RESUMO
BACKGROUND: Patients with acetabular retroversion are at risk of labral tear and hip pain. It is unknown whether femoroacetabular osteoplasty (FAO) without reverse periacetabular osteotomy can be used in these patients. This study evaluated the outcome of mini-open FAO in patients with acetabular retroversion and compared that to patients without acetabular retroversion. METHODS: Fifty-one patients (29 male, 22 female) with acetabular retroversion who had undergone FAO between 2007 and 2015 were identified. The minimum 2-year clinical and radiological outcome was compared with 550 patients without dysplasia or retroversion who underwent FAO by the same surgeon. The preoperative and postoperative alpha angle, center-edge angle, Tonnis grade, joint space, and presence of labral tear and chondral lesion were determined. RESULTS: The mean age in the retroversion cohort was 27.4 ± 9.5 years compared to 34.5 ± 11.2 years in the control. The mean follow-up was 4.8 ± 1.5 years for retroversion and 4.1 ± 1.2 years for the control. The mean preoperative Short-Form 36 Health Survey and modified Harris hip score were not different between the cohorts. At the latest follow-up, the mean modified Harris hip score and Short-Form 36 Health Survey were significantly lower in the retroversion group (75.4 and 76.5) compared to the control (83.4 and 85.6). There was a higher percentage of failure among retroversion patients (13.7%) compared to the control (2.5%). CONCLUSION: Acetabular retroversion resulting in femoroacetabular impingent may be treated by FAO, but the outcome appears to be less optimal compared to patients with femoroacetabular impingent and no evidence of dysplasia and acetabular retroversion. Hip preservation surgeons should be aware of this anatomic variation and possible inferior treatment results after FAO in these patients.
Assuntos
Retroversão Óssea/complicações , Impacto Femoroacetabular/cirurgia , Acetábulo/cirurgia , Adolescente , Adulto , Artrodese , Artroscopia , Feminino , Impacto Femoroacetabular/complicações , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Período Pós-Operatório , Radiografia , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The etiology of hip instability in Down syndrome is not completely understood. We investigated the morphology of the acetabulum and femur in patients with Down syndrome and compared measurements of the hips with those of matched controls. METHODS: Computed tomography (CT) images of the pelvis of 42 patients with Down syndrome and hip symptoms were compared with those of 42 age and sex-matched subjects without Down syndrome or history of hip disease who had undergone CT for abdominal pain. Each of the cohorts had 23 male and 19 female subjects. The mean age (and standard deviation) in each cohort was 11.3 ± 5.3 years. The lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version, and anterior and posterior acetabular sector angles (AASA and PASA) were compared. The neck-shaft angle and femoral version were measured in the patients with Down syndrome only. The hips of the patients with Down syndrome were further categorized as stable (n = 21) or unstable (n = 63) for secondary analysis. RESULTS: The hips in the Down syndrome group had a smaller LCEA (mean, 10.8° ± 12.6° compared with 25.6° ± 4.6°; p < 0.0001), a larger IA (mean, 17.4° ± 10.3° compared with 10.9° ± 4.8°; p < 0.0001), a lower ADR (mean, 231.9 ± 56.2 compared with 306.8 ± 31.0; p < 0.0001), a more retroverted acetabulum (mean acetabular version as measured at the level of the centers of the femoral heads [AVC], 7.8° ± 5.1° compared with 14.0° ± 4.5°; p < 0.0001), a smaller AASA (mean, 55.0° ± 9.9° compared with 59.7° ± 7.8°; p = 0.005), and a smaller PASA (mean, 67.1° ± 10.4° compared with 85.2° ± 6.8°; p < 0.0001). Within the Down syndrome cohort, the unstable hips showed greater femoral anteversion (mean, 32.7° ± 14.6° compared with 23.6° ± 10.6°; p = 0.002) and worse global acetabular insufficiency compared with the stable hips. No differences between the unstable and stable hips were found with respect to acetabular version (mean AVC, 7.8° ± 5.5° compared with 7.6° ± 3.8°; p = 0.93) and the neck-shaft angle (mean, 133.7° ± 6.7° compared with 133.2° ± 6.4°; p = 0.81). CONCLUSIONS: Patients with Down syndrome and hip-related symptoms had more retroverted and shallower acetabula with globally reduced coverage of the femoral head compared with age and sex-matched subjects. Hip instability among those with Down syndrome was associated with worse global acetabular insufficiency and increased femoral anteversion, but not with more severe acetabular retroversion. No difference in the mean femoral neck-shaft angle was observed between the stable and unstable hips in the Down syndrome cohort. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Acetábulo/patologia , Síndrome de Down/complicações , Cabeça do Fêmur/patologia , Articulação do Quadril/patologia , Instabilidade Articular/etiologia , Tomografia Computadorizada por Raios X , Acetábulo/diagnóstico por imagem , Acetábulo/fisiopatologia , Adolescente , Adulto , Anteversão Óssea/diagnóstico por imagem , Anteversão Óssea/etiologia , Anteversão Óssea/patologia , Anteversão Óssea/fisiopatologia , Retroversão Óssea/diagnóstico por imagem , Retroversão Óssea/etiologia , Retroversão Óssea/patologia , Retroversão Óssea/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Síndrome de Down/patologia , Síndrome de Down/fisiopatologia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/patologia , Masculino , Estudos Retrospectivos , Adulto JovemAssuntos
Retroversão Óssea/etiologia , Diarreia/etiologia , Edema/etiologia , Articulação do Joelho/anormalidades , Linfangiectasia Intestinal/diagnóstico , Linfedema/diagnóstico , Endoscopia por Cápsula , Pré-Escolar , Humanos , Linfangiectasia Intestinal/complicações , Linfedema/complicações , Masculino , RecidivaRESUMO
OBJETIVOS: Avaliar a retroversão da cabeça do úmero em jogadores de handebol e sua relação com a movimentação do ombro. MATERIAIS E MÉTODOS: Foram avaliados 17 jogadores profissionais por meio de exame físico e avaliação radiográfica, para se determinar o ângulo de retroversão e, sua relação com o arco de movimento. O mesmo foi realizado num grupo controle. RESULTADOS: A diferença entre a média do ângulo de retroversão da cabeça do úmero do membro dominante e não dominante foi de 3,06°. Entre eles, aqueles que tiveram um início de treino antes dos 10 anos, apresentaram uma média desse ângulo de 36,29°, enquanto que aqueles que iniciaram acima dessa idade tinham uma média de 26,6° (p< 0,05). A média da rotação lateral do membro dominante, cujo ângulo de retroversão era maior que 30°, foi 112,27°, e naqueles, em que o ângulo era inferior ou igual a 30°, a média foi 95,10° (p<0,05). CONCLUSÃO: Houve uma diferença estatística na retroversão quando comparamos os ombros dominantes e não dominantes. Os atletas que começaram a jogar antes dos 10 anos apresentaram, estatisticamente, uma maior retroversão. Há uma relação estatística entre o aumento da retroversão com o aumento da rotação lateral.
OBJECTIVES: To evaluate the humeral head retroversion of handball players and its relationship to shoulder's range of motion. MATERIALS AND METHODS: Seventeen professional players were evaluated by physical examination and X-ray images to determine the humeral head retroversion and its relationship to the range of motion. A control group was also submitted to the same evaluations. RESULTS: The difference between the average of the humeral head retroversion of the dominant and non dominant shoulders was 3.06°. The mean value for this angle between the athletes who had started training as early as 10 years old was 36.29°, compared to those who had started later in life, which was 26.6° (p<0.05). The average of the external rotation of the players whose retroversion angle was bigger than 30° was 112.27°, and for those whose angle was smaller or equal to 30°, it was 95.10° (p<0.05). CONCLUSION: There was a significant difference in the retroversion angle when comparing dominant and non-dominant shoulders. The athletes who started to play before the age of 10 presented, statistically, an increased retroversion. There is a statistical relationship between retroversion increase and shoulder's external rotation gain.