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Sanjeev Madan - One of the best experts on this subject based on the ideXlab platform.
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moderate and severe scfe slipped capital femoral epiphysis arthroscopic Osteoplasty vs open neck osteotomy a retrospective analysis of results
International Orthopaedics, 2019Co-Authors: Balasubramanian Balakumar, Elinor Flatt, Sanjeev MadanAbstract:Aim We intend to compare the outcomes of arthroscopic Osteoplasty with open neck osteotomy for correction of the hip impingement and improvement of hip function in children with moderate to severe healed Slipped Capital Femoral Epiphysis (SCFE). Our aim is to verify if arthroscopic Osteoplasty could achieve the same outcome as open procedures. Patients and methods A retrospective analysis of the hospital hip database retrieved 187 cases of SCFE from 2006 to 2013. We found 12 patients underwent open neck osteotomy and deformity correction for moderate/ severe healed SCFE and ten underwent arthroscopic Osteoplasty of the hip. We compared the outcomes between these groups. Results In the arthroscopy cohort, the mean age at surgery was 15.8 years (range 13-19 years) and mean follow-up was 46.1 months (range 33-66 months). In the neck osteotomy group, the mean age at surgery was 14.6 years (11-20 years) and mean duration of follow-up was 49 months (36-60 months). The outcomes in arthroscopic Osteoplasty group vs. open neck osteotomy were as follows: antero-posterior (AP) slip angle 9.2° (0.3°- 28.8°) vs 10.8° (1°-17.9°) (p = 0.0003), lateral slip angle 44.8° (36.5°-64.2°) vs 13.5° (1°-28.5°) (p = 0.00001), oblique plane deformity 47.1° (40.2°-53.5°) vs 16.7° (1°-28.6°) (p = 0.0003), alpha angle 61.88° (52.1°-123°) vs.34.6° (23.2°-45.6°) (p = 0.0003), anterior offset 0 mm (0 mm-2 mm) vs. 5 mm (2-13 mm) (p = 0.0003), modified Harris hip score (MHHS) 75.5 (58.75-96.8) vs. 90 (86.2-99) (p = 0.003), non-arthroplasty hip score (NAHS) 67.12 (18.75-100) vs. 92.1 (81.25-100) (p = 0.002), internal rotation 20° (0-20°) vs. 50° (30°-70°) (p = 0.0002), respectively. Conclusion Even though the radiographic correction lagged behind in the arthroscopic group, the functional outcomes achieved did convey the gain of function in this cohort. In carefully selected cases, arthroscopy could be a less invasive procedure which has desirable outcomes.
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SEVERE SLIPPED CAPITAL FEMORAL EPIPHYSIS: ARTHROSCOPIC Osteoplasty VERSUS OPEN NECK OSTEOTOMY: A RETROSPECTIVE ANALYSIS OF RESULTS
2018Co-Authors: Balasubramanian Balakumar, S. Basheer, Sanjeev MadanAbstract:PurposeThis report compares midterm results of open neck Osteoplasty + neck osteotomy vs arthroscopic Osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE).MethodDatabase from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and Osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively.ResultsThe unpaired t-test showed that the post-operative corrections were significantly better in the ONO than the AO group. Slip angle (16.7° (1°–28.6°) Vs 47.1° (40.2° – 53.5°) p = .0003), head neck offset correction (5mm (2–13mm) Vs 0mm (0mm – 2mm) p = 0.0003), alpha angle (34.6° (23.2°–45.6°) Vs 61.88° (52.1° – 123°) p= 0.0003), Modified Harris Hip Score (MHHS) (90(86.2–99) Vs 75.5 (58.75 – 96.8) p= 0.003) and internal rotation p= 0.0002Paired t-test showed significant improvement in corrections within the individual g...
