins favorables : le Chiari est possible en presence d'arthrose, mais entraine des boiteries durables ; l'osteotomie periacetabulaire n'est recommandee que pour des dysplasies moderees, sans aucune arthrose. La butee et l'osteotomie femorale necessitent cinq a huit mois d'arret de travail (alors que la prothese n'en demande que cinq), mais permettent de poursuivre une vie bien plus active. La prothese, qui sera necessaire 20 ans (ou plus) apres la chirurgie biologique, aura le meme pronostic qu'une prothese de premiere intention (80 % de bons resultats a 15 ans). Les douleurs vives, aigues, de derangement anterieur de hanche peuvent etre egalement rencontrees dans d'autres anomalies morphologiques : les conflits primaires col–labrum. ● La « came » est la plus frequente, liee au comblement de la jonction tete–col. Elle rend douloureux les mouvements de flexion et d'adduction. Son traitement est le remodelage (volontiers arthroscopique) de la jonction tete–col (osteoplastie). ● La « pince » est un conflit col–acetabulum lie a une retroversion de l'acetabulum proximal. La strategie des explorations d'imagerie (coxometrie, scanner, arthrographie) est precisee. Il importe de differencier ces conflits primaires (lies a une anomalie morphologique) des butoirs secondaires (lies soit a une malposition acetabulaire par bascule du bassin — hyperlordose —, soit a une coxarthrose osteophytique — hanche du sportif, coxarthrose horizontale…) : ces butoirs secondaires relevent rarement de l'osteoplastie. On beneficie donc actuellement d'une meilleure semiologie des derangements anterieurs aigus de hanche (guidant un traitement palliatif efficace au moins a moyen terme), et d'une confirmation de l'efficacite pendant deux decennies de la correction chirurgicale des dysplasies.

RESUME Plus des deux tiers des fractures du femur proximal relevent de l’osteosynthese. La mortalite, chez des patients dont l’âge moyen a l’operation est de 80 ans, est d’environ 25 %a un an. Elle est essentiellement liee au vieillissement, mais aussi au syndrome de glissement (surtout si l’intervention a ete retardee ou l’hospitalisation en chirurgie longue), et aux complications locales (demontage, infection, hematome). Deux materiels d’osteosynthese (une vis-plaque et un clou trochanterien) ont ete specialement concus pour une chirurgie mini vulnerante, realisee sous fluoroscopie par une incision de moins de 50mm : l’objectif etait de respecter des parties molles pour reduire les complications locales, de diminuer la douleur et donc de faciliter l’appui precoce, et d’autoriser la sortie vers trois a quatre jours. Apres des essais en laboratoire de resistance de l’implant et de l’os a l’appui complet, une serie preliminaire de 30 operes a ete realisee, montrant la faisabilite de ces techniques. La consolidation a ete obtenue d’emblee dans 27 cas. Il n’y a pas eu d’infection ni de saignement chez les patients sous anti agregants. La technique ayant ete optimisee, des etudes pluricentriques sont maintenant en cours pour mieux preciser les benefices de cette chirurgie : la consolidation de la fracture et la mobilite de la hanche devraient etre au moins equivalentes a celles des techniques ouvertes (90 a 96 %de consolidation, en fait limitees par la precision du positionnement de l’implant et par l’osteoporose) ; on peut esperer reduire discretement la mortalite (intervention immediate, sortie rapide, peu de complications locales) ; s’il existe des filieres d’aval, le cout des soins sera tres sensiblement diminue grâce a la brievete de l’hospitalisation. Dans quelques annees, les techniques mini vulnerantes pourraient devenir la regle dans la chirurgie des fractures du femur proximal du sujet âge.

We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a distal femoral window (eight cases). Despite significant bone loss, in 24% of the femora and 57% of the acetabula, favourable midterm results were achieved and only six reoperations were required, including two for trochanteric nonunion and two for loosening. It leaves the lateral femoral cortex intact so that a stem longer than 200 mm was needed in only 25% of patients. This is a considerable advantage compared with the extended trochanteric osteotomy in which the long lateral flap (12 to 14 cm) requires an average length of stem of 220 mm beyond the calcar. TSO provides an approach similar in size to the standard trochanteric osteotomy but with a rate of nonunion of 4% versus 15%. It reduces the risk of difficulties with removal of the stem, and removes the need for routine distal anchoring of long revision stems. The limited distal femoral compromise is very important in patients with a long life expectancy.

