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Article ; Online: What Is the Influence of Femoral Version on Size, Tear Location, and Tear Pattern of the Acetabular Labrum in Patients With FAI?

Heimann, Alexander F / Todorski, Inga Almut Senta / Schmaranzer, Florian / Viganò, Martino / Lerch, Till D / Schwab, Joseph M / Steppacher, Simon D / Tannast, Moritz

Clinical orthopaedics and related research

2024

Abstract: Background: Femoral version deformities have recently been identified as a major contributor to femoroacetabular impingement (FAI). An in-depth understanding of the specific labral damage patterns caused by femoral version deformities may help to ... ...

Abstract	Background: Femoral version deformities have recently been identified as a major contributor to femoroacetabular impingement (FAI). An in-depth understanding of the specific labral damage patterns caused by femoral version deformities may help to understand the underlying pathomorphologies in symptomatic patients and select the appropriate surgical treatment. Questions/purposes: We asked: (1) Is there a correlation between femoral version and the mean cross-sectional area of the acetabular labrum? (2) Is there a difference in the location of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? (3) Is there a difference in the pattern of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? Methods: This was a retrospective, comparative study. Between November 2009 and September 2016, we evaluated 640 hips with FAI. We considered patients with complete diagnostic imaging including magnetic resonance arthrography (MRA) of the affected hip with radial slices of the proximal femur and axial imaging of the distal femoral condyles (allowing for calculation of femoral version) as eligible. Based on that, 97% (620 of 640 hips) were eligible; a further 77% (491 of 640 hips) were excluded because they had either normal femoral version (384 hips), incomplete imaging (20 hips), a lateral center-edge angle < 22° (43 hips) or > 39° (16 hips), age > 50 years (8 hips), or a history of pediatric hip disease (20 hips), leaving 20% (129 of 640 hips) of patients with a mean age of 27 ± 9 years for analysis, and 61% (79 of 129 hips) were female. Patients were assigned to either the increased (> 30°) or decreased (< 5°) femoral version group. The labral cross-sectional area was measured on radial MR images in all patients. The location-dependent labral cross-sectional area, presence of labral tears, and labral tear patterns were assessed using the acetabular clockface system and compared among groups. Results: In hips with increased femoral version, the labrum was normal in size (21 ± 6 mm2 [95% confidence interval 20 to 23 mm2]), whereas hips with decreased femoral version showed labral hypotrophy (14 ± 4 mm2 [95% CI 13 to 15 mm2]; p < 0.01). In hips with increased femoral version, labral tears were located more anteriorly (median 1:30 versus 12:00; p < 0.01). Hips with increased femoral version exhibited damage of the anterior labrum with more intrasubstance tears anterosuperiorly (17% [222 of 1322] versus 9% [93 of 1084]; p < 0.01) and partial tears anteroinferiorly (22% [36 of 165] versus 6% [8 of 126]; p < 0.01). Hips with decreased femoral version showed superior labral damage consisting primarily of partial labral tears. Conclusion: In the evaluation of patients with FAI, the term "labral tear" is not accurate enough to describe labral pathology. Based on high-quality radial MR images, surgeons should always evaluate the combination of labral tear location and labral tear pattern, because these may provide insight into associated femoral version abnormalities, which can inform appropriate surgical treatment. Future studies should examine symptomatic patients with normal femoral version, as well as an asymptomatic control group, to describe the effect of femoral version on labral morphology across the entire spectrum of pathomorphologies. Level of evidence: Level III, prognostic study.
Language	English
Publishing date	2024-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/CORR.0000000000002961
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Article: MR-based Bony 3D models enable radiation-free preoperative patient-specific analysis and 3D printing for SCFE patients.

Lerch, Till D / Kaim, Tilman / Grob, Valentin / Hanke, Markus / Schmaranzer, Florian / Steppacher, Simon D / Busch, Jasmin D / Ziebarth, Kai

Journal of children's orthopaedics

2024 Volume 18, Issue 2, Page(s) 162–170

Abstract: Objectives: Slipped capital femoral epiphyses (SCFE) is a common pediatric hip disease with the risk of osteoarthritis and impingement deformities, and 3D models could be useful for patient-specific analysis. Therefore, magnetic resonance imaging (MRI) ... ...

