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Schaible SF, Hanke MS, Tinner C, Bastian JD, Albers CE, Keel MJB. Corona mortis: clinical evaluation of prevalence, anatomy, and relevance in anterior approaches to the pelvis and acetabulum. Eur J Orthop Surg Traumatol 2024; 34:1397-1404. [PMID: 38197970 PMCID: PMC10980617 DOI: 10.1007/s00590-023-03808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To evaluate the clinical prevalence, characteristics, and relevance of the corona mortis (CM) in anterior approaches to the pelvis and acetabulum. METHODS Retrospective analysis of 185 theater reports from patients (73 females; mean age 62.8 ± 17.2 years) who underwent surgeries for pelvic ring injuries, acetabular fractures, or combined injuries using anterior approaches (Modified Stoppa or Pararectus) at our institution between 01/2008 to 12/2022. During procedures, the CM was routinely identified, evaluated, and occluded. Bilateral exposure of the superior pubic branch in 25 cases led to 210 hemipelvises analyzed. EXCLUSIONS CM not mentioned in report and revisions via the initial approach. RESULTS In the 210 hemipelvises examined, the prevalence of any CM vessel was 81% (170/210). Venous anastomoses were found in 76% of hemipelvises (159/210), arterial in 22% (47/210). Sole venous anastomoses appeared in 59% (123/210), sole arterial in 5% (11/210). Both types coexisted in 17% (36/210), while 19% (40/210) had none. A single incidental CM injury occurred without significant bleeding. In ten cases, trauma had preoperatively ruptured the CM, but bleeding was readily managed. Females had a significantly higher CM prevalence than males (p = 0.001). CONCLUSION Our findings show a CM prevalence aligning more with anatomical studies than prior intraoperative series. Although we observed one incidental and ten trauma-related CM injuries, we did not encounter uncontrollable bleeding. Our data suggest that in anterior pelvic approaches, when the CM is actively identified and occluded, it is not associated with bleeding events, despite its high prevalence.
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Affiliation(s)
- Samuel Friedrich Schaible
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland.
| | - Markus Simon Hanke
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Marius Johann Baptist Keel
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland
- Trauma Center Hirslanden, Clinic Hirslanden Zurich, Medical School University of Zurich, Witellikerstrasse 40, CH-8032, Zurich, Switzerland
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Aregger FC, Kreuzer S, Häckel S, Bigdon SF, Tinner C, Erbach G, Deml MC, Albers CE. Return to sports/activity level after 360° thoracolumbar fusion after burst fractures in young patients. Brain Spine 2024; 4:102762. [PMID: 38510642 PMCID: PMC10951747 DOI: 10.1016/j.bas.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
Introduction Traumatic thoracolumbar burst fractures are the most common spinal injuries and the proper treatment is controversial. In central Europe in particular, these fractures are often treated with minimally invasive anterior-posterior reduction and fusion, whereas a conservative approach is preferred in the USA. Independent of the treatment strategy, no data exists regarding the outcome related to return to activity level/sport. Research question The aim of this study was to evaluate the return to sports and activity levels after 360° fusion in patients with thoracolumbar burst fractures without neurological deficits. Methods Between January 2013 and December 2022, 46 patients aged 18 to 40 years underwent partial or complete vertebral body replacement in the thoracolumbar region due to traumatic burst fractures without neurologic deficit as an isolated injury. Patients were contacted retrospectively by phone calls to assess their activities using a modified version of the Tegner activity scale at different time points: Before trauma, 3, 6, and 12 months post-surgery. Results After applying exclusion criteria, data collection was complete for 28 patients. The median modified Tegner activity scale was 5.4 before sustaining the fracture, declined to 2.9 at three months post-trauma, improved to 4.2 at six months, and reached 5.0 at 12 months. The majority (83%) of patients achieved their pre-accident activity level within 12 months. No significant differences were observed between patients with partial or complete corpectomy. Conclusion This is the first study assessing return to sports/physical activity based on the modified Tegner scale in young patients undergoing 360° fusion for spinal burst fractures. The majority of patients (83%) return to the pre-injury activity level within 12 months after surgery.
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Affiliation(s)
- Fabian Cedric Aregger
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Sebastian Kreuzer
- Department of Orthopaedic Surgery and Traumatology, Spital Thun, Thun, Switzerland
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Switzerland
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Georg Erbach
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Moritz Caspar Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
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Lanter L, Rutsch N, Kreuzer S, Albers CE, Obid P, Henssler J, Torbahn G, Müller M, Bigdon SF. Impact of different surgical and non-surgical interventions on health-related quality of life after thoracolumbar burst fractures without neurological deficit: protocol for a comprehensive systematic review with network meta-analysis. BMJ Open 2023; 13:e078972. [PMID: 38114286 DOI: 10.1136/bmjopen-2023-078972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION There is no international consensus on how to treat thoracolumbar burst fractures (TLBFs) without neurological deficits. The planned systematic review with network meta-analyses (NMA) aims to compare the effects on treatment outcomes, focusing on midterm health-related quality of life (HRQoL). METHODS AND ANALYSIS We will conduct a comprehensive and systematic literature search, identifying studies comparing two or more treatment modalities. We will search MEDLINE, EMBASE, Google Scholar, Scopus and Web of Science from January 2000 until July 2023 for publications. We will include (randomised and non-randomised) controlled clinical trials assessing surgical and non-surgical treatment methods for adults with TLBF. Screening of references, data extraction and risk of bias (RoB) assessment will be done independently by two reviewers. We will extract relevant studies, participants and intervention characteristics. The RoB will be assessed using the revised Cochrane RoB V.2.0 tool for randomised trials and the Newcastle-Ottawa Scale for controlled trials. The OR for dichotomous data and standardised mean differences for continuous data will be presented with their respective 95% CIs. We will conduct a random-effects NMA to assess the treatments and determine the superiority of the therapeutic approaches. Our primary outcomes will be midterm (6 months to 2 years after injury) overall HRQoL and pain. Secondary outcomes will include radiological or clinical findings. We will present network graphs, forest plots and relative rankings on plotted rankograms corresponding to the treatment rank probabilities. The ranking results will be represented by the area under the cumulative ranking curve. Analyses will be performed in Stata V.16.1 and R. The quality of the evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations framework. ETHICS AND DISSEMINATION Ethical approval is not required. The research will be published in a peer-reviewed journal.
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Affiliation(s)
- Lea Lanter
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Niklas Rutsch
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Sebastian Kreuzer
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Peter Obid
- Freiburg University Hospital, Freiburg im Breisgau, Germany
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universitat Erlangen-Nurnberg Medizinische Fakultat, Nürnberg, Germany
| | - Martin Müller
- Department of Emergency Medicine, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Sebastian Frederick Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital Universitatsspital Bern, Bern, Switzerland
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Albers CE, Zderic I, Kastner P, Gueorguiev B, Tosounidis TH, Keel MJB, Bastian JD. The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective. Eur J Trauma Emerg Surg 2022; 49:1449-1458. [DOI: 10.1007/s00068-022-02187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
To compare construct stability of cement augmented sacroiliac screws using two different cementation sites in a biomechanical fragility fracture model of the pelvis.
Methods
A fracture model with an incomplete fracture of the sacral ala and complete fracture of the anterior pelvic ring mimicking a FFP IIB fragility fracture of the pelvis was established in five fresh frozen human cadaveric pelvises. Sacral fracture stabilization was achieved with bilateral 7.3 mm fully threaded sacroiliac screws. Cement augmentation was performed at the tip of the screw (body of S1; Group A) on one side, and at the midshaft of the screw (sacral ala; Group B) on the contralateral side. Biomechanical testing was conducted separately on both sides comprising cyclic loading of axial forces transferred through the tested hemipelvis from L5 to the ipsilateral acetabulum. Combined angular displacement in flexion and internal rotation (“gap angle”), angular displacement of the ilium in relation to the screw (“screw tilt ilium”), and screw tip cutout were evaluated.
Results
Relative interfragmentary movements were associated with significantly higher values in group A versus group B for “gap angle” (2.4° vs. 1.4°; p < 0.001), and for “screw tilt ilium” (3.3° vs. 1.4°; p < 0.001), respectively. No significant difference was indicated for screw tip cutout between the two groups (0.6 mm [Group A] vs. 0.8 mm [Group B]; p = 0.376).
Conclusion
The present study demonstrated less fragment and screw displacements in a FFP IIB fracture model under physiologic cyclic loading by cement augmentation of sacroiliac screws at the level of the lateral mass compared to the center of vertebral body of S1.
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Steppacher SD, Meier MK, Albers CE, Tannast M, Siebenrock KA. Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation. Cartilage 2021; 13:465S-475S. [PMID: 33550853 PMCID: PMC8804723 DOI: 10.1177/1947603521990879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). DESIGN Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). RESULTS Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations (P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o'clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o'clock peripheral, 12 and 2 o'clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI (P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement (P = 0.751). CONCLUSION Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery.
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Affiliation(s)
- Simon Damian Steppacher
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Malin Kristin Meier
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland,Malin Kristin Meier, Department of
Orthoapedic Surgery and Traumatology, Inselspital, Bern University Hospital,
University of Bern, Freiburgstrasse, Bern 3010, Switzerland.
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg,
Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
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Guerrero J, Häckel S, Croft AS, Hoppe S, Albers CE, Gantenbein B. The nucleus pulposus microenvironment in the intervertebral disc: the fountain of youth? Eur Cell Mater 2021; 41:707-738. [PMID: 34128534 DOI: 10.22203/ecm.v041a46] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The intervertebral disc (IVD) is a complex tissue, and its degeneration remains a problem for patients, without significant improvement in treatment strategies. This mostly age-related disease predominantly affects the nucleus pulposus (NP), the central region of the IVD. The NP tissue, and especially its microenvironment, exhibit changes that may be involved at the outset or affect the progression of IVD pathology. The NP tissue microenvironment is unique and can be defined by a variety of specific factors and components characteristic of its physiology and function. NP progenitor cell interactions with their surrounding microenvironment may be a key factor for the regulation of cellular metabolism, phenotype, and stemness. Recently, celltransplantation approaches have been investigated for the treatment of degenerative disc disease, highlighting the need to better understand if and how transplanted cells can give rise to healthy NP tissue. Hence, understanding all the components of the NP microenvironment seems to be critical to better gauge the success and outcomes of approaches for tissue engineering and future clinical applications. Knowledge about the components of the NP microenvironment, how NP progenitor cells interact with them, and how changes in their surroundings can alter their function is summarised. Recent discoveries in NP tissue engineering linked to the microenvironment are also reviewed, meaning how crosstalk within the microenvironment can be adjusted to promote NP regeneration. Associated clinical problems are also considered, connecting bench-to-bedside in the context of IVD degeneration.
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Affiliation(s)
- J Guerrero
- Tissue Engineering for Orthopaedics and Mechanobiology (TOM), Department for BioMedical Research (DBMR) of the Faculty of Medicine of the University of Bern, University of Bern, Bern,
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Haefeli PC, Albers CE, Steppacher SD, Tannast M, Büchler L. What Are the Risk Factors for Revision Surgery After Hip Arthroscopy for Femoroacetabular Impingement at 7-year Followup? Clin Orthop Relat Res 2017; 475:1169-1177. [PMID: 27718121 PMCID: PMC5339133 DOI: 10.1007/s11999-016-5115-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, surgical treatment of symptomatic femoroacetabular impingement (FAI) has been increasingly performed using arthroscopy. Bony pathomorphologies and damage to the labrum as well as cartilage defects can be addressed with comparable results to open surgery with overall less surgery-related complications. Despite the increasing importance of hip arthroscopy, however, reports on midterm clinical and radiographic outcomes and comparison to open surgical hip dislocation are scarce. QUESTIONS/PURPOSES (1) What are the clinical and radiographic outcomes at a mean 7-year followup; (2) what is the cumulative 7-year survivorship, using the endpoints of THA, progression of osteoarthritis according to Tönnis, or poor clinical outcome with a Merle d'Aubigné score of less than 15 points, of hips with symptomatic FAI treated arthroscopically; and (3) what factors were associated with revision surgery? METHODS Between 2003 and 2008 we performed a total of 62 arthroscopic procedures (60 patients) for FAI. For the same indication, we also performed 571 surgical hip dislocations during that time. Standardized treatment was femoral offset correction, acetabular rim trimming, or both and treatment of labral or chondral defects. An arthroscopic approach was generally used if the pathomorphology was located in the anterosuperior quadrant of the hip and was gradually used for more complex cases. We excluded 10 hips (10 patients) in which the standardized treatment was not achieved and no offset correction or acetabular rim trimming was performed. Of the remaining 52 hips (50 patients), 39 hips underwent isolated femoral offset correction, four hips isolated acetabular rim trimming, and nine hips both procedures. At a mean followup of 7 years (range, 5-11 years), the Merle d'Aubigné clinical score was obtained and plain radiographs were examined (Tönnis grade, heterotopic ossification, lateral center-edge [LCE] angle, acetabular index [AI], extrusion index, alpha angle, and pistol grip deformity). Cumulative survivorship was calculated according to Kaplan-Meier using conversion to THA, progression of osteoarthritis (one or more Tönnis grades), or poor clinical outcome (Merle d'Aubigné score < 15 points) as endpoints. Cox regression analysis was used to identify univariate factors associated with revision surgery. RESULTS At last followup we detected a significant but possibly not clinically relevant increase in Merle d'Aubigné scores from preoperative levels to latest followup (14 ± 1 versus 16 ± 2, mean difference 2 points with a 95% confidence interval [95% CI] -3 to 7, p < 0.001). Six hips showed progression of osteoarthritis. Cumulative survivorship (hips free from conversion to THA, progression of osteoarthritis, or poor clinical outcome) of hips treated with hip arthroscopy for FAI at a mean followup of 7 years was 81% (95% CI, 68%-95%). Two patients (two hips, 4%) underwent THA at 7 and 9 years, respectively. An increased preoperative acetabular coverage (LCE angle, AI), increased offset in the superior portion of the femoral neck (pistol grip deformity), and a remaining pistol grip deformity postoperatively were associated with revision surgery. Any treatment of the labrum did not influence the outcome. Factors associated with failure could not be identified. CONCLUSIONS In this series of patients with arthroscopic treatment of symptomatic FAI, hip arthroscopy resulted in an intact hip without progression of osteoarthritis and with a Merle d'Aubigné score of ≥ 15 points in 81% of patients at 7-year followup. Increased acetabular coverage and femoral pistol grip deformity were risk factors for revision surgery. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Pascal Cyrill Haefeli
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Damian Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Orthopaedic Surgery, Inselspital, Murtenstrasse, 3010, Bern, Switzerland.
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Weihs J, Scacchi P, Hess R, Albers CE. [Resection at symptomatic cam impingement. Use of a minimally invasive antero-lateral approach]. Orthopade 2017; 45:349-54. [PMID: 26472111 DOI: 10.1007/s00132-015-3180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical treatment of femoroacetabular impingement (FAI) is nowadays achieved by either open surgical hip dislocation or hip arthroscopy. However, drawbacks of both procedures include the invasiveness of the open procedure and a high learning curve to successfully perform arthroscopic treatment. In our institution, we established a minimally invasive, arthroscopically assisted, antero-lateral approach for the correction of cam type FAI. OBJECTIVES The goal of the study was to describe the surgical technique and highlight the short-term clinical outcome in a consecutive series of patients operated between 2011 and 2014 in our institution. MATERIALS AND METHODS In total, 77 patients were included in this study. The patients were allocated to two groups (Toennis = 0: Group I; Toennis 1 and 2: Group II). Clinical and radiographic follow up was obtained at 6 and 12 weeks postoperatively. Clinical outcome was assessed using the Hip-Outcome-Score. RESULTS The mean age of patients in Group I was 25 (16-48) years and in Group II 38 (17-50) years respectively. Internal rotation (IR) in 90° flexion increased by 11 degrees from pre- to postoperatively in Group I (p < 0.001) and by 14° in Group II (p < 0.001). The Hip Outcome Score revealed the ability to perform sports with reduced pain at three months follow up. Subjectively, all patients benefitted in terms of pain and hip function in both groups (p < 0.001). There were no complications with long-term morbidity during the perioperative course. CONCLUSION Arthroscopically assisted cam resection using a minimally invasive anterolateral approach is a safe technique for the treatment of FAI. At short term follow up, nearly all operated patients seem to benefit in terms of pain and hip function. The influence of progression of osteoarthritis still has to be shown.
