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TREATMENT OF ANTERIOR FEMOROACETABULAR IMPINGEMENT

WITH COMBINED HIP ARTHROSCOPY AND
LIMITED ANTERIOR DECOMPRESSION

John C. Clohisy, M.D. and J. Thomas McClure, M.D.

ABSTRACT symptoms was noted after surgical treatment of the
Anterior femoroacetabular impingement results anterior impingement lesion.
from abnormal abutment of the anterolateral femo- Although anterior femoroacetabular impingement
ral head-neck junction with the anterior acetabu- was initially described as a complication of surgery and
lar-labral complex resulting in pain and progres- noted to be secondary to several other deformities, it
sive hip dysfunction. This under-recognized has recently and appropriately been recognized as a
problem could be the manifestation of acetabular disease process unto itself and as a significant cause of
or proximal femoral deformity, and when left un- hip pain in younger patients.1,5,23,34,38 Femoroacetabular
treated leads to the development of osteoarthritis abutment is classified as either pincer or cam impinge-
of the hip. Conser vative treatment is usually un- ment.5 Pincer-type impingement has been associated
successful and the optimal surgical treatment for with acetabular retroversion,32 protrusio acetabuli, and
these disorders needs to be determined. We coxa profunda33 due to the relative over-coverage by the
present our technique for treating femoral (cam) anterior rim producing a linear contact between the rim
impingement which combines hip arthroscopy and and femoral neck.5 Cam impingement is the result of
a limited open anterior head-neck osteoplasty as decreased head-neck offset with a gradual aspherical
a less invasive and more conser vative surgical contour from the femoral head to the neck
approach, which still adequately addresses the anterolaterally with a relative retroversion of the femo-
anatomy and pathophysiology of this disease. ral head.10,34 This results in an increased radius of cur-
vature anteriorly with a triangular shaped extension of
INTRODUCTION bone and articular cartilage onto the femoral neck. This
Impingement of the femoral neck on the anterior rim osteochondral lesion impacts the acetabular rim with
of the acetabulum (anterior femoroacetabular impinge- flexion and internal rotation of the hip.34 The suspected
ment) has been described in conjunction with malunited etiology of this lesion is abnormal physeal development
femoral neck fractures,3 acetabular dysplasia,12 acetabu- 6,20,28
but it can also occur in slipped capital femoral epi-
lar retroversion,32,33 and as a complication of peria- physis (SCFE),15,30 Legg-Calve-Perthes disease, and
cetabular osteotomy.25 Increasingly, it is being recog- malunited femoral neck fractures.3
nized as a cause of significant hip pain and disability Interestingly, the histopathological and morphologi-
and is strongly implicated as a cause of secondary os- cal changes seen in the labrum and cartilage with both
teoarthritis.5,6,23 In 1999, Ganz and colleagues reported cam and pincer impingements are similar to and con-
the development of a secondary impingement syndrome sistent with chronic degeneration without signs of acute
as a complication of periacetabular osteotomy.25 The inflammation9 and an etiology of repetitive microtrauma.
femoral head-neck junction abutted the anterior rim of Impingement of the femoral head-neck prominence onto
the acetabulum leading to pain in five patients after re- the acetabular rim initially leads to hypertrophy of the
positioning of the dysplastic acetabulum. Most impor- anterior-superior labrum with intrasubstance degenera-
tantly, successful resolution of anterior impingement tion. Over time, delamination of the acetabular cartilage
of the superior acetabular rim-labral junction occurs, and
degenerative labral tears are produced anteriorly by
repetitive compression and sheer forces. As the femo-
Department of Orthopedic Surgery
Barnes-Jewish Hospital / Washington University School of ral head levers out of the acetabulum with flexion, a
Medicine distraction force occurs on the posterior capsular-labral
St. Louis, Missouri junction resulting in the development of a posterior
Correspondence: counter-lesion with small tears noted in the posterior
John C. Clohisy, MD labrum. As severity of the disease progresses, the en-
660 South Euclid, Campus Box 8233
St. Louis, MO 63110 tire labrum becomes degenerative with further delami-
Telephone: 314-747-2566 nation of the acetabular articular cartilage and subse-
FAX: 314-747-2599 quent wear damage to the anterior portion of the
jclohisy@msnotes.wustl.edu