Abstract	Objectives: Slipped capital femoral epiphyses (SCFE) is a common pediatric hip disease with the risk of osteoarthritis and impingement deformities, and 3D models could be useful for patient-specific analysis. Therefore, magnetic resonance imaging (MRI) bone segmentation and feasibility of 3D printing and of 3D ROM simulation using MRI-based 3D models were investigated. Methods: A retrospective study involving 22 symptomatic patients (22 hips) with SCFE was performed. All patients underwent preoperative hip MR with pelvic coronal high-resolution images (T1 images). Slice thickness was 0.8-1.2 mm. Mean age was 12 ± 2 years (59% male patients). All patients underwent surgical treatment. Semi-automatic MRI-based bone segmentation with manual corrections and 3D printing of plastic 3D models was performed. Virtual 3D models were tested for computer-assisted 3D ROM simulation of patients with knee images and were compared to asymptomatic contralateral hips with unilateral SCFE (15 hips, control group). Results: MRI-based bone segmentation was feasible (all patients, 100%, in 4.5 h, mean 272 ± 52 min). Three-dimensional printing of plastic 3D models was feasible (all patients, 100%) and was considered helpful for deformity analysis by the treating surgeons for severe and moderate SCFE. Three-dimensional ROM simulation showed significantly (p < 0.001) decreased flexion (48 ± 40°) and IR in 90° of flexion (-14 ± 21°, IRF-90°) for severe SCFE patients with MRI compared to control group (122 ± 9° and 36 ± 11°). Slip angle improved significantly (p < 0.001) from preoperative 54 ± 15° to postoperative 4 ± 2°. Conclusion: MRI-based 3D models were feasible for SCFE patients. Three-dimensional models could be useful for severe SCFE patients for preoperative 3D printing and deformity analysis and for ROM simulation. This could aid for patient-specific diagnosis, treatment decisions, and preoperative planning. MRI-based 3D models are radiation-free and could be used instead of CT-based 3D models in the future.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2279410-4
ISSN	1863-2548 ; 1863-2521
ISSN (online)	1863-2548
ISSN	1863-2521
DOI	10.1177/18632521241229618
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Article ; Online: Therapieentscheidung bei Kombinationspathologien Dysplasie – FAI – Fehlrotation : Wann und wieviel sollte korrigiert werden?

Vuillemin, Nicolas / Steppacher, Simon D / Meier, Malin K / Büchler, Lorenz

Orthopadie (Heidelberg, Germany)

2022 Volume 51, Issue 6, Page(s) 438–449

Abstract: Background: Hip dysplasia, FAI and femoral malrotation often occur together, resulting in mixed symptoms and severe biomechanical limitations of the hip.: Objectives: To report on the current recommendations for the best possible diagnosis and ... ...

Title translation	Treatment strategies for the combination of hip dysplasia, femoroacetabular impingement and malrotation of the proximal femur : How much should be corrected?
Abstract	Background: Hip dysplasia, FAI and femoral malrotation often occur together, resulting in mixed symptoms and severe biomechanical limitations of the hip. Objectives: To report on the current recommendations for the best possible diagnosis and treatment strategies of combination pathologies in hip-preserving surgery. Methods: Review and discussion of the relevant literature with consideration of own experience in the treatment of complex combined pathomorphologies of the hip. Results: Patient history and a thorough clinical examination are key for determining the predominant pathomorphologies causing the symptoms. Standardized conventional ap pelvic and axial images of the hip are the basis for the radiological assessment of the hip, supplemented with MRI, CT and animations of the hip, depending on the case. As the pathologies influence each other functionally, a stepwise approach to treatment is recommended. The functionally most relevant pathology is treated first, followed by further corrections as needed. The primary goal is to achieve a stable hip with normal acetabular coverage, followed by an impingement-free range of motion and normalized musculoskeletal function. Care must be taken in the choice of surgical method to ensure that all pathologies can be adequately treated. Conclusion: Complex, combined pathologies of the hip can be treated sufficiently with hip-preserving surgery. A thorough diagnosis is important in order to recognize the functional interaction of the different pathologies. The goal of the surgical therapy is a correctly covered, stable hip with a normal range of motion.
MeSH term(s)	Acetabulum/pathology ; Femoracetabular Impingement/diagnostic imaging ; Femur/diagnostic imaging ; Hip Dislocation/diagnostic imaging ; Hip Dislocation, Congenital/pathology ; Hip Joint/diagnostic imaging ; Humans
Language	German
Publishing date	2022-05-23
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2731-7153
ISSN (online)	2731-7153
DOI	10.1007/s00132-022-04252-7
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Article ; Online: High treatment failure rate in haematogenous compared to non-haematogenous periprosthetic joint infection.

