link
Bookmarks
FAI and Adult DDH: Postoperative Imaging
MK Jesse, MD; Julia R. Crim, MD
To access 4,300 diagnoses written by the world's leading experts in radiology.Try it free - 15 days
0
7
6
0

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
            • Nonarticular lateral margin of ilium becomes lateral acetabular roof
            • Performed in young children, rarely performed today
          • Acetabular rim debridement or acetabuloplasty ("rim trim")
            • Labrum is detached, prominent bone is debrided, labrum is reattached
          • Femoral osteochondroplasty (open or arthroscopic)
            • Recontouring of femoral head-neck junction
              • Usually anterolateral portion
            • Restores head-neck offset in cam FAI
            • Greater trochanter osteotomy often performed with open procedure
          • Subtrochanteric or derotational femoral osteotomy (DFO)
            • Improve femoral torsion angles to normalize femoral neck version
            • Varus angulation at osteotomy to redirect femoral head

        IMAGING

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  CLINICAL ISSUES

                  • Complications of Surgery

                    Selected References

                    1. Foreman SC et al: Postoperative MRI findings and associated pain changes after arthroscopic surgery for femoroacetabular impingement. AJR Am J Roentgenol. 214(1):177-84, 2020
                    2. Wells J et al: Are complications after the Bernese periacetabular osteotomy associated with subsequent outcomes scores? Clin Orthop Relat Res. 477(5):1157-63, 2019
                    3. Woyski D et al: Surgical treatment of labral tears: debridement, repair, reconstruction. Curr Rev Musculoskelet Med. 12(3):291-9, 2019
                    4. Kim CO et al: Arthroscopic hip surgery: frequency of postoperative MR arthrographic findings in asymptomatic and symptomatic patients. Radiology. 283(3):779-88, 2017
                    5. Cvetanovich GL et al: Revision hip arthroscopy: a systematic review of diagnoses, operative findings, and outcomes. Arthroscopy. 31(7):1382-90, 2015
                    6. Matsuda DK et al: Anchor-induced chondral damage in the hip. J Hip Preserv Surg. 2(1):56-64, 2015
                    7. Mei-Dan O et al: Arthroscopic anterior capsular reconstruction of the hip for recurrent instability. Arthrosc Tech. 4(6):e711-5, 2015
                    8. Dietrich TJ et al: Postoperative imaging in femoroacetabular impingement. Semin Musculoskelet Radiol. 17(3):272-8, 2013
                    9. Bedi A et al: The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 40(4):854-63, 2012
                    10. Clohisy JC et al: Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 468(2):555-64, 2010
                    11. 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
                    12. Beck M: Groin pain after open FAI surgery: the role of intraarticular adhesions. Clin Orthop Relat Res. 467(3):769-74, 2009
                    13. 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
                    14. 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
                    15. Vukasinovic Z et al: Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications. Hip Int. 19(4):315-22, 2009
                    16. Espinosa N et al: Extraarticular fractures after periacetabular osteotomy. Clin Orthop Relat Res. 466(7):1645-51, 2008
                    17. 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
                    Loading...
                    Related Differential Diagnoses
                    Loading...
                    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
                              • Nonarticular lateral margin of ilium becomes lateral acetabular roof
                              • Performed in young children, rarely performed today
                            • Acetabular rim debridement or acetabuloplasty ("rim trim")
                              • Labrum is detached, prominent bone is debrided, labrum is reattached
                            • Femoral osteochondroplasty (open or arthroscopic)
                              • Recontouring of femoral head-neck junction
                                • Usually anterolateral portion
                              • Restores head-neck offset in cam FAI
                              • Greater trochanter osteotomy often performed with open procedure
                            • Subtrochanteric or derotational femoral osteotomy (DFO)
                              • Improve femoral torsion angles to normalize femoral neck version
                              • Varus angulation at osteotomy to redirect femoral head

                          IMAGING

                          • Radiographic Findings

                            • CT Findings

                              • MR Findings

                                • Imaging Recommendations

                                  DIFFERENTIAL DIAGNOSIS

                                    CLINICAL ISSUES

                                    • Complications of Surgery

                                      Selected References

                                      1. Foreman SC et al: Postoperative MRI findings and associated pain changes after arthroscopic surgery for femoroacetabular impingement. AJR Am J Roentgenol. 214(1):177-84, 2020
                                      2. Wells J et al: Are complications after the Bernese periacetabular osteotomy associated with subsequent outcomes scores? Clin Orthop Relat Res. 477(5):1157-63, 2019
                                      3. Woyski D et al: Surgical treatment of labral tears: debridement, repair, reconstruction. Curr Rev Musculoskelet Med. 12(3):291-9, 2019
                                      4. Kim CO et al: Arthroscopic hip surgery: frequency of postoperative MR arthrographic findings in asymptomatic and symptomatic patients. Radiology. 283(3):779-88, 2017
                                      5. Cvetanovich GL et al: Revision hip arthroscopy: a systematic review of diagnoses, operative findings, and outcomes. Arthroscopy. 31(7):1382-90, 2015
                                      6. Matsuda DK et al: Anchor-induced chondral damage in the hip. J Hip Preserv Surg. 2(1):56-64, 2015
                                      7. Mei-Dan O et al: Arthroscopic anterior capsular reconstruction of the hip for recurrent instability. Arthrosc Tech. 4(6):e711-5, 2015
                                      8. Dietrich TJ et al: Postoperative imaging in femoroacetabular impingement. Semin Musculoskelet Radiol. 17(3):272-8, 2013
                                      9. Bedi A et al: The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 40(4):854-63, 2012
                                      10. Clohisy JC et al: Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 468(2):555-64, 2010
                                      11. 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
                                      12. Beck M: Groin pain after open FAI surgery: the role of intraarticular adhesions. Clin Orthop Relat Res. 467(3):769-74, 2009
                                      13. 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
                                      14. 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
                                      15. Vukasinovic Z et al: Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications. Hip Int. 19(4):315-22, 2009
                                      16. Espinosa N et al: Extraarticular fractures after periacetabular osteotomy. Clin Orthop Relat Res. 466(7):1645-51, 2008
                                      17. 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