164 The Iowa Orthopaedic Journal

After characterization of the Figure 2b patient history and symptoms. CLINICAL AND RADIOGRAPHIC EVALUATION OF ANTERIOR FEMOROACETABULAR IMPINGEMENT Histor y Anterior femoroacetabular impingement usually pre- sents in young athletic patients less than 50 years old and involved in activities that require repetitive hip flex- ion. The end result of this process is the de- velopment of global hip arthrosis (Figure 1). arthroscopy and a limited osteoplasty of the anterior head-neck junction. catching. less. patients may complain of mechanical symptoms (locking. a careful physical exami- nation is critical. Therefore. symptomatic anterior femoroacetabular impingement. femoral head. it is impor- tant to elicit any history of previous hip disease or hip surgery. and giving way) indicative of labral tears or articular cartilage delamination lesions. spe- cifically limited hip flexion and limited internal rotation in flexion. Case Example—A 21-year old collegiate wrestler with purpose of this report is to describe an alternative. Spe. Volume 25 165 . Note the aspherical femoral heads bi- laterally. Patients with more severe defor- mity may also complain of restricted hip motion. Eighteen-month femoroacetabular impingent that combines hip follow-up frog lateral. These patients frequently complain of hip discom- fort with sitting and hip flexion activities. AP (a) and frog-leg lateral (b) radiographs demonstrate an aspherical femoral invasive surgical strategy for the treatment of early head with deficient head-neck offset anterolaterally. Early surgical intervention has been proposed to avert the pathologic sequence of events starting with impingement and resulting in end-stage arthrosis. Anterior femoroacetabular impingement is consistently associated with anterior labral pathology. but can be associated with buttock and lower lumbar discomfort. especially SCFE. Radiograph demonstrating severe arthrosis of the right hip secondar y to untreated femoroacetabular impingement in a thirty-eight year old patient.4 The Figure 2. When interviewing the patient. The location of the discomfort is predominantly in the groin (ante- rior inguinal). Ganz and colleagues have recommended sur- gical dislocation of the hip to treat this disorder. Figure 2a cifically. Treatment of Anterior Femoroacetabular Impingement Figure 1.

false- profile view.29 internal rotation in hip flexion is due to osseous impinge- ment of the anterolateral femoral head-neck junction Surgical Techniques with the acetabulum. Posterior im. The offset ratio is determined by the ratio normal or slight limp will be present occasionally. a hip motion exam with fluoroscopy can deter- striction of hip flexion and hip internal rotation is quite mine the presence or absence of osseous impingement.7.27 The anterior impingement test The basic principle of surgical treatment of anterior is almost universally positive and should reproduce the femoroacetabular impingement is to restore sphericity symptom of groin pain. A parallel line tangent to the anterior femoral tear and aspherical femoral head.6. findings and questionable femoroacetabular impinge- Hip motion should be evaluated very carefully. Many of these patients have hip flexion lim. with a value less than nine millimeters be- On physical examination. The and to also address the pathologic changes in the la- hip is extended and externally rotated to produce pos. A re.27 This has led to the can produce clinical symptoms of posterior impinge. anterior femoroacetabular impingement.11.2 In patients with subtle radiographic tinely assessed and commonly reveals slight weakness. The frog lateral and cross-table lateral radiographs are used specifically to quantify the femoral head-neck offset along the anterolateral aspect of the head-neck junction (Figure 2b). common.17 disease is more established. MR arthrogram shows hypertrophic degenerative labral ral head. regarding the integrity of the acetabular labrum. treatment approach we describe below which addresses ment in extension. A of the head-neck offset distance relative to the diam- Trendelenburg test may be positive. This restricted acetabular cartilage deterioration (Figure 2c). 2. We presently prefer general endotracheal anesthesia with muscle relaxation to aid in distraction 166 The Iowa Orthopaedic Journal . MRI arthrography can provide additional information ited to 90-100 degrees (normally 120-130 degrees). In cases of cam posteroinferior rim of the acetabulum.2. Fullness or a prominence of this region laterally on the AP view is indicative of anterolateral disease (Figure 2a). with a value of less than 0.17.24 The head-neck offset is mea- sured on the cross-table lateral radiograph using a method described by Eijer et al. brum and articular cartilage. frog lateral view. ment. neck and a second parallel line tangent to the anterior femoral head are then drawn. Abductor strength is rou. and cross-table lateral view of the hip. In. however. The patient is positioned supine on a standard frac- ture table. this disorder with a less-invasive surgical approach.14 anterior femoral head cov- erage. hip is assessed with the patient in a prone position.J. Treatment can be tailored terior impingement of the head-neck junction with the to the specific pattern of the disease.16. Specifically assess the acetabular version. C. T. being abnormal. the patient’s gait is either ing abnormal. this is not necessarily through the center of the femo- Figure 2c. The perpendicular dis- tance between these two lines is the measured head- Physical Examination neck offset.2 A line bisecting the longitudinal axis of the femoral neck is drawn. especially if the eter of the femoral head. McClure Radiographic Evaluation Radiographic evaluation includes an AP pelvis.24 Specific attention is directed to the head-neck region. The cartilage space of the hip is assessed and any structural abnormalities about the hip are noted. the offending pingement is more common as the disease progresses lesion is consistently located in the anterolateral aspect and a posteroinferior traction osteophyte develops which of the femoral head-neck junction. Clohisy and J.40 inclination of the acetabular articular surface. ternal rotation in 90 degrees of flexion is quite restricted anatomy of the head-neck junction and the degree of and is usually between 0 and 10 degrees.39 and the contour and sphericity of the femoral head. thereby relieving the impingement.19 lat- eral femoral head coverage.22.18 Posterior impingement of the to the femoral head.

