Skip to main content

Limited Open Procedures

  • Chapter
  • First Online:
Hip Joint Restoration

Abstract

Limited open procedures allow the surgeon to address the majority of lesions associated with femoroacetabular impingement. The anterior approach to the hip is employed, but a formal surgical dislocation of the hip is not performed. Sufficient exposure is gained to address femoral cam lesions, labral tears and acetabular cartilage delamination lesions, as most of these occur in the antero-superior region of the hip. The procedure can be combined with arthroscopy. Satisfactory results have been obtained using this technique, but, as with all non-arthroplasty techniques for treatment of early degenerative hip disease, success depends on appropriate patient selection.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;(418):61–6.

    Google Scholar 

  2. 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;87:1012–8.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res. 2008;466:273–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112–20.

    Google Scholar 

  6. Ito K, Minka 2nd MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–6.

    Article  CAS  PubMed  Google Scholar 

  7. Zebala LP, Schoenecker PL, Clohisy JC. Anterior femoroacetabular impingement: a diverse disease with evolving treatment options. Iowa Orthop J. 2007;27:71–81.

    PubMed  PubMed Central  Google Scholar 

  8. Bardakos NV, Vasconcelos JC, Villar RN. Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg Br. 2008;90:1570–5.

    Article  CAS  PubMed  Google Scholar 

  9. Parvizi J, Huang R, Diaz-Ledezma C, Og B. Mini-open femoroacetabular osteoplasty: how do these patients do? J Arthroplasty. 2012;27(8 Suppl):122–5.

    Article  PubMed  Google Scholar 

  10. Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, Siebenrock KA. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage. 2003;11:508–18.

    Article  CAS  PubMed  Google Scholar 

  11. Naal FD, Miozzari HH, Schar M, Hesper T, Notzli HP. Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement. Am J Sports Med. 2012;40:1501–10.

    Article  PubMed  Google Scholar 

  12. Cohen SHR, Ciccotti M, Dodson C, Parvizi J. Treatment of femoroacetabular impingement in athletes using a mini-direct anterior approach. Am J Sports Med. 2012;40:1620–7.

    Article  PubMed  Google Scholar 

  13. Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clin Sports Med. 2006;25:327–35. x.

    Article  PubMed  Google Scholar 

  14. Larson CM, Guanche CA, Kelly BT, Clohisy JC, Ranawat AS. Advanced techniques in hip arthroscopy. Instr Course Lect. 2009;58:423–36.

    PubMed  Google Scholar 

  15. Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. 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.

    Google Scholar 

  16. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85-A:278–86.

    Article  CAS  PubMed  Google Scholar 

  17. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281–8.

    Article  CAS  PubMed  Google Scholar 

  18. Biedermann R, Donnan L, Gabriel A, Wachter R, Krismer M, Behensky H. Complications and patient satisfaction after periacetabular pelvic osteotomy. Int Orthop. 2008;32:611–7.

    Article  CAS  PubMed  Google Scholar 

  19. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–24.

    Article  CAS  PubMed  Google Scholar 

  20. Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–9.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Konan S, Rhee SJ, Haddad FS. Hip arthroscopy: analysis of a single surgeon’s learning experience. J Bone Joint Surg Am. 2011;93 Suppl 2:52–6.

    Article  PubMed  Google Scholar 

  23. Byrd JW. Hip arthroscopy. The supine position. Clin Sports Med. 2001;20:703–31.

    Article  CAS  PubMed  Google Scholar 

  24. Boos N, Krushell R, Ganz R, Muller ME. Total hip arthroplasty after previous proximal femoral osteotomy. J Bone Joint Surg Br. 1997;79:247–53.

    Article  CAS  PubMed  Google Scholar 

  25. Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–70.

    Article  CAS  PubMed  Google Scholar 

  26. Smith-Petersen MN. Treatment of malum coxae senilis, old slipped upper capital femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxae plana by means of acetabuloplasty. J Bone Joint Surg Am. 1936;18:869–80.

    Google Scholar 

  27. Heyman CH, Herndon CH, Strong JM. Slipped femoral epiphysis with severe displacement; a conservative operative treatment. J Bone Joint Surg Am. 1957;39-A:293–303.

    Article  CAS  PubMed  Google Scholar 

  28. Ribas M, Ledesma R, Cardenas C, Marin-Pena O, Toro J, Caceres E. Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage. Hip Int. 2010;20 Suppl 7:36–42.

    Article  Google Scholar 

  29. Trevino-Garza O, Rivas-Fernandez M, Marin-Pena O, Esteban-Ledezma R, Vilarubias-Guillament JM. [Treatment of femoro-acetabular impingement by a minimally invasive approach. Results at 2 years follow-up]. Acta Ortop Mex. 2009;23:57–69.

    PubMed  Google Scholar 

  30. Chiron P, Espie A, Reina N, Cavaignac E, Molinier F, Laffosse JM. Surgery for femoroacetabular impingement using a minimally invasive anterolateral approach: analysis of 118 cases at 2.2-year follow-up. Orthop Traumatol Surg Res. 2012;98:30–8.

    Article  CAS  PubMed  Google Scholar 

  31. Laude F, Sariali E. [Treatment of FAI via a minimally invasive ventral approach with arthroscopic assistance. Technique and midterm results]. Orthopade. 2009;38:419–28.

    Article  CAS  PubMed  Google Scholar 

  32. Barton C, Banga K, Beaule PE. Anterior Hueter approach in the treatment of femoro-acetabular impingement: rationale and technique. Orthop Clin North Am. 2009;40:389–95.

    Article  PubMed  Google Scholar 

  33. Clohisy JC, Zebala LP, Nepple JJ, Pashos G. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am. 2010;92:1697–706.

    Article  PubMed  Google Scholar 

  34. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–72.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Barton C, Salineros MJ, Rakhra KS, Beaule PE. Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2011;469:464–9.

    Article  PubMed  Google Scholar 

  36. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–60.

    Article  CAS  PubMed  Google Scholar 

  37. Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–5.

    PubMed  Google Scholar 

  38. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;(119):39–47.

    Google Scholar 

  39. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;(418):67–73.

    Google Scholar 

  40. Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;(429):178–81.

    Google Scholar 

Download references

Acknowledgement

The authors wish to thank Dr Claudio Diaz Ledezma for his help in the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Aaron Glynn MCh, FRCS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Glynn, A., Parvizi, J. (2017). Limited Open Procedures. In: McCarthy, J., Noble, P., Villar, R. (eds) Hip Joint Restoration. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0694-5_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0694-5_31

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0693-8

  • Online ISBN: 978-1-4614-0694-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics