Background: Femoroacetabular impingement syndrome (FAI) is a complex, often post-traumatically developing impairment of the hip joint. It is characterized by ambiguous symptomatology, which makes early diagnosis difficult. Aim: The study was conducted to evaluate the applicability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. Methods: Ninety-two patients were included in the experimental retrospective study and 62 completed the examination. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint and patients walked approximately 15 steps. Data were also evaluated while the patients climbed stairs. A complete clinical examination of the dynamics and physiological movements in the joint was performed. The data measured by the gyroscopic sensor were processed using differential geometry methods and subsequently evaluated using spectral analysis and neural networks. Results: FAI diagnosis using gyroscopic measurement is fast and easy to implement. Our approach to processing the gyroscopic signals used to detect the stage of osteoarthritis and post-traumatic FAI could lead to more accurate detection and capture early in FAI development. Conclusions: The obtained data are easily evaluated, interpretable, and beneficial in the diagnosis of the early stages of FAI. The results of the study show that this approach can lead to more accurate and early detection of osteoarthritis and post-traumatic FAI.

• MeSH
• analýza chůze metody   MeSH
• biomechanika * MeSH
• femoroacetabulární impingement * chirurgie   diagnóza   patofyziologie   MeSH
• kyčelní kloub patofyziologie   MeSH
• lidé MeSH
• nositelná elektronika * MeSH
• osteoartróza diagnóza   patofyziologie   MeSH
• retrospektivní studie MeSH
• telemedicína metody   MeSH
• umělá inteligence MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY Femoroacetabular impingement syndrome is a complex, often post-traumatically developing impairment of the hip joint, characterized by ambiguous symptomatology, which makes early diagnosis diffi cult, especially in the early stages. Experimental retrospective study was carried out to evaluate the usability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. MATERIAL AND METHODS 92 patients were included in the retrospective study, and 62 completed the investigation. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint, and the patients walked approximately 15 steps. Furthermore, an evaluation of the data during stair climbing and a complete clinical examination of the dynamics and physiological movements in the joint was carried out. Data measured with a gyroscopic sensor were processed using differential geometry methods and then evaluated using spectral analysis and neural networks. The proposed technique of diagnosing FAI using gyroscope measurement is a fast, easy-to-perform method. RESULTS Our approach in processing gyroscopic signals used to detect the stage of arthrosis and post-traumatically developing FAI could lead to more accurate early detection and capture in the early stages. CONCLUSIONS The obtained data are easily evaluated, interpretable and benefi cial in diagnosing the early stages of FAI. The results of the conducted research showed this approach to more accurate early detection of arthrosis and post-traumatically developing FAI. Key words: wearable sensors; osteoarthritis; mathematical biophysics; telemedicine.

• MeSH
• femoroacetabulární impingement * diagnóza   chirurgie   MeSH
• kyčelní kloub chirurgie   MeSH
• lidé MeSH
• nemoci kloubů * MeSH
• neuronové sítě (počítačové) MeSH
• osteoartróza * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P < 0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P< 0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.

• MeSH
• acetabulum chirurgie   MeSH
• artroskopie MeSH
• femoroacetabulární impingement * chirurgie   MeSH
• kvalita života MeSH
• kyčelní kloub chirurgie   MeSH
• lidé MeSH
• následné studie MeSH
• prospektivní studie MeSH
• stresové fraktury * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

PURPOSE: Arthroscopy of the hip joint is considered a demanding procedure with long learning curve. There are only a few studies that concentrate on this topic. This prospective clinical study evaluates the learning curve of the hip arthroscopy based on clinical outcomes, surgical time, and complication rate. MATERIALS: In this study, we first evaluated 150 hip arthroscopy procedures performed by a single surgeon. The patient group consisted of 86 females and 64 males with mean age 37 years (range 16-69). Study cohorts were divided into groups of 50 patients. Surgical time, complication rate and clinical results based on NAHS score were recorded for each group. Statistical analysis of differences between groups was performed using the ANOVA method and paired t-test. RESULTS: We found a statistically significant decrease of complication rate with more procedures performed. There were significantly better clinical outcomes after at least 100 procedures. No difference in surgical time was found, but towards the end of the learning curve, more complex procedures were performed. The only statistical difference was the portal setup time. The learning curves were constructed based on these results. CONCLUSIONS: Hip arthroscopy provides very good clinical outcomes if precisely indicated and performed. It is, however, a demanding procedure with many possible pitfalls and complications. According to our study, at least 100 procedures are needed to gain basic technical and indication skills. The presence of a more skilled surgeon in the beginning of the learning curve is advised to reduce the complication rate.