Knoll, Leonard / Steppacher, Simon D / Furrer, Hansjakob / Thurnheer-Zürcher, Maria C / Renz, Nora

The bone & joint journal

2023 Volume 105-B, Issue 12, Page(s) 1294–1302

Abstract: Aims: A higher failure rate has been reported in haematogenous periprosthetic joint infection (PJI) compared to non-haematogenous PJI. The reason for this difference is unknown. We investigated the outcome of haematogenous and non-haematogenous PJI to ... ...

Abstract	Aims: A higher failure rate has been reported in haematogenous periprosthetic joint infection (PJI) compared to non-haematogenous PJI. The reason for this difference is unknown. We investigated the outcome of haematogenous and non-haematogenous PJI to analyze the risk factors for failure in both groups of patients. Methods: Episodes of knee or hip PJI (defined by the European Bone and Joint Infection Society criteria) treated at our institution between January 2015 and October 2020 were included in a retrospective PJI cohort. Episodes with a follow-up of > one year were stratified by route of infection into haematogenous and non-haematogenous PJI. Probability of failure-free survival was estimated using the Kaplan-Meier method, and compared between groups using log-rank test. Univariate and multivariate analysis was applied to assess risk factors for failure. Results: A total of 305 PJI episodes (174 hips, 131 knees) were allocated to the haematogenous (n = 146) or the non-haematogenous group (n = 159). Among monomicrobial infections, Conclusion: Treatment failure was significantly higher in haematogenous compared to non-haematogenous PJI. Retention of the prosthesis was the only independent risk factor for failure in both groups.
MeSH term(s)	Humans ; Prosthesis-Related Infections/therapy ; Prosthesis-Related Infections/surgery ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use ; Treatment Failure ; Hip Joint/surgery ; Arthroplasty, Replacement, Hip/adverse effects
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-12-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.105B12.BJJ-2023-0454.R1
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Article ; Online: Retrotilt of the Pelvis During Periacetabular Osteotomy: How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement.

Vuillemin, Nicolas / Meier, Malin Kristin / Moosmann, Angela Maria / Siebenrock, Klaus Arno / Steppacher, Simon Damian

The American journal of sports medicine

2023 Volume 51, Issue 5, Page(s) 1224–1233

Abstract: Background: Pelvic tilt directly influences acetabular version on radiographs. Changes of pelvic tilt potentially affect acetabular reorientation after periacetabular osteotomy (PAO).: Purpose: (1) To compare the ratio of the pubic symphysis height ... ...

Abstract	Background: Pelvic tilt directly influences acetabular version on radiographs. Changes of pelvic tilt potentially affect acetabular reorientation after periacetabular osteotomy (PAO). Purpose: (1) To compare the ratio of the pubic symphysis height to the sacroiliac width (PS-SI) between hips with dysplasia and acetabular retroversion, uni- and bilateral PAO, and male and female patients. (2) To evaluate pelvic tilt (quantified using the PS-SI ratio) in patients after PAO by tracking it from preoperative to intra- and postoperative and short- and middle-term follow-up. Study design: Case series; Level of evidence, 4. Methods: A retrospective and radiographic study was conducted evaluating pelvic tilt in 124 patients (139 hips) with dysplasia and 46 patients (57 hips) with acetabular retroversion who were undergoing PAO (January 2005-December 2019). Patients were excluded if they had insufficient radiographic data, previous or concomitant hip surgery, posttraumatic or pediatric deformities, or combined dysplasia and retroversion (90 patients, 95 hips). Dysplasia was defined as a lateral center-edge angle <23°; retroversion was defined by simultaneous appearance of a retroversion index 30% and positive ischial spine and posterior wall signs. Anteroposterior pelvic radiographs were taken in the supine position preoperatively, during PAO, postoperatively, and at short- and middle-term follow-up (mean ± SD [range]; 9 ± 3 weeks [5-23 weeks] and 21 ± 21 weeks [6-125 months]). The PS-SI ratio was calculated at 5 observation periods (preoperatively to middle-term follow-up) for different subgroups (dysplasia vs retroversion, uni- vs bilateral surgery, male vs female) and validated with intra- and interobserver agreement (intraclass correlation coefficients, 0.984 (95%CI, 0.976-0.989) and 0.991 (95% CI, 0.987-0.994), respectively). Results: The PS-SI ratio differed between dysplasia and retroversion at all observation periods ( Conclusion: A lower PS-SI ratio was found for male or dysplastic hips. In all subgroups, the PS-SI ratio decreased during surgery, indicating retrotilt of the pelvis. Correct pelvic orientation during surgery is crucial for accurate acetabular reorientation. Retrotilt during surgery results in underestimation of acetabular version and iatrogenic retroversion of the acetabulum at follow-up, with the pelvis in the correct and more forward-tilted orientation. Not taking into account retrotilt during PAO potentially results in femoroacetabular impingement. Therefore, we changed our intraoperative setting with adjustment of the central beam to compensate for retrotilt of the pelvis.
MeSH term(s)	Humans ; Male ; Female ; Child ; Acetabulum/diagnostic imaging ; Acetabulum/surgery ; Femoracetabular Impingement/diagnostic imaging ; Femoracetabular Impingement/surgery ; Retrospective Studies ; Pelvis/diagnostic imaging ; Pelvis/surgery ; Hip Joint/diagnostic imaging ; Hip Joint/surgery ; Hip Joint/abnormalities ; Osteotomy/methods ; Treatment Outcome
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231155201
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Article ; Online: Development of acetabular retroversion in LCPD hips-an observational radiographic study from early stage to healing.

Leibold, Christiane Sylvia / Whitlock, Patrick / Schmaranzer, Florian / Ziebarth, Kai / Tannast, Moritz / Steppacher, Simon Damian

Archives of orthopaedic and trauma surgery

2022 Volume 143, Issue 7, Page(s) 3945–3956

Abstract: Background: Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured ... ...

Abstract	Background: Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters. Methods: In a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion. Results: Both parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip. Conclusions: This is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version. Level of evidence: Level III, retrospective observational study.
MeSH term(s)	Child ; Humans ; Child, Preschool ; Acetabulum/diagnostic imaging ; Acetabulum/surgery ; Legg-Calve-Perthes Disease/diagnostic imaging ; Retrospective Studies ; Hip ; Hip Joint/surgery
Language	English
Publishing date	2022-10-23
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-022-04612-0
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Article ; Online: Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease.

Leibold, Christiane Sylvia / Vuillemin, Nicolas / Büchler, Lorenz / Siebenrock, Klaus Arno / Steppacher, Simon Damian

Operative Orthopadie und Traumatologie

2022 Volume 34, Issue 5, Page(s) 352–360

Abstract: Objective: Correction of post-LCP (Legg-Calve-Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the ... ...