the patient had an anterior labral tear (d). After careful inspection of the joint. FL) to debride unstable flaps of acetabular labrum and degree angled arthroscope. These are established with fluoroscopic assis. 4. Oratec ar throscopy cannulas (Dyonics. Treatment of Anterior Femoroacetabular Impingement Figure 2d Figure 2e Figure 2f Figure 2g Figure 2h At arthroscopy.5 and 4. CA). Largo. full-radius shaver and Andover. and early articular cartilage delamination (e). and major unstable nal rotation of the lower extremity (5˚). severe. We employ the tance placing 5. It is also com- arthroscopy to inspect the severity of disease and to mon to find articular cartilage disease at the articular- address labral and articular cartilage lesions. formed. these posterior changes are mild. anterolateral and posterolateral labrum and articular cartilage disease are treated with portals. The ease posteriorly is commonly less extensive and less joint is distracted 8-10 mm with fracture table traction.0. instru- cartilage disease can extend along the entire anterior ments are removed. the unstable We utilize the anterior. form this with slight hip abduction (5˚) and slight inter. the joint is irrigated. After tears of the anterior and anterolateral acetabular labrum the anterior labral and chondral debridement is per- are common (Figure 2d). These lesions were treated with arthroscopic debridement (f). Intraoperative fluoroscopic views demonstrating the aspherical femoral head (g) and restoration of head-neck of fset (h) after anterolateral osteoplasty. conservative debridement (Figure 2f). These labral lesions are fre. In articular cartilage if necessary. The first stage of the operation is a hip and lateral margin of the acetabulum. and traction is released. labral transition zone posteroinferiorly. systematically evaluated with both a 70-degree and 30. flaps of articular cartilage are uncommon. The articular cartilage of associated articular cartilage flaps. of the joint. After arthroscopic de- more severe cases. Interventions. In patients with anterior cartilage. the acetabulum and the acetabular sect only unstable regions of the labrum and articular labr um are inspected. Further delamination of the articular margin femoroacetabular impingement complex. Volume 25 167 . Labral dis- tained in a neutral position of flexion and extension. The hip is main. We per. The joint is an aggressive arthroscopic shaver (Linvatech. Smith&Nephew. MA) in the respective portals. Care is taken to re- the femoral head. In early stages. we proceed with a conservative debridement quently associated with delamination of the adjacent of the posteroinferior acetabular labrum and associated articular cartilage at the transition zone (Figure 2e). Menlo Park.0 mm cannulated hip combination of a ligament chisel (Vulcan EAS. the labral and adjacent articular bridement is completed. degenerative is possible if aggressive resection is performed.

35. Clohisy and J. Bleeding from visualization of the proximal femur. The fascia is incised. Crutches are discontinued at six weeks and and the direct and reflected heads are released. patients are observed overnight in cia lata muscle. has been described as a perform an osteoplasty at the head-neck junction. additional resection sion. previous anterior arthroscopy portal incision. If the anterior acetabular rim is overgrown sec- that the deformity might represent an anatomical vari- ondary to labral calcification or osteophyte formation. sphericity has not been achieved. over the years.24.7 Subclinical slipped plasty is performed and the head-neck offset has been capital femoral epiphysis has been suggested as a pos- established anterolaterally.37 This anterolateral prominence. Physical therapy is instituted for toe-touch belly is retracted laterally. Post-operative Care ally to dissect directly onto the fascia of the tensor fas- Postoperatively. Prior to inci. The joint is irrigated and the longitudinal and su- cross-table lateral or a frog-leg lateral view (Figure 2g).27 The oval-shaped head. tributes to an aspherical shape of the femoral head. is best recognized on lateral radiographs. The The contour of the femoral head and neck radio- normal head-neck offset anteromedially serves as a ref- graphically has been noted to be a predictor of anterior erence point for resection of the abnormal osteochon- femoroacetabular impingement.2 The a beveled resection to prevent delamination of the re- pistol-grip deformity has. fluoroscopy images are taken to insure excellent of the head-neck junction is performed.J. osteoarthritis. Impact rectus is reflected distally and the adipose tissue and activities like running are not encouraged for at least iliocapsularis muscle fibers are dissected off the ante- six months.36. The fascia is reflected medi- weight bearing with crutches to minimize the risk of ally. the surface of the osteoplasty is controlled with bone ral head-neck junction. The rectus origin is identified. noted that tion (Figure 2h). If open anterior decompression of the hip. Both eral femoral head-neck junction. The interval between the tensor and sar- tuted immediately and continued with a home exercise torius is then developed. A pillow is used under the femoral cutaneous nerve which should be protected by thigh to protect the rectus repair and active flexion is placing the fascial incision lateral to the tensor-sarto- avoided for six weeks. The pistol-grip deformity. an are taken for six weeks. After the osteo- lated with idiopathic osteoarthritis. and the muscle the hospital. This is performed while mity was primary and not secondary to remodeling from palpating the anterior hip to test for residual impinge- osteoarthritis. specifically the femo.31 Goodman et al. dral lesion. thus implying that the defor- flexion and internal rotation. of secondary resection is confirmed with intra-operative fluoroscopy. Abductor strengthening is insti- rius interval. the patient rotation. starting just inferior to suture and the remainder of the wound is closed in stan- the anterior superior iliac spine and incorporating the dard fashion.8. been corre- tained femoral head articular cartilage. Hip motion should improve at least 5-15 de- it was hypothesized that this variant could result in con- grees in flexion and at least 5-20 degrees in internal tact between the femoral neck and acetabulum with flex- 168 The Iowa Orthopaedic Journal . The activities are resumed gradually as tolerated. and thus.37 Other authors have disputed this The frog-leg lateral or cross-table lateral views in neu- suggestion and attribute the deformity to secondary tral and varying degrees of internal rotation are very remodeling of the proximal femur as a result of idio- effective for visualizing the anterolateral head-neck junc- pathic osteoarthritis itself. The offset from the DISCUSSION femoral head to the neck in this region is deficient. A half-inch curved osteotome is utilized to as seen on the AP radiograph. This is best visualized with a wax. McClure After completion of the hip arthroscopy. outgrowth of osteochondral tissue is observed along the anterolateral head-neck junction. the accuracy of the surgical sible cause of this deformity. The goal of the osteoplasty is to remove all remains in the same position and open debridement is prominent anterolateral osteochondral tissue that con- performed or the patient is repositioned for a limited. perior transverse arms of the arthrotomy are closed Internal rotation in the frog lateral position can better with absorbable sutures. An of the rectus tendon are repaired with nonabsorbable 8-10 cm incision is then made. Most commonly. The hip can also be examined at this the post-slip morphology was present at a constant rate time to assess impingement in hip flexion and combined in multiple age groups. Aspirin 325mg is taken as thromboembolic rior hip capsule. osteotome is directed distally and posteriorly to perform however.6 It was also suggested in the same study ment. achieved. The direct and reflected heads define the anterolateral osteochondral prominence. program. This medial sleeve of tissue contains the lateral femoral neck stress fracture. C. ant in the shape of the adult femur instead of a conse- this is carefully debrided until adequate clearance is quence of unrecognized childhood disease. An “I”-shaped capsulotomy is then per- prophylaxis and indomethacin 75mg sustained release formed to provide adequate exposure of the anterolat- is utilized for heterotophic ossification prophylaxis. Dissec- tion is carried through the subcutaneous tissue later. Moreover. T.

