Skip to main content
SpringerLink
Log in

Surgical Technique: Open Acetabular Rim Trimming, Labral Refixation, and Open Femoral Osteochondroplasty

Hip Arthroscopy and Hip Joint Preservation Surgery

  • 149 Accesses

Abstract

Femoroacetabular impingement (FAI) of the hip is an osseous abnormality of the proximal femur and/or acetabulum as described by Ganz. Although no longer the most commonly used approach for the treatment of cam FAI, open surgical dislocation is the most established technique for hip preservation surgery and is a more powerful tool than arthroscopy as it allows the surgeon to address any atypical or complex intra- and extra-articular pathology and can be combined to a concomitant femoral or pelvic osteotomy. This surgery is performed through a Gibson approach, the femoral head is dislocated after a trochanteric osteotomy (trochanteric slide), and the whole head-neck junction is perfectly visualized as well as the acetabulum. This chapter describes the surgical setup, the dissection, the location of the neurovascular structure at risk, and how to avoid complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Ganz R, Parvizi J, Leunig M, Siebenrock KA. Femoroacetabular Impingement: a cause for osteoarthritis of the hip. Clin Orthop. 2003;417(417):112–20.

    PubMed  Google Scholar 

  2. Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of ligamentum teres and iliofemoral ligament cause subluxation? Arthrosc. 2012;28(3):440–5.

    Article  Google Scholar 

  3. Ranawat AS, McClincy M, Sekiya JK. Anterior dislocation of the hip after arthroscopy in a patient with capsular laxity of the hip. A case report. J Bone Joint Surg. 2009;91(1):192–7.

    Article  PubMed  Google Scholar 

  4. Ayeni OR, Naudie D, Crouch S et al. Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1676–83.

    Google Scholar 

  5. Leunig M, Beck M, Woo A, et al. Acetabular rim degeneration. A constant finding in the aged hip. Clin Orthop. 2003;413:201–7.

    Article  PubMed  Google Scholar 

  6. Matsuda DK, Carlisle JC, Arthurs SC, et al. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252–69.

    Article  PubMed  Google Scholar 

  7. Wenger DE, Kendall KR, Miner M, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop. 2004;426(426):145–50.

    Article  PubMed  Google Scholar 

  8. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8.

    Article  CAS  PubMed  Google Scholar 

  9. Hack K, Diprimio G, Rakhra K, Beaule PE. Prevalence of CAM type femoroacetabular impingement in asymptomatic volunteers. J Bone Joint Surg. 2010;92A(14):2436–44.

    Article  Google Scholar 

  10. Khannas V, Caragianis A, DiPrimio G et al. Incidence of hip pain in a prospective cohort of asymptomatic volunteers: is the cam deformity a risk factor for hip pain? Am J Sports Med. 2014;42(4):793–7, http://www.ncbi.nlm.nih.gov/pubmed/24481825

  11. Kapron AL, Anderson AE, Peters CL, et al. Hip internal rotation is correlated to radiographic findings of cam femoroacetabular impingement in collegiate football players. Arthroscopy. 2012;28(11):1661–70.

    Article  PubMed  Google Scholar 

  12. Beaule PE, Hynes K, Parker G, Kemp KA. Can the alpha angle assessment of cam impingement predict acetabular cartilage delamination? Clin Orthop Relat Res. 2012;470(12):3361–7.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39(2):296–303.

    Article  PubMed  Google Scholar 

  14. Johnston TL, Schenker ML, Briggs KK, Philippon MJ. Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy. 2008;24(6):669–75.

    Article  PubMed  Google Scholar 

  15. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW. How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers? Radiology. 2012;264(2):514–21.

    Article  PubMed  Google Scholar 

  16. Allen DJ, Beaule PE, Ramadan O, Doucette S. Prevalence of associated deformities and hip pain in patients with cam type femoroacetabular impingement. J Bone Joint Surg. 2009;91B(5):589–94.

    Article  Google Scholar 

  17. Sansone M, Ahlden M, Jonasson P, Sward L, Eriksson T, Karlsson J. Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):420–3.

    Article  PubMed  Google Scholar 

  18. Ilizaliturri Jr VM. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res. 2009;467(3):760–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Philippon MJ, Schenker ML, Briggs KK, et al. Revision hip arthroscopy. Am J Sports Med. 2007;35(11):1918–21.

    Article  PubMed  Google Scholar 

  20. Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23(12):1295–302.

    Article  PubMed  Google Scholar 

  21. Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med. 2011;39(Suppl):20S–8.

    Article  PubMed  Google Scholar 

  22. Beaule PE, LeDuff MJ, Zaragoza EJ. Quality of life outcome of femoral head/neck offset correction for femoroacetabular impingement. J Bone Joint Surg. 2007;89A(4):773–9.

    Article  Google Scholar 

  23. Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.

    Article  PubMed  Google Scholar 

  24. Espinosa N, Beck M, Rothenfluh DA, et al. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt 1):36–53.

    PubMed  Google Scholar 

  25. Murphy SB, Tannast M, Kim Y-J, et al. Debridement of the adult hip for femoroacetabular impingement. Indications and preliminary clinical results. Clin Orthop. 2004;429(429):178–81.

    Article  PubMed  Google Scholar 

  26. Naal FD, Miozzari HH, Wyss TF, Notzli HP. Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med. 2011;39(3):544–50.

    Article  PubMed  Google Scholar 

  27. Naal FD, Miozzari HH, Wyss TF, Notzli HP. Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med. 2012;40(7):1501–10.

    Article  PubMed  Google Scholar 

  28. Sink EL, Fabricant PD, Pan Z, Daytonm MR, Novais EN. Results of treatment of femoroacetabular impingement in adolescents with a surgical hip dislocation approach. Clin Orthop Relat Res. 2013;471(8):2563–9. Ref Type: Generic.

    Article  PubMed  Google Scholar 

  29. Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop. 2004;429(429):170–7.

    Article  PubMed  Google Scholar 

  30. Wilson AS, Cui Q. Current concepts in management of femoroacetabular impingement. World J Orthop. 2012;3(12):204–11.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip. A new technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83(8):1119–24.

    Article  CAS  PubMed  Google Scholar 

  32. Gibson A. Posterior exposure of the hip joint. J Bone Joint Surg Am. 1950;32:36–53.

    Google Scholar 

  33. Nork SE, Schar M, Pfander G, et al. Anatomic considerations for the choice of surgical approach for hip resurfacing arthroplasty. Orthop Clin North Am. 2005;36(2):163–70.

    Article  PubMed  Google Scholar 

  34. Gautier E, Ganz K, Krugel N, et al. Anatomy of the medial circumflex artery and its surgical implications. J Bone Joint Surg. 2000;82B(5):679–83.

    Article  Google Scholar 

  35. Lavigne M, Parvizi J, Beck M, et al. Anterior femoro-acetabular impingement. Part I: Techniques of joint preserving surgery. Clin Orthop. 2004;418(418):61–6.

    Article  PubMed  Google Scholar 

  36. Bastian JD, Wolf AT, Wyss TF, Notzli H. Stepped osteotomy of the trochanter for stable, anatomic refixation. Clin Orthop Relat Res. 2009;467:732–8.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Burnett SJ, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg. 2006;88(7):327–33.

    Article  Google Scholar 

  38. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429(429):262–71.

    Article  PubMed  Google Scholar 

  39. Geyer MR, Philippon MJ, Fagrelins TS, Briggs KK. Acetabular labral reconstruction with an iliotibial band autograft: outcome and survivorship analysis at minimum 3-year follow-up. Am J Sports Med. 2013;41(8):1750–6.

    Article  PubMed  Google Scholar 

  40. Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26(6):750–6.

    Article  PubMed  Google Scholar 

  41. Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467(3):753–9.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Mardones RM, Gonzalez C, Chen Q, et al. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. J Bone Joint Surg. 2005;87A(2):273–9.

    Article  Google Scholar 

  43. Notzli HP, Siebenrock KA, Hempfing A, et al. Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. J Bone Joint Surg Br. 2002;84(2):300–4.

    Article  CAS  PubMed  Google Scholar 

  44. Lavigne M, Boddu Siva Rama KR, Doyon J, Vendittoli PA. Bone-wax granuloma after femoral neck osteoplasty. Can J Surg. 2008;51(3):58–60.

    Google Scholar 

  45. Lamontagne M, Brisson N, Kennedy MJ, Beaulé PE. Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoro-acetabular impingement. J Bone Joint Surg. 2011;93A Suppl 2:40–5.

    Article  Google Scholar 

  46. Beck M. Groin pain after open FAI surgery: the role of intraarticular adhesions. Clin Orthop Relat Res. 2009;467(3):769–74.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Hellman MD, Riff AJ, Haughom BD, Patel R, Stover MD, Nho SJ. Operative treatment of FAI: open hip preservation surgery. Curr Rev Musculoskelet Med. 2013;6(3):258–63.

    Article  PubMed  Google Scholar 

  48. Bizzini M, Notzli HP, Maffiuletti NA. Femoroacetabular impingement in professional ice hockey players: a case series of 5 athletes after open surgical decompression of the hip. Am J Sports Med. 2007;35(11):1955–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Ottawa Hospital, Adult Reconstruction, University of Ottawa, 501 Smyth Rd, Room W1646, Ottawa, ON, Canada

    Dr. Luca Gala M.D. & Dr. Paul E. Beaulé M.D., FRCSC (Professor of Surgery, Head, Adult Reconstruction)

Authors
  1. Dr. Luca Gala M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dr. Paul E. Beaulé M.D., FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul E. Beaulé M.D., FRCSC .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane Nho

  2. Dept. Orthopaedics, Hip Service, Schulthess Clinic, Zurich, Switzerland

    Michael Leunig

  3. Caspary Building, Ground Floor, Center for Hip Pain and Preservation, New York, New York, USA

    Bryan Kelly

  4. Department of Orthopaedics, University of Michigan Domino's Farms Lobby A, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher Larson

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this entry

Cite this entry

Gala, L., Beaulé, P.E. (2014). Surgical Technique: Open Acetabular Rim Trimming, Labral Refixation, and Open Femoral Osteochondroplasty. In: Nho, S., Leunig, M., Kelly, B., Bedi, A., Larson, C. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_54-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_54-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-7321-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Surgical Technique: Open Acetabular Rim Trimming, Labral Refixation, and Open Femoral Osteochondroplasty
    Published:
    08 April 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_54-2

  2. Original

    Surgical Technique: Open Acetabular Rim Trimming, Labral Refixation, and Open Femoral Osteochondroplasty
    Published:
    30 May 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_54-1

Search

Navigation