Introduction L’orientation et la hauteur de la coupe tibiale dans les protheses unicompartimentales mediales (PUCm) du genou conditionnent le positionnement des implants tibiaux et (dans la technique des coupes dependantes) femoraux et, l’alignement du membre inferieur. Notre objectif principal etait de determiner le taux de succes de l’utilisation du guide de coupes personnalise tibial (GCPt) pour l’obtention d’une coupe tibiale correctement realisee (orientation frontale [OF], orientation sagittale [OS] et hauteur de coupe [HC]). L’objectif secondaire etait d’identifier les causes eventuelles d’echec. Materiel et methodes Trente-deux genoux ont ete operes d’une PUCm avec GCPt et coupe femorale dependante. En preoperatoire, les donnees radiographiques et de planification du GCPt etaient recueillies. En peroperatoire, une station de navigation mesurait l’alignement du membre et la position du GCPt et de la coupe a differents temps d’utilisation du guide (guide pose sur l’os, fixe a l’os et coupe realisee). La HC etait mesuree au pied a coulisse en fin d’intervention par la mesure de la piece de resection. A 6 mois postoperatoire, l’orientation (OF et OS) de la coupe tibiale etait mesuree sur un pangonogramme. Comparativement aux valeurs planifiees, l’echec etait defini par un positionnement : au-dela de 4° (OF et OC) ou 3 mm (HC) en peroperatoire (dans ce cas la procedure etait interrompue), de plus de 1,5 mm a la mesure au pied a coulisse de la HC, ou de plus de 2° (OF et OC) sur les radiographies a 6 mois. Les analyses statistiques ont ete effectuees avec le logiciel SAS 9.4® (seuil de significativite de 5 %). Resultats Deux genoux n’ont pas pu etre evalues completement (1 perdu de vu, 1 fracture peri-prothetique). Pour 10 genoux, la procedure a ete interrompue en peroperatoire. Sur les 20 genoux restants, 19 avaient une HC correcte, et a 6 mois, 12 avaient une OF correcte et 15 une OS correcte, mais seuls 9 reunissaient les trois criteres, soit un taux de succes global de 30 % (9 sur 30). Les mesures peroperatoires de position du GCPt montraient des differences significatives (p Conclusion Les GCP ne sont pas une solution satisfaisante pour la realisation de la coupe tibiale dans les PUCm. La faible surface d’application du GCPt dans les PUCm et le manque de rigidite du guide expliquent potentiellement les echecs de la technique.

Introduction L’instabilite est une complication majeure des reprises des protheses totales de hanche (RPTH). L’utilisation des cupules a double mobilite (CDM) permet de reduire ce risque sans toutefois le supprimer. L’objectif principal de cette etude cas temoins retrospective etait d’evaluer les facteurs de risque de luxation des CDM. Leur traitement etait un objectif secondaire. Materiel et methodes De janvier 2007 a avril 2016, toutes les luxations vraies de cupules a double mobilite (Medial Cup, Aston Medical®) ont ete repertoriees et chacune appariee en âge, sexe, annee et geste chirurgical avec 3 CDM non compliquees de luxation. Les facteurs de risques lies au patient (IMC, ASA, antecedents medicaux), aux antecedents chirurgicaux locaux ou a l’intervention index ont ete analyses. Resultats Onze luxations ont ete repertoriees sur 559 CDM consecutives, soit un taux de luxation de 1,97 %. En analyse univariee, une trop grande inclinaison acetabulaire (p = 0,02), le nombre de reprises chirurgicales anterieures (p = 0,02) ainsi que la defaillance de l’appareil abducteur (p = 0,02) etaient significativement associes a la survenue d’une luxation. En analyse multivariee, les facteurs de risque independamment associes etaient le nombre de reprises prothetiques anterieures (OR = 3,5 [1,35–9,06]) et l’inclinaison acetabulaire (OR = 1,1 [0,99–1,22]). Cinq luxations ont necessite une intervention a visee stabilisatrice. Une n’a pas recidive apres reduction orthopedique. Un patient est decede, un a ete perdu de vue, un a ete recuse pour une reprise et un va etre repris et un est attente de decision. Conclusion Si les CDM permettent de limiter la survenue de luxation des RPTH, elles ne suppriment pas totalement ce risque. Le nombre d’interventions et notamment le nombre de revisions prothetiques anterieures, l’inclinaison acetabulaire ainsi que la defaillance de l’appareil abducteur sont des facteurs de risque de luxation des protheses de hanche avec CDM. Une reintervention est necessaire dans plus de 45 % des cas pour stabiliser la hanche.