leading to the development of osteoarthritis. In a midterm report of 19 patients with aver. Demonstrates maintained head-neck offset without pro- overall incidence of heterotopic ossification was 37 per. which is an excellent reference point for quent conversion to THA. neck junction.7 years. The open osteoplasty is performed via intraarticular pathology is limited to labral degenera. deformity. unknown.4 to baseline after reduction of the joint. the consequences of which are cur rently verified the efficacy of arthroscopy for labral pathology. or as arthroscopy with an open osteoplasty of the femoral we recommend. which combines the advantages of hip with trochanteric osteotomy. and four to six additional weeks to regain abductor strength.1. our experience with hip arthroscopy11 has bers. labral disease at the acetabular margin and any associ- mary anterior femoroacetabular impingement is consis.27 In early and mid stages of the disease process. This allows excellent exposure of the antero- lesions and delamination around the acetabular rim. series of open debridements via hip dislocation.38 This surgical approach was reported in 2001 by Ganz for the treatment of multiple hip pathologies and included 164 patients with anterior impingement. Our current opinion is that debridement of the femoral age follow-up of 4. ated chondral damage. and colleagues made an intraoperative decision to per- laser Doppler flowmetry showed transient changes in form primary THA on patients with advanced chondral head perfusion during the procedure.9 lateral femoral head-neck junction and the anterior and These lesions can be addressed appropriately with the lateral acetabular rims. arthroscopic debridement of the bony impingement mentum teres with loss of its proprioceptive nerve fi. The inciting mechanical lesion in pri. This provides adequate expo- arthroscopic portion of the procedure. There were joint.1 dement.26 The disloca. Possible surgical treatment options for anterior We have taken an intermediate approach to treating femoroacetabular impingement include hip dislocation this disease. Beck et al. sure for osteoplasty of these anatomic sites. While we admittedly have no experience with tion also requires the rupture or division of the liga. Additionally. and open debridement of the labrum and acetabular rim.25. gression of degenerative changes.4 This allows for access to the femoral head for debridement. The Figure 2i.3. and has been combined with femoral osteotomy. arthroscopically. cent and there were two transient sciatic nerve palsies. While there were no reported cases of avascular necro. The arthroscopy addresses the decompression.23. This exposure combines the ad- Volume 25 169 . sure also allows visualization of the anteromedial head- ment.1.5 who de- veloped an approach that involves dislocation of the hip joint anteriorly with a trochanteric flip osteotomy.4 Average blood loss was 300ml with an average of eight weeks until osteotomy healing. with a high incidence of progression and subse. Treatment of Anterior Femoroacetabular Impingement ion and internal rotation. arthroscopy alone. the verted to total hip arthroplasty(THA). noted that there head-neck junction arthroscopically has certain poten- was significant improvement in the pain score and the tial disadvantages including the potential for inadequate overall Merle d’Aubigne hip score. ar ticular cartilage disease is accessed and treated tion. to address the various causes of femoroacetab- ular impingement. posterior labral and tently located along the anterolateral head-neck junc. Ganz sis (AVN) in the initial description of the procedure. Advanced chon. exposure of the anterolateral head-neck junction. Five hips were con. hip arthroscopy with limited anterior head-neck junction. which returned lesions. The contention that the deformity is an anatomic variant rather than the consequence of a sub- clinical SCFE is further supported by an MRI study showing that the orientation of the capital physeal scar remains in normal position in these patients. when needed. while the rest potential for bony debris to become entrapped in the were rated with good or excellent results. and the possibility of inadequate osseous debri- no instances of AVN reported. a limited anterior approach through the Smith-Peterson tion and tears associated with small articular cartilage interval. The expo- dral lesions have not responded well to open debride.13.34 Surgical treatment of femoroacetabular impingement has been described by Ganz and colleagues.5.23 In their original reported normal neck contour.

