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Muri, Switzerland

Beck M.,Clinic for Orthopaedic Surgery | Buchler L.,University of Bern
Journal of Bone and Joint Surgery - Series A | Year: 2011

Background: Femoro-acetabular impingement can cause pain and degenerative changes of the hip joint. Traditionally, surgical dislocation of the hip joint has been performed for correction of pathologic abnormalities in the proximal part of the femur and the acetabulum. Failures of surgical treatment are often related to postoperative pain in the groin or in the area of the greater trochanter, associated with this surgical approach. The aim of our study was to determine the prevalence and functional impact of pain at the greater trochanter after surgical dislocation of the hip. Methods: Fifty consecutive patients in whom femoro-acetabular impingement had been treated with surgical dislocation of the hip at our institution were seen for clinical and radiographic follow-up at one year. The Merle d'Aubigné score was calculated preoperatively and at the time of follow-up. Pain in the groin or at the greater trochanter during activity and at rest was recorded. Results: The mean Merle d'Aubigné score significantly improved from 14.4 points preoperatively to 17 points postoperatively. Preoperatively, eight patients (16%) had pain over the greater trochanter. At one year after surgery, twenty-three (46%) had such pain; these patients were primarily female (seventeen of the twenty-three). The mean Merle d'Aubigné score was 17.4 points for the patients without groin pain and 16.1 points for those with groin pain. The presence or absence of pain at the greater trochanter had no significant influence on the outcome, but groin pain was associated with inferior results. Conclusions: Tenderness or pain over the greater trochanter is frequent after osteotomy of the greater trochanter and has a distinct female predominance. However, it has no significant negative influence on outcome. This is in contrast to groin pain, which is associated with inferior results. Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.

Buchler L.,University of Bern | Schwab J.M.,Medical College of Wisconsin | Whitlock P.W.,Cincinnati Childrens Hospital Medical Center | Beck M.,Clinic for Orthopaedic Surgery | Tannast M.,University of Bern
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2016

Purpose To compare quantitative measurements of acetabular morphology obtained using intraoperative fluoroscopy, to standardized anteroposterior (AP) pelvis radiographs. Methods Ten dried human pelvis specimens (20 hips) were imaged using hip-centered fluoroscopy and standardized AP pelvis radiographs. Each hip was evaluated for acetabular version and coverage, including lateral center edge (LCE) angle, acetabular index (AI), total anterior and posterior coverage, and crossover sign. Results No statistically significant differences existed between the mean LCE angle (fluoroscopy 36.5° ± 8.3° v plain films 36.1° ± 7.9°, P =.59), acetabular index (0.6° ± 8.6° v 0.2° ± 7.1°, P =.61), ACM angle (44.0° ± 2.6° v 44.1° ± 3.8°, P =.89), Sharp's angle (31.8° ± 5.7° v 32.4° ± 3.9°, P =.44), and the total femoral coverage (80.9% ± 6.4% v 80.7% ± 7.5%, P =.83). Conversely, total anterior coverage (30.7% ± 8.5% v 33.3% ± 8.2%, P <.0001) appeared significantly decreased and the total posterior coverage (54.1% ± 6.9% v 49.1% ± 7.8%, P <.0001) appeared significantly increased in fluoroscopy compared with plain film radiographs. Fluoroscopy also failed to identify the presence of a crossover sign in 30% and underestimated the retroversion index (9% ± 16%, v 13% ± 16%, P =.016). Conclusions The values for the LCE angle and AI determined by hip-centered fluoroscopy did not differ from those obtained by standardized AP plain film radiography. However, fluoroscopy leads to a more anteverted projection of the acetabulum with significantly decreased total anterior coverage, significantly increased total posterior coverage, and underestimated signs of retroversion compared with standardized AP pelvis radiography. Clinical Relevance This study shows reliable LCE and AI angles but significant differences in the projected anteversion of the acetabulum between standardized AP pelvis radiography and hip-centered fluoroscopy. © 2016 Arthroscopy Association of North America.

Buchler L.,University of Bern | Neumann M.,Zieglerspital | Schwab J.M.,University of Bern | Iselin L.,Clinic for Orthopaedic Surgery | And 2 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The purpose of this study was to evaluate if osseous correction of the femoral neck achieved arthroscopically is comparable to that achieved by surgical dislocation. Methods: We retrospectively analyzed all patients who were treated with hip arthroscopy or surgical dislocation for cam or mixed type femoroacetabular impingement (FAI) in our institution between 2006 and 2009. Inclusion criteria were complete clinical and radiologic documentation with standardized radiographs. Group 1 consisted of 66 patients (49 female patients, mean age 33.8 years) treated with hip arthroscopy. Group 2 consisted of 135 patients (91 male patients, mean age 31.2 years) treated with surgical hip dislocation. We compared the preoperative and postoperative alpha and gamma angles, as well as the triangular index. Mean follow-up was 16.7 months (range, 2 to 79 months). Results: In group 1, the mean alpha angle improved from 60.7° preoperatively to 47.8° postoperatively (P <.001) and the mean gamma angle improved from 47.3° to 44.5° (P <.001). Over time, the preoperative mean alpha angle increased from 56.3° in 2006 to 67.5° in 2009, whereas the postoperative mean alpha angle decreased from 51.2° in 2006 to 47.5° in 2009. In group 2, the mean alpha angle improved from 75.3° preoperatively to 44.8° postoperatively (P <.001), and the mean gamma angle improved from 65.1° to 52.2° (P <.001). Arthroscopic revision of intra-articular adhesions was performed in 4 patients (6.1%) in group 1 and 16 patients (12%) in group 2. Three patients (2.2%) in group 2 underwent revision for nonunion of the greater trochanter. Conclusions: Osseous correction of cam-type FAI with hip arthroscopy is comparable to the correction achieved by surgical hip dislocation. There is a significant learning curve for hip arthroscopy, with postoperative osseous correction showing improved results with increasing surgical experience. Level of Evidence: Level III, retrospective comparative study. © 2013 by the Arthroscopy Association of North America.

Konrad G.,Orthopaedic and Trauma Surgery | Audige L.,AO Clinical Investigation and Documentation | Lambert S.,Shoulder and Elbow Service | Hertel R.,Clinic for Orthopaedic Surgery | Sudkamp N.P.,Albert Ludwigs University of Freiburg
Clinical Orthopaedics and Related Research | Year: 2012

Background: There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures. Questions/purposes: The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures. Patients and Methods: Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts. Results: Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure. Conclusions: The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant. Level of Evidence: Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons®.

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