The diagnosis of non-traumatic knee complaints relies on history taking and clinical examination, joint fluid analysis and imaging tests. This paper aims at reminding the benefits of conventional radiography and clarifying the role of ultrasound and magnetic resonance imaging based on illustrated case reports.

Fixation is used to treat more than two-thirds of proximal femur fractures. The mortality rate is about 25% at one year in these patients, who have an average age of about 80 years. This is mainly due to aging, but also to a gradual deterioration of general health (especially if the operation has been delayed, or after a long stay in the surgical ward) and to local complications (displacement, infection, hematoma). Two fixation devices (a sliding screw plate and a trochanteric nail) have been designed for mini-invasive treatment with fluoroscopic guidance and an incision smaller than 50 mm. The aim is to respect the soft tissues and thereby to avoid local complications, diminish pain, and facilitate early weight-bearing Hospital discharge is possible after 3 or 4 days. Laboratory experiments have shown the satisfactory resistance of the implant and bone at full weight bearing A preliminary series of 30 patients showed the feasibility of these techniques. Primary fusion was achieved in 27 cases. There were no infections and no bleeding, despite antiplatelet treatment. The techniques have now been optimized and multicenter studies are held to determine their real benefit. Fracture fusion and hip motion should be at least as good as with open surgery (90 to 96% fusions, albeit influenced by the precise position of the implants and by osteoporosis). Mortality may be slightly reduced, thanks to immediate operation, early discharge, and fewer local complications. The cost of treatment could also be significantly reduced by the shorter hospital stay. In a few years' time, mini-invasive treatment may become the standard for elderly patients with proximal femur fractures.

Trochanteric rotation osteotomies displace the necrotic zone of the femoral head outside the major acetabular weight-bearing zone and rotate the head anteriorly or posteriorly. Nineteen consecutive patients were selected for rotation osteotomy based on age,absence of progressive disease, and preoperative imaging studies predicting that rotation osteotomy would move the entire necrotic zone away from the acetabular roof. Factors associated with failure were head flattening and necrosis deeper than one third of the femoral head diameter. Among patient subsets with identical disease stages, outcomes seemed better after posterior rotation than after anterior rotation. Rotation osteotomies,fixed by a nail plate, can be recommended in a few selected patients with shallow necrosis involving less than one third of the femoral head diameter and without osteoarthritis or head flattening. Under these conditions, good outcomes may be achieved for 10 years or longer.

Anterior hip pain in young adult (20 to 50) has two main causes: secondary osteo-arthritis on development dysplasia of the hip, and femoro-acetabular impigement (FAI). This symposium had two parts: the first one analyses long-term results of non-prosthetic surgery (283 osteotomies and shelfs at 15 years FU). The second part concerned the different syndromes with acute anterior hip pain, especially due to FAI and to labral tears.In hip dysplasia, 56 shelf operations, 100 proximal femoral varus osteotomies associated or not with a shelf arthroplasty,and 127 Chiari osteotomies were examined with 10 years minimum follow-up. Only 15% of patients were lost at follow-up before 10 years and average follow-up was 15 years. Results were considered as satisfactory when the Merle d'Aubigne rating was 15/18 or more. The 3 main factors of good prognosis were: a complete correction of both femoral and acetabular dysplasia; age at operation under 40; a moderate arthritis (grade I or II according to De Mourgues and Patte). In single acetabular dysplasia with 3 favorable prognosis factors(no coxa valga, age under 40, arthritis 1 or 2), 85% good results were achieved at 15 years. When patients were over 40 at operation, or in arthritis grade over 2, only 55% of good results were observed. Varus osteotomies, associated or not with shelf arthroplasties, achieved also 85% goods results at 15 years when the 3 favorable prognosis factors were present. Similar good results were also obtained by Chiari osteotomy, but this operation was associated with 12% complications, and more that 25% of lasting limping. Therefore, with 85% good results at 15 years (and often over 20 years), non prosthetic surgery performed at 30-35 years, achieved better functional results than total hip arthroplasty, longer lasting, and not jeopardizing any further possibility of prosthetic surgery.As concerns acute anterior pain of the hip, the clinical and imaging patterns of the different syndromes have been precised: femoro-acetabular impigement by cam (or by pincer), labral tears in hip dysplasia. There were distinguished from the other secondary impigements, for example by acetabular malposition due to pelvis anteflexion or by other hip diseases: overuse arthritis, coxa retrorsa, etc. Several examples of typical syndromes were presented to support the recommended imaging techniques. The results of the speakers with different surgical treatments were reported as well as concerns open surgery than arthroscopic treatment (60 cases).