Title translation	Chirurgische Hüftluxation mit relativer Schenkelhalsverlängerung und retinakulärem Weichteillappen zur Behandlung von residueller Deformität nach Morbus Perthes.
Abstract	Objective: Correction of post-LCP (Legg-Calve-Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the native hip joint. Indications: Typical post-LCP deformity with external and internal hip impingement due to aspherical enlarged femoral head and shortened femoral neck with high riding trochanter major without advanced osteoarthritis (Tönnis classification ≤ 1) in the younger patient (age < 50 years). Contraindications: Advanced global osteoarthritis (Tönnis classification ≥ 2). Surgical technique: By performing surgical hip dislocation, full access to the hip joint is gained which allows intra-articular corrections like cartilage and labral repair. Relative femoral neck lengthening involves osteotomy and distalization of the greater trochanter with reduction of the base of the femoral neck, while maintaining vascular perfusion of the femoral head by creation of a retinacular soft-tissue flap. Postoperative management: Immediate postoperative mobilization on a passive motion device to prevent capsular adhesions. Patients mobilized with partial weight bearing of 15 kg with the use of crutches for at least 8 weeks. Results: In all, 81 hips with symptomatic deformity of the femoral head after healed LCP disease were treated with surgical hip dislocation and offset correction between 1997 and 2020. The mean age at operation was 23 years; mean follow-up was 9 years; 11 hips were converted to total hip arthroplasty and 1 patient died 1 year after the operation. The other 67 hips showed no or minor progression of arthrosis. Complications were 2 subluxations due to instability and 1 pseudarthrosis of the lesser trochanter; no hip developed avascular necrosis.
MeSH term(s)	Adult ; Disease Progression ; Femur Neck/diagnostic imaging ; Femur Neck/surgery ; Hip Dislocation/diagnostic imaging ; Hip Dislocation/surgery ; Hip Joint/diagnostic imaging ; Hip Joint/surgery ; Humans ; Legg-Calve-Perthes Disease/complications ; Legg-Calve-Perthes Disease/diagnostic imaging ; Legg-Calve-Perthes Disease/surgery ; Middle Aged ; Osteoarthritis/complications ; Osteotomy ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2022-08-05
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1007514-8
ISSN	1439-0981 ; 0934-6694
ISSN (online)	1439-0981
ISSN	0934-6694
DOI	10.1007/s00064-022-00780-9
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Article ; Online: Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison.

Meier, Malin K / Wagner, Moritz / Brunner, Alexander / Lerch, Till D / Steppacher, Simon D / Vavron, Peter / Schmaranzer, Ehrenfried / Schmaranzer, Florian

European radiology

2023 Volume 33, Issue 9, Page(s) 6369–6380

Abstract: Objective: To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution.: Methods: IRB-approved retrospective study of 140 age and ... ...

Abstract	Objective: To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution. Methods: IRB-approved retrospective study of 140 age and sex-matched symptomatic patients with femoroacetabular impingement, who either underwent intra-articular injection of 15-20 mL gadopentetate dimeglumine (GBCA), 2.0 mmol/L ("GBCA-MRA" group, n = 70), or 0.9% saline solution ("Saline-MRA" group, n = 70) for preoperative hip MRA and subsequent hip arthroscopy. 1.5 T hip MRA was performed including leg traction. Two readers assessed image quality using a 5-point Likert scale (1-5, excellent-poor), labrum and femoroacetabular cartilage lesions. Arthroscopic diagnosis was used to calculate diagnostic accuracy which was compared between groups with Fisher's exact tests. Image quality was compared with the Mann-Whitney U tests. Results: Mean age was 33 years ± 9, 21% female patients. Image quality was excellent (GBCA-MRA mean range, 1.1-1.3 vs 1.1-1.2 points for Saline-MRA) and not different between groups (all p > 0.05) except for image contrast which was lower for Saline-MRA group (GBCA-MRA 1.1 ± 0.4 vs Saline-MRA 1.8 ± 0.5; p < 0.001). Accuracy was high for both groups for reader 1/reader 2 for labrum (GBCA-MRA 94%/ 96% versus Saline-MRA 96%/93%; p > 0.999/p = 0.904) and acetabular (GBCA-MRA 86%/ 83% versus Saline-MRA 89%/87%; p = 0.902/p = 0.901) and femoral cartilage lesions (GBCA-MRA 97%/ 99% versus Saline-MRA 97%/97%; both p > 0.999). Conclusion: Diagnostic accuracy and image quality of Saline-MRA and GBCA-MRA is high in assessing chondrolabral lesions underlining the potential role of non-gadolinium-based hip MRA. Key points: • Image quality of Saline-MRA and GBCA-MRA was excellent for labrum, acetabular and femoral cartilage, ligamentum teres, and the capsule (all p > 0.18). • The overall image contrast was lower for Saline-MRA (Saline-MRA 1.8 ± 0.5 vs. GBCA-MRA 1.1 ± 0.4; p < 0.001). • Diagnostic accuracy was high for Saline-MRA and GBCA-MRA for labrum (96% vs. 94%; p > 0.999), acetabular cartilage damage (89% vs. 86%; p = 0.902), femoral cartilage damage (97% vs. 97%; p > 0.999), and extensive cartilage damage (97% vs. 93%; p = 0.904).
MeSH term(s)	Humans ; Female ; Adult ; Male ; Arthrography/methods ; Hip Joint/diagnostic imaging ; Hip Joint/pathology ; Contrast Media/pharmacology ; Pilot Projects ; Gadolinium/pharmacology ; Retrospective Studies ; Saline Solution ; Cartilage, Articular/diagnostic imaging ; Cartilage, Articular/pathology ; Acetabulum/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Arthroscopy/methods
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT) ; Saline Solution
Language	English
Publishing date	2023-04-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-023-09586-0
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Article ; Online: Correction: Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison.