1986:213:20-33. Semin Ar- 3. Peele MW. Meyer AW. have circumferential lesions of the femoral head. Keeney JA. J Bone Joint Surg. Eijer H.418:48-53. Lefaux profil du bassin. Clin ment: Indications and preliminary clinical results. Murr y RO. T. 73. The aetiology of primary osteoarthritis tis of the hip: Etiology and epidemiology. Sub. caused by the prominent femoral metaphysic. Kim YJ. Steinbach LS. Murphy S. Clin Or thop. Anterior femoro-ac- 9. Perthes disease with special regard to the progno- 6. Orthop. J Am Acad of the hip. pingement. of hip dysplasia. 25. Tannast M. Ganz R. Femoroace.83B:1119. Mose K. Ito K. Minka II MA. Ganz R. Leunig M. MacDonald SJ. trochanteric osteotomy and surgical dislo. 170 The Iowa Orthopaedic Journal . Beck M.J. 2004. 2004. Surg. Leunig M. with dysplasia and impingement. Midterm re. this technique are promising. REFERENCES 16. Ganz R.79B:230-234. Orthop Surg. netic resonance arthrography verses arthroscopy in cate the use of this procedure for more advanced dis. Mast JW. Importantly. Clin Orthop. Ganz R. In our ini. 26. Clin Orthop. Ganz R.418:67.7:257-269. Clin Orthop. Garbaz D. Feighan JE.429. J 19. Somer ville EW. 2003:417:112-120. Methods of measuring in Legg-Calve- hip. et al. syndrome: A clinical presentation of dysplasia of the cation as described by Ganz et al. Clin Orthop. Anterior resonance arthrography of labral disorders in hips femeroacetabular impingement: part II. Lequesne M. Ganz R. Am J Phys the femoral head and acetabulum without the risk of Anthropol. Histopathologic features etabular impingement after periacetabular osteotomy. exposure to address more extensive disease patterns. Surgical disloca. Anterior femoroac. 2001:9:320-327. Etiology of osteoarthritis of the hip. 1960. Durnin CW. mal growth at the upper end of the femur. 1999. 2000:71:370-375. Beck.Eijer H. 1965.163-169. Jackson J.15:475-481. Klaue K.83B:171-176. clinical slipped capital femoral epiphysis. Ito K. Mag- lower complication rate. Brunner RL. of the acetabular labrum in femoroacetabular im.4 13. Ito K.363:93-99. Beck M. et al. Werlen S.11:37-41. 2004. Siebenrock KA. J Bone Joint Surg. J Bone Joint 23. 2001. 2004. Primary osteoarthri. throplasty.28:643-652. Son utilite dans les dysplasies et les fied with the rapid recovery and clinical results over differentes coxopathies. Perfusion of the femoral head during surgical dislo- etabular impingement and the cam effect. 2001. Par vizi J. R. continued follow-up for 15. Hamlet M. we have been very satis. Clin Orthop. Magnetic 1. In 12. tabular impingement: A cause for osteoarthritis of the 22. While our early results with 1961. C. Leunig M. Clin Orthop. ease with posterior impingement lesions. 2004. Myers SR. 2004.8:3-9. Beck M. 2002. Myers SR. provides superior hip. The “cervical fossa” of Allen. et al. 10. acetabular version in the radiographic presentation 4. J Bone Joint 5. Gill TJ. Notzli HP. McClure vantages of a less invasive surgery with a theoretical 11. Normal and abnor- 1124. unpublished data). disease pattern relevant to its development. etabular impingement after femoral neck fractures. Goodman DA.418:74-80. 2001. 24. flowmetry.429:262-271.84B:300-304. Hoaglund FT. Ganz R. sults of surgical treatment. avascular necrosis. The acetabular rim these cases.79A:1489-1497. Par vizi J. Gautier E. et al. 2001. et al. Cassilas MM. Eijer H. deSeze S. J Bone Joint Surg. Clin Orthop. Lavigne M. ment of the adult hip for femoroacetabular impinge- 7. Clin Orthop. Ganz 2. Leunig M. ation of the symptomatic young adult hip. Mahomed MN. tion of the adult hip: A technique with full access to 20. 1980.42B:264-272. Zebrack J. Clinical evalu- etabular impingement. Recognizing Orthop Trauma. Acta Orthop Scand. Leunig M.418:61-66. et al. Harris WH. Femoroac. British J Radiol. we do not advo. Ganz R.150:103-109.38:810-824. 21. Slipped mid-term and long-term results is essential to verify the capital femoral epiphysis: Early mechanical damage efficacy of this technique. Parvizi J. Ganz R. Anterior femoro- This report presents our current surgical technique acetabular impingement: Part I: Technique of joint for primary cam femoroacetabular impingement and the preserving surgery. sis. 1924. Clin Orthop. Luenig M. Smith A. et al. Hip Int. 14. the short term (Figure 2i). Podeszwa D.429:178-181. et al. 1997.73B:423-429. Rev Rhum Mal Osteoartic. Morgan JD. Cross. 1997. Clohisy and J. 17. 8. J Bone Joint cation of the hip: Monitoring by laser Doppler Surg. Leunig M. et al. 18. Evaluation of the acetabular labrum by MR ar- table lateral radiograph for screening of anterior thrography. et al. Ungersbock A. 1991. hanche. tial cohor t of patients treated with this procedure Nouvelle incidence radiographique pour l’tude de la (Clohisy. the evaluation of articular hip pathology. J Bone Joint Surg. Debride- Surg. femoral head-neck offset in patients with femoro-ac. 1997. Hempfing A. or for hips that 2004.

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