• MeSH
• artroskopie škodlivé účinky   výchova   metody   MeSH
• chirurgové výchova   MeSH
• délka operace MeSH
• dospělí MeSH
• femoroacetabulární impingement chirurgie   MeSH
• klinické kompetence statistika a číselné údaje   MeSH
• křivka učení MeSH
• kyčelní kloub chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH
• práce podpořená grantem MeSH

Proximální femorální osteotomie dříve patřily k nejčastěji prováděným výkonům na kyčelním kloubu, s vývojem nových úhlově stabilních dlah umožňujících současnou intraartikulární intervenci dochází k jejich renesanci. Základním zobrazovacím vyšetřením je nativní skiagram obou kyčlí, s jehož pomocí stanovíme základní koxometrické parametry. Kontrastní (artrografie) a výpočetní vyšetření (CT a MRI) představují vyšetření někdy sice důležitá, ale doplňková. Proximální femorální osteotomie indikujeme u deformit kyčelního kloubu, resp. u preartrotických vad. Smyslem chirurgické léčby kyčelní dysplazie je dosáhnout anatomicky normálního kyčelního kloubu, a to jak na acetabulární, tak femorální straně. Totéž platí u léčby coxa vara adolescentium a femoroacetabulárního impingementu. U Perthesovy choroby se naopak snažíme jistou hyperkorekcí jak na straně acetabulární, tak na straně femorální dosáhnout zhojení hlavice femuru, stejně tak chirurgická léčba avaskulární nekrózy hlavice předpokládá změnu normální anatomie kyčelního kloubu.Osteotomie proximálního femuru můžeme rozdělit podle proximodistální výše, techniky provedení a směru korekce. Nejpoužívanějším chirurgickým přístupem je přístup laterální, u klasické Dunnovy osteotomie pak přístup anterolaterální, při současné intraartikulární intervenci přístup lateroposteriorní s odtětím velkého trochanteru. Varizační osteotomii indikujeme u vývojové dysplazie kyčelní, Perthesovy choroby, případně u avaskulární nekrózy hlavice v dospělém věku. Valgizační osteotomii používáme nejčastěji u postluxačních ischemických změn, méně často při řešení poúrazových stavů. Vícerovinné a víceetážové osteotomie pak mají u jednotlivých preartrotických vad specifické použití. Technicky obtížné a pro vitalitu hlavice rizikové jsou krčkové a intrakapitální osteotomie, u určitých vad ale představují metodu volby. Proximální femorální osteotomie představují nedílnou součást ošetření preartrotických vad kyčelního kloubu. Hrubě neatomický výsledek operace může ale kompromitovat kyčel pro eventuální následnou konverzi na kloubní náhradu, stejně tak představuje riziko ponechaný robustní osteosyntetický materiál.

Proximal femoral osteotomy previously belonged among the most commonly performed hip joint procedures and with the development of new angularly stable splints allowing for simultaneous intraarticular intervention, we are seeing their renaissance. The basic imaging examination is the native skiagram of both hips, with which we determine the basic coxometric parameters. Contrast examinations (arthrography) and computerized examinations (CT and MRI) are sometimes important but complementary examinations. Proximal femoral osteotomy is indicated for hip joint deformities, or for pre-arthritic defects. The purpose of surgical treatment of hip dysplasia is to achieve an anatomically normal hip joint, both on the acetabular and femoral sides. The same applies to Coxa vara adolescentium and Femoroacetabular Impingement. In the case of Perthes disease, on the other hand, we are attempting a certain hypercorrection on both the acetabular and the femoral side to achieve the healing of the femoral head, as well as the surgical treatment of the Avascular Necrosis of the Head presupposes a change in normal hip anatomy.Osteotomy of the proximal femur can be divided according to proximodistal height, technique and direction of correction. The most commonly used surgical approach is the lateral approach, with the classic Dunn osteotomy, anterolateral approach is used, with simultaneous intraarticular intervention access latero-posterior with the depression of a large trochanter. Varicose osteotomy is indicated for developmental dysplasia of the hip, Perthes disease, or adult avascular necrosis of the head. Valgation osteotomy is most often used in post-ischemic changes, less frequently in the treatment of post-traumatic conditions. Multivariate and multithreaded osteotomies have a specific use for individual pre-prostatic defects. Technically difficult and for the vitality of the risk head are cervical and intracapital osteotomy, but with certain defects they are the method of choice. Proximal femoral osteotomy is an integral part of the treatment of pre-articular hip defects. However, the roughly non-anatomical outcome of the operation may compromise the hip for eventual subsequent conversion to the joint replacement, as well as the risk of leaving a robust ostheosynthetic material

