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17. The Lisbon Agreement on femoroacetabular impingement imaging—part 2: general issues, parameters, and reporting

Author

Mascarenhas, Vasco V., Castro, Miguel O., Afonso, P. Diana, Rego, Paulo, Dienst, Michael, Sutter, Reto, Schmaranzer, Florian, Sconfienza, Luca, Kassarjian, Ara, Ayeni, Olufemi R., Beaulé, Paul E., Dantas, Pedro, Lalam, Radhesh, Weber, Marc-André, Vanhoenacker, Filip M., Dietrich, Tobias Johannes, Jans, Lennart, Robinson, Philip, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Llopis, Eva

Published
2021
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18. The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 3: imaging techniques

Author

Castro, Miguel O., Mascarenhas, Vasco V., Afonso, P. Diana, Rego, Paulo, Schmaranzer, Florian, Sutter, Reto, Kassarjian, Ara, Sconfienza, Luca, Dienst, Michael, Ayeni, Olufemi R., Beaulé, Paul E., Dantas, Pedro, Lalam, Radhesh, Weber, Marc-André, Vanhoenacker, Filip M., Dietrich, Tobias Johannes, Jans, Lennart, Robinson, Philip, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Llopis, Eva

Published
2021
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20. Femoro-Epiphyseal Acetabular Roof Index Values on Anteroposterior Pelvic Radiographs Significantly Increase With Hip Adduction and Decrease With Abduction.

Author

Jud, Lukas, Neopoulos, Georgios, Dimitriou, Dimitris, and Zingg, Patrick O.

Abstract

To investigate the impact of hip adduction and abduction on the femoro-epiphyseal acetabular roof (FEAR) index using conventional anteroposterior pelvic radiographs of patients with borderline hip dysplasia (BHD). Patients with BHD (lateral center edge angle [LCEA] with values of 18° ≤ LCEA <25°) and who were subject to periacetabular osteotoym were selected from a consecutive retrospective cohort from January 2009 to January 2016. The hip ad-/abduction (adduction handled as negative values) and the FEAR index (lateral opening angles handled as positive values) were measured in the initially standardized acquired pelvic radiographs. Thereafter, using surgical planning software, different degrees of hip adduction and abduction were simulated from 20° of adduction to 30° of abduction, and the FEAR index was measured at each position. Pearson correlation was used to identify a potential correlation between the hip ad-/abduction and the FEAR index. Eighty-nine hips were included. Initial radiographs showed unintentional mean ad-/abduction of –5.3° ± 3.1° (range, –14° to 2°). The mean FEAR index at the initial ad-/abduction angle was –3.6° ± 7.2° (range, –18.0° to 16.0°) and was significantly different from neutral position (0° of ad-/abduction) –9.2° ± 7.0° (range, –27.0° to 10.0°) (P <.001). The FEAR index was negatively correlated to the hip ad-/abduction angle (r = 1, P <.001), with lower values for the FEAR index with the hip in abduction. Significant differences in FEAR index measurements were observed depending on hip ad-/abduction on pelvic radiographs. A linear change of the FEAR index of 5° per 5° of hip adduction or abduction could be demonstrated, with adduction resulting in increasing and abduction in decreasing values for the FEAR index. Level III, diagnostic study. [ABSTRACT FROM AUTHOR]

Published
2024
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23. The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Author

Mascarenhas, Vasco V., Castro, Miguel O., Rego, Paulo A., Sutter, Reto, Sconfienza, Luca Maria, Kassarjian, Ara, Schmaranzer, Florian, Ayeni, Olufemi R., Dietrich, Tobias Johannes, Robinson, Philip, Weber, Marc-André, Beaulé, Paul E., Dienst, Michael, Jans, Lennart, Lalam, Radhesh, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Vanhoenacker, Filip M., Dantas, Pedro, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Llopis, Eva, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Afonso, P. Diana

Published
2020
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32. No Difference in Patient-Reported Outcomes for Periacetabular Osteotomy and Hip Arthroscopy With Capsular Plication in the Setting of Borderline Hip Dysplasia: A Propensity-Matched Multicenter Study With Minimum 5-Year Follow-Up.

Author

Andronic, Octavian, Chaharbakhshi, Edwin O., Zingg, Patrick O., Germann, Christoph, Rahm, Stefan, Lall, Ajay C., and Domb, Benjamin G.

Abstract

To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia. Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions. A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P =.001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P <.001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P <.001). The relative risk of subsequent surgery in the PAO group was 3.49 (P =.024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P =.65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group. Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively. Level III, retrospective, comparative therapeutic trial. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Correction to: The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Author

Mascarenhas, Vasco V., Castro, Miguel O., Rego, Paulo A., Sutter, Reto, Sconfienza, Luca Maria, Kassarjian, Ara, Schmaranzer, Florian, Ayeni, Olufemi R., Dietrich, Tobias Johannes, Robinson, Philip, Weber, Marc-André, Beaulé, Paul E., Dienst, Michael, Jans, Lennart, Lalam, Radhesh, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Vanhoenacker, Filip M., Dantas, Pedro, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Llopis, Eva, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Afonso, P. Diana

Published
2020
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36. Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months

Author

Kaiser, Dominik, Hoch, Armando, Sutter, Reto, and Zingg, Patrick O

Abstract

Introduction: Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively.Methods: We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months.Results: The mean age of the patients was 69 years, mean follow-up was 35 (26–54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p=0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p=0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up.Conclusions: In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.

Published
2024
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37. Treatment outcomes of patients with Cutibacterium acnes-positive cultures during total joint replacement revision surgery: a minimum 2-year follow-up

Author

Hoch, A, Fritz, Y, Dimitriou, D; https://orcid.org/0000-0002-9558-7080, Bossard, D A, Fucentese, S F, Wieser, K, Achermann, Y, Zingg, P O, Hoch, A, Fritz, Y, Dimitriou, D; https://orcid.org/0000-0002-9558-7080, Bossard, D A, Fucentese, S F, Wieser, K, Achermann, Y, and Zingg, P O

Abstract

INTRODUCTION Periprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for "aseptic" causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics. METHODS Medical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated. RESULTS A total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33-86) years were included. At an average follow-up of 67 ± 33 (24-127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively. CONCLUSION Infection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspirat

Published
2023

38. Combined Anteversion Threshold to Avoid Anterior Dislocation in Primary Total Hip Arthroplasty Performed Through the Direct Anterior Approach.

Author

Dimitriou, Dimitris, Zindel, Christoph, Winkler, Elin, Cornaz, Frédéric, Mazel, Peter, and Zingg, Patrick O.

Abstract

Component malposition in total hip arthroplasty (THA) can lead to dislocation, early implant failure, and revision surgery. As the surgical approach might affect the targeted combined anteversion (CA) of THA components, the present study aimed to evaluate the optimal CA threshold to avoid anterior dislocation in primary THA performed through a direct anterior approach (DAA). A total of 1,176 THAs in 1,147 consecutive patients (men: 593, women: 554) who had an average age of 63 years (range, 24 to 91) and a mean body mass index of 29 (range, 15 to 48) were identified. Medical records were reviewed for dislocation, whereas postoperative radiographs were assessed to measure the acetabular inclination and CA using a previously validated radiographic method. An anterior dislocation occurred in 19 patients at an average of 40 days postoperatively. The average CA in patients who did and did not have a dislocation was 66 ± 8° and 45 ± 11°, respectively (P <.001). In 5 of 19 of the patients, a THA was performed for secondary osteoarthritis and 17 of 19 had a 28-mm femoral head. A CA ≥ 60° yielded a sensitivity of 93% and specificity of 90% for predicting an anterior dislocation in the present cohort. A CA ≥ 60° was associated with a significantly higher risk of anterior dislocation (odds ratio = 75.6; P <.001) compared to patients who had a CA<60 points. The optimal CA to avoid anterior dislocations in THA performed through the DAA should be less than 60°. Cross-sectional study, Level III. [ABSTRACT FROM AUTHOR]

Published
2024
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43. The periacetabular osteotomy: angulation of the supraacetabular osteotomy for quantification of correction

Author

Hoch, Armando, Grossenbacher, Geraldine, Jungwirth-Weinberger, Anna, Götschi, Tobias, Fürnstahl, Philipp, and Zingg, Patrick O

Abstract

Background: Malcorrection of the acetabular fragment in periacetabular osteotomy (PAO) is associated with inferior outcomes. 2-dimensional radiographic parameters are being used for intraoperative verification of a satisfactory result. After reorientation of the fragment, the acetabular version must be verified with an intraoperative radiograph. In the case of an unsatisfactory correction, a reorientation would be required. A slim and radiation-free intraoperative navigation method to directly quantify the correction is highly desirable.Aim: To find out whether the measurable angulation of the supraacetabular osteotomy can be used for this purpose.Methods: To determine the angulation, 13 consecutive patients who underwent a PAO were investigated. The preoperative and postoperative standard radiographs as well as CT scans were available. The surgically produced alteration of radiographic parameters was correlated to tilting and spreading of the supraacetabular osteotomy planes.Results: Tilting of the supraacetabular osteotomy planes correlates strongly to alteration of the lateral centre-edge angle (LCEA) and the acetabular index (ACI), whereas spreading of the same planes showed also a strong correlation, but to the LCEA only. 1° of tilting resulted in a 0.2° alteration of the LCEA and a 0.5° alteration of the ACI, whereas 1° of spreading resulted in a 0.5° alteration of the LCEA.Conclusions: This study shows that the measurable angulation of the supraacetabular osteotomy planes can be used to monitor the three-dimensional reorientation of the acetabular fragment in PAO. As long as sophisticated modalities are lacking, this technique offers an easy way to intraoperatively navigate the correction in PAO.

Published
2023
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44. Augmented Reality Based Surgical Navigation of the Periacetabular Osteotomy of Ganz – A Pilot Cadaveric Study

Author

Hoch, A, Liebmann, F, Carrillo, F, Farshad, Mazda, Rahm, S, Zingg, P O, Fürnstahl, P, University of Zurich, Rauter, Georg, Cattin, Philippe C, Zaman, Azfar, Riener, Robert, et al, and Hoch, A

Subjects
2211 Mechanics of Materials, 2210 Mechanical Engineering, 610 Medicine & health, 10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center
Published
2021
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46. Femoroacetabular impingement inducing non-union of a femoral neck fracture: a case report

Author

Lenz, C G, Zingg, P O, Kamath, A F, Dora, C, University of Zurich, and Lenz, C G

Subjects
2732 Orthopedics and Sports Medicine, 610 Medicine & health, 10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center, 2746 Surgery
Abstract

INTRODUCTION We describe a case in which femoroacetabular impingement (FAI) was identified as the cause of non-union of a femoral neck fracture and the subsequent treatment strategy. MATERIALS AND METHODS Retrospective review of a 35-year-old patient, without any risk factors for non-union, who sustained a femoral neck fracture. Pre-existing FAI was identified as the cause for the non-union of the femoral neck fracture, with successful treatment of the non-union according to established arthroscopic treatment of the hip. RESULTS After treatment of the FAI, the non-union healed uneventfully within 3 months. CONCLUSIONS FAI may be a less common but potential cause of delayed union or non-union in the setting of femoral neck fracture in the young.

Published
2021

47. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers

Author

Flury, Andreas, Aregger, Fabian, Rahm, Stefan, Hoch, Armando, and Zingg, Patrick O

Abstract

Aim: The purpose of this study was to investigate the greater trochanter’s (GT) behaviour in simulated subtrochanteric osteotomy.Materials and methods: Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°.Results: With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2= 0.866, p< 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02–1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p< 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12–30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4–1.71 cm) and 2.6 ± 0.6 cm (range 1.8–3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2= 0.946; p< 0.001).Conclusions: Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.

Published
2023
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