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severe slipped capital femoral epiphysis arthroscopic Osteoplasty versus open neck osteotomy a retrospective analysis of results
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: Balasubramanian Balakumar, S. Basheer, Sanjeev MadanAbstract:Purpose This report compares midterm results of open neck Osteoplasty + neck osteotomy vs arthroscopic Osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE). Method Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and Osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively. Results The unpaired t -test showed that the post-operative corrections were significantly better in the ONO than the AO group. Slip angle (16.7° (1°–28.6°) Vs 47.1° (40.2° – 53.5°) p = .0003), head neck offset correction (5mm (2–13mm) Vs 0mm (0mm – 2mm) p = 0.0003), alpha angle (34.6° (23.2°–45.6°) Vs 61.88° (52.1° – 123°) p =0.0003), Modified Harris Hip Score (MHHS) (90(86.2–99) Vs 75.5 (58.75 – 96.8) p =0.003) and internal rotation p=0.0002 Paired t -test showed significant improvement in corrections within the individual groups compared with their own preoperative values. The results of AO group were oblique plane slip angle (55° (47.7° – 63.2°) Vs 47.1° (40.2° – 53.5°) p =0.001), alpha angle (90.7° (65° – 131°) Vs 61.88° (52.1° – 123°) p = 0.0001), head neck offset (0mm (−3 mm to 0mm) Vs 0mm (0mm – 2mm) p =0.001) and MHHS (52.7 (28.7 – 89.1) Vs 75.5 (58.75 – 96.8) p =0.0005). Complications in ONO group were varus malunion (1) and non-union(1) of the osteotomy. In the arthroscopic group persistent impingement in 3 patients and 5 were not able to return to sports. Conclusion Our results showed improved hip function following arthroscopic Osteoplasty in severe SCFE. Considering the risks of an open surgical dislocation we could find that arthroscopy contributed worthy improvement in hip function in low demand patients.
Reinhold Ganz - One of the best experts on this subject based on the ideXlab platform.
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In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report
Clinical Orthopaedics and Related Research®, 2010Co-Authors: Michael Leunig, Kevin Horowitz, Hannes Manner, Reinhold GanzAbstract:Background There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic Osteoplasty. Description of Techniques Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access was obtained and head-neck Osteoplasty was completed. Methods Between March 2008 and August 2009, three male patients (age range, 11–15 years; BMI, 22–31 kg/m^2) presented with slip angles between 15º and 30º. All were ambulatory without assistance but had 2 to 12 weeks of hip and/or knee pain, limited motion and a positive impingement test. Postoperatively, patients were assessed at 6 weeks; 3 and 6 months; then every 6 months for the first two years. Hip motion, epiphyseal-metaphyseal offsets and alpha angles were determined. Patients completed the UCLA activity scale at latest followup that ranged from 6 to 23 months. Results Arthroscopic evaluation revealed labral fraying, acetabular chondromalacia, and a prominent metaphyseal ridge. At last followup, each was pain-free and had returned to unrestricted activities. Hip motion improved in all and none demonstrated clinical impingement. Radiographs showed normalized epiphyseal-metaphyseal offsets and alpha angles. Conclusions In situ pinning with arthroscopic Osteoplasty can limit impingement after mild slipped capital femoral epiphysis. Due to limited followup, we are unable to say whether this protocol reduces subsequent articular damage. Although we recommend performing these procedures concomitantly, they can be performed in a staged fashion, especially since hip arthroscopy following an epiphyseal slip can be challenging. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report
Clinical orthopaedics and related research, 2010Co-Authors: Michael Leunig, Hannes M. Manner, Kevin Horowitz, Reinhold GanzAbstract:Background There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic Osteoplasty.
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Femoroacetabular impingement.
The Journal of the American Academy of Orthopaedic Surgeons, 2007Co-Authors: Javad Parvizi, Michael Leunig, Reinhold GanzAbstract:Evidence is emerging that subtle morphologic abnormalities around the hip, resulting in femoroacetabular impingement, may be a contributing factor in some instances to osteoarthritis in the young patient. The morphologic abnormalities result in abnormal contact between the femoral neck/head and the acetabular margin, causing tearing of the labrum and avulsion of the underlying cartilage region, continued deterioration, and eventual onset of arthritis. Nonsurgical treatment typically fails to control symptoms. Surgical management involves dislocation of the hip (while preserving the blood supply to the femoral head) and femoroacetabular Osteoplasty. Encouraging results have been reported following femoroacetabular Osteoplasty and arthroscopic treatment of femoroacetabular impingement.
Richard N. Villar - One of the best experts on this subject based on the ideXlab platform.
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early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral Osteoplasty in symptomatic improvement
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: N V Bardakos, J C Vasconcelos, Richard N. VillarAbstract:Introduction and Aims: There is a known association between femoroacetabular impingement (FAI) and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms. Materials and Methods: This study compares the one-year results of hip arthroscopy for cam-type FAI in two groups of patients. The study (Osteoplasty) group comprised 24 patients (24 hips) with cam-type FAI who underwent arthroscopic debridement with excision of their impingement lesion. The control (no Osteoplasty) group comprised 47 patients (47 hips) who underwent arthroscopic debridement without excision of their impingement lesion. In both groups, the presence of FAI was confirmed on pre-operative plain radiographs. The modified Harris hip score (MHHS) was used for evaluation pre-operatively and at one year’s follow-up. Non-parametric tests were used for statistical analysis. Results: A tendency towards higher median post-operative MHHS scores was observed in the study than in the control group (83 vs. 77, p = 0.11). This was supported by a significantly higher portion of patients in the Osteoplasty group with excellent/good results (83% vs. 60%, p = 0.043). Conclusions: It appears that even further symptomatic improvement may be obtained after hip arthroscopy for FAI by means of the femoral Osteoplasty. When treating cam impingement arthroscopically, both central and peripheral compartments of the hip should always be accessed.
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early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral Osteoplasty in symptomatic improvement
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: N V Bardakos, J C Vasconcelos, Richard N. VillarAbstract:There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient's symptoms. This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (Osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis. A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the Osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral Osteoplasty.
Balasubramanian Balakumar - One of the best experts on this subject based on the ideXlab platform.
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moderate and severe scfe slipped capital femoral epiphysis arthroscopic Osteoplasty vs open neck osteotomy a retrospective analysis of results
International Orthopaedics, 2019Co-Authors: Balasubramanian Balakumar, Elinor Flatt, Sanjeev MadanAbstract:Aim We intend to compare the outcomes of arthroscopic Osteoplasty with open neck osteotomy for correction of the hip impingement and improvement of hip function in children with moderate to severe healed Slipped Capital Femoral Epiphysis (SCFE). Our aim is to verify if arthroscopic Osteoplasty could achieve the same outcome as open procedures. Patients and methods A retrospective analysis of the hospital hip database retrieved 187 cases of SCFE from 2006 to 2013. We found 12 patients underwent open neck osteotomy and deformity correction for moderate/ severe healed SCFE and ten underwent arthroscopic Osteoplasty of the hip. We compared the outcomes between these groups. Results In the arthroscopy cohort, the mean age at surgery was 15.8 years (range 13-19 years) and mean follow-up was 46.1 months (range 33-66 months). In the neck osteotomy group, the mean age at surgery was 14.6 years (11-20 years) and mean duration of follow-up was 49 months (36-60 months). The outcomes in arthroscopic Osteoplasty group vs. open neck osteotomy were as follows: antero-posterior (AP) slip angle 9.2° (0.3°- 28.8°) vs 10.8° (1°-17.9°) (p = 0.0003), lateral slip angle 44.8° (36.5°-64.2°) vs 13.5° (1°-28.5°) (p = 0.00001), oblique plane deformity 47.1° (40.2°-53.5°) vs 16.7° (1°-28.6°) (p = 0.0003), alpha angle 61.88° (52.1°-123°) vs.34.6° (23.2°-45.6°) (p = 0.0003), anterior offset 0 mm (0 mm-2 mm) vs. 5 mm (2-13 mm) (p = 0.0003), modified Harris hip score (MHHS) 75.5 (58.75-96.8) vs. 90 (86.2-99) (p = 0.003), non-arthroplasty hip score (NAHS) 67.12 (18.75-100) vs. 92.1 (81.25-100) (p = 0.002), internal rotation 20° (0-20°) vs. 50° (30°-70°) (p = 0.0002), respectively. Conclusion Even though the radiographic correction lagged behind in the arthroscopic group, the functional outcomes achieved did convey the gain of function in this cohort. In carefully selected cases, arthroscopy could be a less invasive procedure which has desirable outcomes.
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SEVERE SLIPPED CAPITAL FEMORAL EPIPHYSIS: ARTHROSCOPIC Osteoplasty VERSUS OPEN NECK OSTEOTOMY: A RETROSPECTIVE ANALYSIS OF RESULTS
2018Co-Authors: Balasubramanian Balakumar, S. Basheer, Sanjeev MadanAbstract:PurposeThis report compares midterm results of open neck Osteoplasty + neck osteotomy vs arthroscopic Osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE).MethodDatabase from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and Osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively.ResultsThe unpaired t-test showed that the post-operative corrections were significantly better in the ONO than the AO group. Slip angle (16.7° (1°–28.6°) Vs 47.1° (40.2° – 53.5°) p = .0003), head neck offset correction (5mm (2–13mm) Vs 0mm (0mm – 2mm) p = 0.0003), alpha angle (34.6° (23.2°–45.6°) Vs 61.88° (52.1° – 123°) p= 0.0003), Modified Harris Hip Score (MHHS) (90(86.2–99) Vs 75.5 (58.75 – 96.8) p= 0.003) and internal rotation p= 0.0002Paired t-test showed significant improvement in corrections within the individual g...
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severe slipped capital femoral epiphysis arthroscopic Osteoplasty versus open neck osteotomy a retrospective analysis of results
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: Balasubramanian Balakumar, S. Basheer, Sanjeev MadanAbstract:Purpose This report compares midterm results of open neck Osteoplasty + neck osteotomy vs arthroscopic Osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE). Method Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and Osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively. Results The unpaired t -test showed that the post-operative corrections were significantly better in the ONO than the AO group. Slip angle (16.7° (1°–28.6°) Vs 47.1° (40.2° – 53.5°) p = .0003), head neck offset correction (5mm (2–13mm) Vs 0mm (0mm – 2mm) p = 0.0003), alpha angle (34.6° (23.2°–45.6°) Vs 61.88° (52.1° – 123°) p =0.0003), Modified Harris Hip Score (MHHS) (90(86.2–99) Vs 75.5 (58.75 – 96.8) p =0.003) and internal rotation p=0.0002 Paired t -test showed significant improvement in corrections within the individual groups compared with their own preoperative values. The results of AO group were oblique plane slip angle (55° (47.7° – 63.2°) Vs 47.1° (40.2° – 53.5°) p =0.001), alpha angle (90.7° (65° – 131°) Vs 61.88° (52.1° – 123°) p = 0.0001), head neck offset (0mm (−3 mm to 0mm) Vs 0mm (0mm – 2mm) p =0.001) and MHHS (52.7 (28.7 – 89.1) Vs 75.5 (58.75 – 96.8) p =0.0005). Complications in ONO group were varus malunion (1) and non-union(1) of the osteotomy. In the arthroscopic group persistent impingement in 3 patients and 5 were not able to return to sports. Conclusion Our results showed improved hip function following arthroscopic Osteoplasty in severe SCFE. Considering the risks of an open surgical dislocation we could find that arthroscopy contributed worthy improvement in hip function in low demand patients.
Cyril Mauffrey - One of the best experts on this subject based on the ideXlab platform.
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Study protocol: trial of inflation Osteoplasty in the management of tibial plateau fractures.
European Journal of Orthopaedic Surgery and Traumatology, 2013Co-Authors: Robert W. Jordan, Douglas Gibula, Robert Fader, J. Hao, Cyril MauffreyAbstract:Introduction Restoration of articular congruency is a key factor in preventing post-traumatic osteoarthritis following tibial plateau fractures. Current surgical techniques using a bone tamp carry the risk of joint perforation and comminution of the depressed fragments which affect patient outcome. Successful use of inflation Osteoplasty has been reported in both in vitro studies (Broome et al. in J Orthopaed Traumatol 13(2):89–95, 2012; Mauffrey et al. in Patient Saf Surg 6:6, 2012) and case reports in the management of fractures of the calcaneus, cuboid, distal radius, tibial plateau and acetabulum (Gupta et al. in Foot Ankle Int 32(2):205–210, 2011; Heim et al. in Foot Ankle Int 29(11):1154–1157, 2008; Konig et al. in Case Rep Unfallchirurg 109(4):328–331, 2006; Reiley in J Orthop Trauma 17:141–163, 2006). The aim of our study is to assess whether the use of the balloon Osteoplasty improves the quality of reduction of a depressed tibial plateau fracture when compared to traditional methods of fracture reduction.