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Affiliation(s)
- Johannes Weihs
- Klinik für Orthopädie, Traumatologie und Sportmedizin Spital STS AG Thun, Krankenhausstrasse 12, 3600, Thun, Schweiz.
| | - P Scacchi
- Klinik für Orthopädie, Traumatologie und Sportmedizin Spital STS AG Thun, Krankenhausstrasse 12, 3600, Thun, Schweiz
| | - R Hess
- Klinik für Orthopädie, Traumatologie und Sportmedizin Spital STS AG Thun, Krankenhausstrasse 12, 3600, Thun, Schweiz
| | - C E Albers
- Dept. of Orthopaedic Surgery, Fiona Stanley Hospital, 102-108 Murdoch Dr, 6150, Murdoch, WA, Australien
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Steppacher SD, Albers CE, Siebenrock KA, Tannast M, Ganz R. Reply to the Letter to the editor: Femoroacetabular impingement predisposes to traumatic posterior hip dislocation. Clin Orthop Relat Res 2013; 471:3720-1. [PMID: 24014272 PMCID: PMC3792271 DOI: 10.1007/s11999-013-3276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Simon Damian Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Reinhold Ganz
- Faculty of Medicine, University of Bern, Walchstrasse 10, 3073 Guemligen, Switzerland
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Albers CE, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calvé-Perthes disease. Clin Orthop Relat Res 2012; 470:2450-61. [PMID: 22528379 PMCID: PMC3830093 DOI: 10.1007/s11999-012-2345-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients after Legg-Calvé-Perthes disease (LCPD) often develop pain, impaired ROM, abductor weakness, and progression of osteoarthritis (OA) in early adulthood. Based on intraoperative observations during surgical hip dislocation, we established an algorithm for more detailed characterization of the underlying pathomorphologies with a proposed joint-preserving surgical treatment. QUESTIONS/PURPOSES We asked if patients after LCPD treated with our algorithm experienced (1) reduced pain; (2) improved hip function; and/or (3) prevention of OA progression; we then determined (4) the intraoperative damage patterns; (5) the survival of the hip; and (6) factors predicting the need for a conversion to THA; radiographic progression of OA; a Merle d'Aubigné-Postel score below 15 at last followup; and/or the need for revision surgery. METHODS We retrospectively reviewed 53 patients after LCPD who underwent joint-preserving surgery (40 surgical hip dislocations, eight acetabular osteotomies, four combined procedures, and one intertrochanteric osteotomy). We obtained Merle d'Aubigné-Postel scores to assess pain; OA was assessed using Tönnis grades. Survival and predictive factors were calculated with the univariate Cox regression. Fifty of the 53 patients were evaluated at a minimum of 5.1 years (mean, 8.2 years; range, 5.1-12.8 years). RESULTS Pain and hip function improved at followup from a median of 4 points to 5 points. The mean increase in Tönnis grades at last followup was 0.3 to 0.8. The survival of surgery at 5 years was 86%; 13 factors related to survival. CONCLUSION Patients with symptoms resulting from pathomorphologic deformities after LCPD benefit from joint-preserving surgery with specific treatment of individual structural abnormalities.
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Affiliation(s)
- Christoph Emanuel Albers
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Simon Damian Steppacher
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Reinhold Ganz
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
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