Meier, Malin K / Wagner, Moritz / Brunner, Alexander / Lerch, Till D / Steppacher, Simon D / Vavron, Peter / Schmaranzer, Ehrenfried / Schmaranzer, Florian

European radiology

2023 Volume 33, Issue 12, Page(s) 9481

Language	English
Publishing date	2023-07-05
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-023-09844-1
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Article: Hip Impingement of severe SCFE patients after in situ pinning causes decreased flexion and forced external rotation in flexion on 3D-CT.

Lerch, Till D / Kim, Young-Jo / Kiapour, Ata / Boschung, Adam / Steppacher, Simon D / Tannast, Moritz / Siebenrock, Klaus A / Novais, Eduardo N

Journal of children's orthopaedics

2023 Volume 17, Issue 5, Page(s) 411–419

Abstract: Introduction: In situ pinning is an accepted treatment for stable slipped capital femoral epiphysis. However, residual deformity of severe slipped capital femoral epiphysis can cause femoroacetabular impingement and forced external rotation.: Purpose/ ... ...

Abstract	Introduction: In situ pinning is an accepted treatment for stable slipped capital femoral epiphysis. However, residual deformity of severe slipped capital femoral epiphysis can cause femoroacetabular impingement and forced external rotation. Purpose/questions: The aim of this study was to evaluate the (1) hip external rotation and internal rotation in flexion, (2) hip impingement location, and (3) impingement frequency in early flexion in severe slipped capital femoral epiphysis patients after in situ pinning using three-dimensional computed tomography. Patients and methods: A retrospective Institutional Review Board-approved study evaluating 22 patients (26 hips) with severe slipped capital femoral epiphysis (slip angle > 60°) using postoperative three-dimensional computed tomography after in situ pinning was performed. Mean age at slipped capital femoral epiphysis diagnosis was 13 ± 2 years (58% male, four patients bilateral, 23% unstable, 85% chronic). Patients were compared to contralateral asymptomatic hips (15 hips) with unilateral slipped capital femoral epiphysis (control group). Pelvic three-dimensional computed tomography after in situ pinning was used to generate three-dimensional models. Specific software was used to determine range of motion and impingement location (equidistant method). And 22 hips (85%) underwent subsequent surgery. Results: (1) Severe slipped capital femoral epiphysis patients had significantly (p < 0.001) decreased hip flexion (43 ± 40°) and internal rotation in 90° of flexion (-16 ± 21°, IRF-90°) compared to control group (122 ± 9° and 36 ± 11°). (2) Femoral impingement in maximal flexion was located anterior to anterior-superior (27% on 3 o'clock and 27% on 1 o'clock) of severe slipped capital femoral epiphysis patients and located anterior to anterior-inferior (38% on 3 o'clock and 35% on 4 o'clock) in IRF-90°. (3) However, 21 hips (81%) had flexion < 90° and 22 hips (85%) had < 10° of IRF-90° due to hip impingement and 21 hips (81%) had forced external rotation in 90° of flexion (< 0° of IRF-90°). Conclusion: After in situ pinning, patient-specific three-dimensional models showed restricted flexion and IRF-90° and forced external rotation in 90° of flexion due to early hip impingement and residual deformity in most of the severe slipped capital femoral epiphysis patients. This could help to plan subsequent hip preservation surgery, such as hip arthroscopy or femoral (derotation) osteotomy.
Language	English
Publishing date	2023-08-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2279410-4
ISSN	1863-2548 ; 1863-2521
ISSN (online)	1863-2548
ISSN	1863-2521
DOI	10.1177/18632521231192462
Database	MEDical Literature Analysis and Retrieval System OnLINE

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