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Postoperative Findings, Hip
Julia R. Crim, MD
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KEY FACTS

  • Imaging

    TERMINOLOGY

    • Definitions

      • To understand postoperative findings, need to understand basics of surgeries commonly performed
      • Periacetabular osteotomy (PAO)
        • Osteotomies of ilium, ischium, pubis
        • Acetabulum rotated to compensate for areas of deficient or excessive coverage
        • May be performed for developmental dysplasia (DDH) or femoroacetabular impingement (FAI)
      • Surgeries for FAI
        • Impinging lesions may be corrected with open, mini-open, or arthroscopic surgery
        • Femoral head recontouring (osteochondroplasty)
          • Resection of femoral head prominence thought to cause cam-type FAI
        • Acetabular trimming and labral advancement
          • Removes anterior acetabular bony prominence causing pincer-type FAI
          • Labrum first detached then reattached to debrided bony acetabulum
        • Greater trochanteric osteotomy
          • Performed to allow access to hip joint for open procedures
          • Fixed with 1-2 threaded screws
          • Do not mistake for fracture; diagonal, clean cut is distinctive
      • Surgeries for DDH
        • Salter osteotomy
          • Children < 6-8 years old
          • Osteotomy of supra-acetabular ilium, anterior bone wedge placed
          • Acetabulum rotated for increased anterior and lateral femoral head coverage
          • May result in over-coverage of femoral head anteriorly, predisposing to FAI
        • Chiari osteotomy
          • Supra-acetabular osteotomy with medialization of acetabulum relative to ilium
          • Causes limb length shortening
        • Valgus or varus-producing femoral osteotomies
          • Improve alignment of femoral head relative to triradiate cartilage
          • Shift weight bearing from abnormal areas of femoral head
          • MR artifact from retained blade plate may be severe
      • Slipped capital femoral epiphysis (SCFE) fixation
        • Usually fixed in situ, because attempted reduction can cause osteonecrosis
        • Contour deformity therefore not corrected and may cause FAI

    IMAGING

    • General Features

      • Imaging Recommendations

        • MR Findings

          CLINICAL ISSUES

          • Presentation

            • Natural History & Prognosis

              DIAGNOSTIC CHECKLIST

              • Image Interpretation Pearls

                Selected References

                1. Crim J: Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement. Skeletal Radiol. ePub, 2017
                2. Mills MK et al: Postoperative imaging in the setting of hip preservation surgery. Radiographics. 36(6):1746-1758, 2016
                3. Espinosa N et al: Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 89 Suppl 2 Pt, 2007
                4. Peters CL et al: Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 88(9):1920-6, 2006
                5. 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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                References
                Tables

                Tables

                KEY FACTS

                • Imaging

                  TERMINOLOGY

                  • Definitions

                    • To understand postoperative findings, need to understand basics of surgeries commonly performed
                    • Periacetabular osteotomy (PAO)
                      • Osteotomies of ilium, ischium, pubis
                      • Acetabulum rotated to compensate for areas of deficient or excessive coverage
                      • May be performed for developmental dysplasia (DDH) or femoroacetabular impingement (FAI)
                    • Surgeries for FAI
                      • Impinging lesions may be corrected with open, mini-open, or arthroscopic surgery
                      • Femoral head recontouring (osteochondroplasty)
                        • Resection of femoral head prominence thought to cause cam-type FAI
                      • Acetabular trimming and labral advancement
                        • Removes anterior acetabular bony prominence causing pincer-type FAI
                        • Labrum first detached then reattached to debrided bony acetabulum
                      • Greater trochanteric osteotomy
                        • Performed to allow access to hip joint for open procedures
                        • Fixed with 1-2 threaded screws
                        • Do not mistake for fracture; diagonal, clean cut is distinctive
                    • Surgeries for DDH
                      • Salter osteotomy
                        • Children < 6-8 years old
                        • Osteotomy of supra-acetabular ilium, anterior bone wedge placed
                        • Acetabulum rotated for increased anterior and lateral femoral head coverage
                        • May result in over-coverage of femoral head anteriorly, predisposing to FAI
                      • Chiari osteotomy
                        • Supra-acetabular osteotomy with medialization of acetabulum relative to ilium
                        • Causes limb length shortening
                      • Valgus or varus-producing femoral osteotomies
                        • Improve alignment of femoral head relative to triradiate cartilage
                        • Shift weight bearing from abnormal areas of femoral head
                        • MR artifact from retained blade plate may be severe
                    • Slipped capital femoral epiphysis (SCFE) fixation
                      • Usually fixed in situ, because attempted reduction can cause osteonecrosis
                      • Contour deformity therefore not corrected and may cause FAI

                  IMAGING

                  • General Features

                    • Imaging Recommendations

                      • MR Findings

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Crim J: Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement. Skeletal Radiol. ePub, 2017
                              2. Mills MK et al: Postoperative imaging in the setting of hip preservation surgery. Radiographics. 36(6):1746-1758, 2016
                              3. Espinosa N et al: Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 89 Suppl 2 Pt, 2007
                              4. Peters CL et al: Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 88(9):1920-6, 2006
                              5. 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