• MeSH
• chirurgie operační metody   využití   MeSH
• femoroacetabulární impingement chirurgie   MeSH
• femur * chirurgie   MeSH
• kyčelní kloub abnormality   diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• osteotomie * klasifikace   metody   využití   MeSH
• Perthesova nemoc chirurgie   MeSH
• rentgendiagnostika MeSH
• skluz proximální femorální epifýzy chirurgie   MeSH
• vývojová kyčelní dysplazie chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE: The purpose of this study was to determine whether X-ray attributes of the femoro-acetabular impingement (FAI) - alpha angle (AA) and offset ratio (OR) reflect real measurements on resected femoral heads. METHODS: FAI AA and OR were assessed on 50 consecutively-resected femoral heads. The parameters were measured on heads cut through the maximum range of the deformity and compared to the same parameters on standardized X-ray projections (anterior-posterior [AP] and axial views). RESULTS: Mean AA was 76.47° on dissected heads vs. 75.81° on axial X-ray (p = 0.688). Mean OR was 0.132 on dissected heads vs. 0.220 on axial X-ray (p < 0.001). Mean AA on ideal AP X-ray was 79.46° vs. 81.51° on AP standing plain X-ray view (p = 0.431). AA measurements on plain X-ray AP and axial view of halved femoral heads correlated highly. CONCLUSIONS: AA on axial X-ray view reflected the real AA in our series, but the risk of cartilage damage cannot be predicted.

• MeSH
• dospělí MeSH
• femoroacetabulární impingement diagnostické zobrazování   chirurgie   MeSH
• hlavice femuru anatomie a histologie   diagnostické zobrazování   chirurgie   MeSH
• kyčelní kloub diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu metody   MeSH
• počítačová rentgenová tomografie MeSH
• reprodukovatelnost výsledků MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• artroskopie MeSH
• artróza kyčelních kloubů * etiologie   chirurgie   MeSH
• femoroacetabulární impingement * diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• vývojová kyčelní dysplazie MeSH
• Check Tag
• lidé MeSH

• MeSH
• acetabulum abnormality   chirurgie   MeSH
• artróza kyčelních kloubů MeSH
• femoroacetabulární impingement diagnóza   chirurgie   patofyziologie   ultrasonografie   MeSH
• femur abnormality   chirurgie   MeSH
• kyčelní kloub chirurgie   MeSH
• miniinvazivní chirurgické výkony MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie

PURPOSE: The aim of this study was to assess the outcome of hip preserving surgery for femoroacetabular impingement relative to the condition resulting in FAI and to the patient's age at the time of the surgery. METHODS: With the conditions for exclusion duly met, enrolled in our study were a total of 100 hip joints (83 operated on with the aid of SHD, 17 with AMIS). The minimum follow-up period was 12 months, and the mean follow-up time was three years four months. WOMAC and NAHS questionnaires were used as rating instruments. To analyse the significance of the differences relative to the age at the time of surgery and to the basic diagnosis leading to FAI and subsequently to surgical operation we used non-parametric forms of analysis of variance (Friedman test and Kruskal-Wallis test), i.e., comparisons of the patients' pre-operative and postoperative states, estimation of the rate of improvement in the postoperative functional skills in relation to the age at the time of surgery and/or relative to the basic diagnosis necessitating surgical intervention, with respect to statistical significance at the level of p < 0.05. RESULTS: As testing of our cohort of patients and results analysis showed, the youngest group (<30 years) compared with the rest of the cohort shows greater postoperative improvement and consequently also a better surgical result. Proof was also obtained that the diagnosis leading to surgery for FAI has no effect on the patient's pre- or postoperative state or on the degree of improvement. CONCLUSIONS: The results of the study affirm the relevance of hip preserving surgery, especially in younger-aged groups.

• MeSH
• dospělí MeSH
• femoroacetabulární impingement diagnóza   etiologie   chirurgie   MeSH
• kyčelní kloub chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační bolest epidemiologie   MeSH
• senioři MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

UNLABELLED: Articular cartilage assessment in femoroacetabular impingement (FAI) is challenging. Recent studies on T2* relaxation time mapping suggest the technique may be useful in diagnosing cartilage damage. The purpose of this case report is to describe how quantitative T2*-mapping may improve cartilage assessment of the acetabulum in patients with FAI. MR arthrography was performed at 3 Tesla (T) using intra-articular Gadolinium and a T2* mapping protocol. Data from the acetabular cartilage was separated from femoral head cartilage data and then superimposed on a flattened, map projection representation of the patient's acetabulum. The areas of unhealthy cartilage observed at the time of arthroscopy - including debonding and delamination - were seen preoperatively at the same anatomic locations as areas of decreased T2* values. T2* mapping values provided a non-invasive assessment of the acetabular articular cartilage. A flattened acetabular map projection allowed for anatomic visualization of areas of unhealthy cartilage. LEVEL OF EVIDENCE: Level IV.

• MeSH
• acetabulum chirurgie   MeSH
• dospělí MeSH
• femoroacetabulární impingement patologie   chirurgie   MeSH
• kloubní chrupavka chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH