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Correcting proximal femoral abnormalities can enhance acetabular reorientation outcomes

Researchers find reduced femoral head-neck offset and asphericity of the femoral neck occur frequently in dysplastic hips.

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SAN ANTONIO — Surgeons conducting acetabular reorientation should consider correcting proximal femoral abnormalities at the same time, according to a study presented here at the American Orthopaedic Association’s annual meeting.

Associated femoral deformities can contribute to a suboptimal articulation and secondary impingement following reorientation. But the prevalence and characteristics of femoral head and proximal femoral abnormalities have received little attention in connection with symptomatic dysplastic hips.

John C. Clohisy, MD, and colleagues at Washington University School of Medicine in St. Louis, Mo., radiographically analyzed 115 consecutive hips treated for symptomatic acetabular dysplasia. This included 84 women and 31 men with an average age of 24.8 years.

The researchers found that reduced femoral head-neck offset as well as femoral neck asphericity occur frequently in dysplastic hips. In the study, 47% of patients had proximal femoral alignment (neck-shaft angle) abnormalities, 54 hips (47%) had reduced femoral head-neck offset and 90 hips (78%) had femoral head asphericity.

The authors noted that reorientation using a Bernese peri-acetabular osteotomy can effectively treat symptomatic acetabular dysplasia. However, clinical results depend on optimizing congruency, avoiding overcorrection and preventing secondary femoroacetabular impingement.

The results suggest that evaluating such abnormalities for possible correction could help optimize joint congruity and stability, and minimize secondary impingement. Diagnosing and treating femoral-sided deformities can help further optimize reconstructions, they added.

For more information:

• Clohisy JC, Robison JF, McClure TJ, et al. Radiographic analysis of femoral deformities associated with acetabular dysplasia. Presented at the American Orthopaedic Association 119th Annual Meeting. June 21-24, 2006. San Antonio.