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Session: Surgical Techniques - Needles
Session starts: Thursday 24 January, 10:40
Presentation starts: 11:40
Room: Lecture room 557

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Peter Krekel (Delft University of Technology)
Charl Botha (Delft University of Technology)
Maarten Röling (Reinier de Graaf Gasthuis Delft)
Rolf Bloem (Reinier de Graaf Gasthuis Delft)

Abstract:
In femoroacetabular impingement (FAI), deformations of the femoral head or the acetabular rim lead to bony impingement, resulting in limited hip motion, pain and progressive damage to the labrum. Recent work suggests that FAI may lead to osteoarthritis (OA) [1]. Although the etiology of FAI is still unclear, a variety of possible causes are described, such as excessive sporting activities and posttraumatic deformities (e.g. acetabular dysplasia). No golden standard has yet been developed for the diagnostic pathway in FAI. Regular x-rays, marcainization, MRI scans and CT scan are widely used and might indicate for FAI. The alpha-angle, determined on an x-ray, is often used for indicating FAI, but does not have a high specificity. Our objective was to determine if 3D motion simulation [2] is an improvement in the analysis compared to regular diagnostic methods of FAI. We analyzed 20 patients with chronic groin pain with the 3D software from Clinical Graphics, Delft, for the presence of hip impingement (see Figure 1). This software analyses CT scans and creates a three-dimensional movement analysis of the joint. With this analysis, a precise localization of the impingement deformity (cam and pincer) as well as the range of motion can be obtained. Also, the amount of resection to create a free range of motion can be determined. These results are compared to the alpha angle, measured on an x-ray. Demography, preoperative complaints, postoperative pain relief and complications were analyzed in all patients. In total 20 patients, 12 male, were analyzed. The average age was 36.4 years (18-60). Patients experienced pain for an average of 4.0 years (1.0-14.0) and 55% were active athletes. The average alpha-angle was 65° (40-105). In 35% of all patients, the alpha-angle was not indicative for cam-deformity (<60°), but with the 3D CT movement analysis an impinging deformity was diagnosed in all patients. The impingement was confirmed during arthroscopy in all patients. 95% of the patients improved in pain relief after surgery, and no complications were registered. We conclude that three-dimensional CT movement analysis is a promising innovative technique in visualizing FAI and might be used for diagnosis. The technique is now used and evaluated in a prospective follow up cohort.