The Journal of Bone and Joint Surgery (American) 85:278-286 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Anterior Femoro-Acetabular Impingement Due to Acetabular Retroversion
Treatment with Periacetabular Osteotomy
K. A. Siebenrock, MD,
R. Schoeniger, MD and
R. Ganz, MD
Investigation performed at the Department of Orthopaedic Surgery, University of Berne, Berne, Switzerland
K.A. Siebenrock, MD
R. Schoeniger, MD
R. Ganz, MD
Department of Orthopaedic Surgery, University of Berne, Inselspital, 3010 Berne, Switzerland. E-mail address for K.A. Siebenrock: klaus.siebenrock{at}insel.ch
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy.
Methods: The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigné and Postel, and the anterior center-edge angle of Lequesne and de Sèze was measured on radiographs preoperatively and at the time of the latest follow-up.
Results: The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Sèze decreased significantly from a preoperative average of 36° (range, 26° to 52°) to a postoperative average of 28° (range, 16° to 46°) (p = 0.002). There was a significant increase in the average range of internal rotation (10°, p = 0.006), flexion (7°, p = 0.014), and adduction (8°, p = 0.017). The average Merle d'Aubigné score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement.
Conclusion: Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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