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FAI and Adult DDH: Postoperative Imaging
Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Periacetabular osteotomy (PAO)
            • Performed for pincer femoral acetabular impingement (FAI) or developmental dysplasia of hip (DDH)
              • Multiple types: Triple innominate (Ganz), Bernese, Steele, Pemberton are types of periacetabular osteotomy
            • Triple innominate osteotomy is most common
              • Osteotomies of ilium, ischium, and pubis isolate acetabulum and allow realignment
              • Allows adjustment of acetabular version, femoral head coverage
          • Salter osteotomy
            • Supraacetabular iliac osteotomy performed for DDH at age < 6 years
            • Acetabulum, pubic bone, and ischium rotated on pubic symphysis
          • Chiari (shelf) osteotomy
            • Oblique supraacetabular osteotomy to improve depth of acetabulum in DDH
            • Nonarticular lateral margin of ilium becomes lateral acetabular roof
            • Performed in young children, rarely performed today
          • Acetabular rim debridement ("rim trim")
            • Labrum is detached, prominent bone is debrided, labrum is reattached
          • Femoral osteochondroplasty (open or arthroscopic)
            • Recontouring of femoral head/neck junction
            • Improves head/neck offset in cam FAI
            • Greater trochanteric osteotomy often performed with open procedure
          • Subtrochanteric femoral osteotomy
            • Performed in childhood to redirect femoral head into acetabulum

        IMAGING

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  CLINICAL ISSUES

                  • Complications of Surgery

                    Selected References

                    1. Cvetanovich GL et al: Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes. Arthroscopy. 31(7):1382-90, 2015
                    2. Dietrich TJ et al: Postoperative imaging in femoroacetabular impingement. Semin Musculoskelet Radiol. 17(3):272-8, 2013
                    3. Bedi A et al: The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 40(4):854-63, 2012
                    4. Clohisy JC et al: Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 468(2):555-64, 2010
                    5. Rehan-Ul-Ha et al: An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum. Arch Orthop Trauma Surg. 130(1):65-70, 2010
                    6. Beck M: Groin pain after open FAI surgery: the role of intraarticular adhesions. Clin Orthop Relat Res. 467(3):769-74, 2009
                    7. Matheney T et al: Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 91(9):2113-23, 2009
                    8. Parvizi J et al: Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 24(6 Suppl):110-3, 2009
                    9. Vukasinovic Z et al: Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications. Hip Int. 19(4):315-22, 2009
                    10. Murray KA et al: Radiographic imaging for treatment and follow-up of developmental dysplasia of the hip. Semin Ultrasound CT MR. 22(4):306-40, 2001
                    Related Anatomy
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                    Related Differential Diagnoses
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Imaging

                        • Clinical Issues

                          TERMINOLOGY

                          • Definitions

                            • Periacetabular osteotomy (PAO)
                              • Performed for pincer femoral acetabular impingement (FAI) or developmental dysplasia of hip (DDH)
                                • Multiple types: Triple innominate (Ganz), Bernese, Steele, Pemberton are types of periacetabular osteotomy
                              • Triple innominate osteotomy is most common
                                • Osteotomies of ilium, ischium, and pubis isolate acetabulum and allow realignment
                                • Allows adjustment of acetabular version, femoral head coverage
                            • Salter osteotomy
                              • Supraacetabular iliac osteotomy performed for DDH at age < 6 years
                              • Acetabulum, pubic bone, and ischium rotated on pubic symphysis
                            • Chiari (shelf) osteotomy
                              • Oblique supraacetabular osteotomy to improve depth of acetabulum in DDH
                              • Nonarticular lateral margin of ilium becomes lateral acetabular roof
                              • Performed in young children, rarely performed today
                            • Acetabular rim debridement ("rim trim")
                              • Labrum is detached, prominent bone is debrided, labrum is reattached
                            • Femoral osteochondroplasty (open or arthroscopic)
                              • Recontouring of femoral head/neck junction
                              • Improves head/neck offset in cam FAI
                              • Greater trochanteric osteotomy often performed with open procedure
                            • Subtrochanteric femoral osteotomy
                              • Performed in childhood to redirect femoral head into acetabulum

                          IMAGING

                          • Radiographic Findings

                            • CT Findings

                              • MR Findings

                                • Imaging Recommendations

                                  DIFFERENTIAL DIAGNOSIS

                                    CLINICAL ISSUES

                                    • Complications of Surgery

                                      Selected References

                                      1. Cvetanovich GL et al: Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes. Arthroscopy. 31(7):1382-90, 2015
                                      2. Dietrich TJ et al: Postoperative imaging in femoroacetabular impingement. Semin Musculoskelet Radiol. 17(3):272-8, 2013
                                      3. Bedi A et al: The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 40(4):854-63, 2012
                                      4. Clohisy JC et al: Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 468(2):555-64, 2010
                                      5. Rehan-Ul-Ha et al: An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum. Arch Orthop Trauma Surg. 130(1):65-70, 2010
                                      6. Beck M: Groin pain after open FAI surgery: the role of intraarticular adhesions. Clin Orthop Relat Res. 467(3):769-74, 2009
                                      7. Matheney T et al: Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 91(9):2113-23, 2009
                                      8. Parvizi J et al: Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 24(6 Suppl):110-3, 2009
                                      9. Vukasinovic Z et al: Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications. Hip Int. 19(4):315-22, 2009
                                      10. Murray KA et al: Radiographic imaging for treatment and follow-up of developmental dysplasia of the hip. Semin Ultrasound CT MR. 22(4):306-40, 2001