Advertisement

International Orthopaedics

, Volume 43, Issue 1, pp 35–38 | Cite as

Os acetabuli and femoro-acetabular impingement: aetiology, incidence, treatment, and results

  • Filippo Randelli
  • Daniela Maglione
  • Sara Favilla
  • Paolo Capitani
  • Alessandra Menon
  • Pietro Randelli
Original Paper

Abstract

Purpose

The purpose of this study was to investigate the pathogenesis, the incidence, and the results of arthroscopic treatment of os acetabuli (OSA) in a group of patients with diagnosis of femoro-acetabular impingement (FAI).

Methods

We retrospectively analyzed the full documentation of 294 hips in 273 patients (21 bilateral) operated for FAI through hip arthroscopy. We reviewed all radiographs and arthro-MRI in order to identify the incidence of OSA. All patients with OSA were then assessed with a modified Harris hip score (MHHS) pre-operatively and at the final follow-up.

Results

Twenty-one patients (7.7%), 20 (95%) of them were male, were diagnosed with concomitant FAI and os acetabuli. In 21 cases, OSA was excised and FAI was treated with rim trimming, femoral osteoplasty, or both. In one case, a large OSA fragment was fixed with a 4 mm screw avoiding an acetabular uncoverage if excised. The average follow-up was 31 months (range from 6 to 69 months). The MHHS showed an improvement from a pre-operative MHHS of 57.5 (range from 39 to 82) to 95 (range from 73 to 100).

Conclusions

Os acetabuli is not uncommon and certainly associated with FAI and male gender. The etiology is probably microtraumatic. The arthroscopic OSA removal or fixation and concomitant FAI treatment showed very good results. Interestingly, these outcomes seem better than FAI treatment alone. Further studies with a wider number of patients and a longer follow-up are needed to confirm these results and understand the real role of OSA in this setting.

Keywords

Femoro-acetabular impingement Os acetabuli Modified Harris hip score (MHHS) 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Smith-Petersen MN (1936) Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. JBJS 18(4):869–880.  https://doi.org/10.1007/s11999-008-0670-0 Google Scholar
  2. 2.
    Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg (Br) 87(7):1012–1018.  https://doi.org/10.1302/0301-620X.87B7.15203 CrossRefGoogle Scholar
  3. 3.
    Zaltz I, Kelly BT, Larson CM, Leunig M, Bedi A (2014) Surgical treatment of femoroacetabular impingement: what are the limits of hip arthroscopy? Arthroscopy 30(1):99–110.  https://doi.org/10.1016/j.arthro.2013.10.005 CrossRefGoogle Scholar
  4. 4.
    Griffiths EJ, Khanduja V (2012) Hip arthroscopy: evolution, current practice and future developments. International Orthopaedics (SICOT) 36:1115.  https://doi.org/10.1007/s00264-011-1459-4 CrossRefGoogle Scholar
  5. 5.
    Zini R (2009) Artroscopia dell’anca. Argalia editore UrbinoGoogle Scholar
  6. 6.
    Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg (Br) 73:423–429CrossRefGoogle Scholar
  7. 7.
    Ponsetti I (1978) Growth and development of the acetabulum in the normal child. J Bone Joint Surg Am 60-A:575–585CrossRefGoogle Scholar
  8. 8.
    Freedman E (1934) Os acetabuli. J Bone Joint Surg 31:492–495Google Scholar
  9. 9.
    Pitto RP, Klaue K, Ganz R, Ceppatelli S (1995) Acetabular rim pathology secondary to congenital hip dysplasia in the adult. A radiographic study. Chir Organi Mov 80(4):361–368Google Scholar
  10. 10.
    Ludvigsen TM, Løken S (2011) Hip arthroscopy and os acetabuli: a frequent finding in FAI patients. Arthroscopy 27(10):106–e107CrossRefGoogle Scholar
  11. 11.
    Werner CM, Ramseier LE, Ruckstuhl T, Stromberg J, Copeland CE, Turen CH, Rufibch K, Bouaicha S (2012) Normal values of Wiberg’s lateral center-edge angle and Lequesne’s acetabular index a coxometric update. Skelet Radiol 41(10):1273–1278.  https://doi.org/10.1007/s00256-012-1420-7 CrossRefGoogle Scholar
  12. 12.
    Byrd JW, Jones KS (2000) Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy 16:578–587.  https://doi.org/10.1053/jars.2000.7683 CrossRefGoogle Scholar
  13. 13.
    Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391 Suppl:S362–9Google Scholar
  14. 14.
    Martinez AE, Ganz R, Beck M (2006) Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim? Hip International 16(4):281–286CrossRefGoogle Scholar
  15. 15.
    Hergan K, Oser W, Moriggl B (2000) Acetabular ossicles: normal variant or disease entity? Eur Radiol 10(4):624–628.  https://doi.org/10.1007/s003300050974 CrossRefGoogle Scholar
  16. 16.
    Singh PJ, O’Donnell JM (2010) The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy 26(6):743–749.  https://doi.org/10.1016/j.arthro.2009.10.010 CrossRefGoogle Scholar
  17. 17.
    Epstein NJ, Safran MR (2009) Stress fracture of the acetabular rim: arthroscopic reduction and internal fixation A case report. J Bone Joint Surg Am 91(6):1480–1486CrossRefGoogle Scholar
  18. 18.
    Larson CM, Stone RM (2011) The rarely encountered rim fracture that contributes to both femoroacetabular impingement and hip stability: a report of 2 cases of arthroscopic partial excision and internal fixation. Arthroscopy 27(7):1018–1022.  https://doi.org/10.1016/j.arthro.2011.04.006 CrossRefGoogle Scholar
  19. 19.
    Clohisy JC, Zebala LP, Nepple JJ, Pashos G (2010) Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am 92(8):1697–1706.  https://doi.org/10.2106/JBJS.I.00326 CrossRefGoogle Scholar
  20. 20.
    Nielsen TG, Miller LL, Lund B, Christiansen SE, Lind M (2014) Outcome of arthroscopic treatment for symptomatic femoroacetabular impingement. BMC Musculoskelet Disord 15:394.  https://doi.org/10.1186/1471-2474-15-394 CrossRefGoogle Scholar
  21. 21.
    Gupta A, Redmond JM, Stake CE, Dunne KF, Domb BG (2015) Does primary hip arthroscopy result in improved clinical outcomes? 2-year clinical follow-up on a mixed group of 738 consecutive primary hip arthroscopies performed at a high-volume referral center. Am J Sports Med 28.  https://doi.org/10.1177/0363546514562563

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Hip Department and TraumaI.R.C.C.S. Policlinico San DonatoMilanItaly
  2. 2.1° Clinica Ortopedica Istituto Ortopedico Gaetano PiniMilanItaly

Personalised recommendations