Hip preservation surgery for young adults with femoroacetabular impingement, hip dysplasia, and acetabular retroversion. Literature review
V. S. Cherkasov,
D. G. Pliev,
A. N. Kovalenko,
A. D. Sineokiy,
M. S. Guatsaev,
G. A. Airapetov,
K. A. Dzampaev https://doi.org/10/17238/issn2226-2016.2025.3.83-90
Abstract
Introduction: Hip preservation techniques for young adults with structural abnormalities (FAI, dysplasia, retroversion) aim to prevent joint degeneration. T his review assesses surgical innovations, outcomes, and unresolved challenges in the field.
Materials and Methods: A literature search across PubMed, Scopus, Web of Science, e-Library. identified 45 studies. Inclusion criteria: focus on joint preservation surgery, comparative analysis of techniques (PAO, arthroscopy, surgical dislocation), and ≥5-year follow-up. Excluded: case reports, animal studies.
Results: Hip arthroscopy shows favorable short-term outcomes for FAI (mHHS 85.9±12.1), yet 4.2 % require conversion to arthroplasty. Surgical dislocation of the hip allows surgeons who do not have hip arthroscopy to correct pronounced deformity with femoroacetabular impingement, as well as to suture a massive rupture of the acetabulum lip with minimal risk of avascular necrosis but correlates with pseudarthrosis and heterotopic ossification. PAO provides 91.3% (95 % Cl: 87.7–94.8 %) of 10-year survivorship; however, The survival of the hip joint after periacetabular osteotomy was influenced by the presence of correction errors and the initial condition of the hip joint.
The following issues also remain unresolved: standardization of protocols, minimization of complications, individualization of approaches. The integration of digital technologies and biomechanical research will expand the indications for organ-preserving operations.
About the Authors
V. S. Cherkasov
State Budgetary Healthcare Institution of the City of Moscow “City clinical hospital №31 named after academician G.M. Savelyeva of the Moscow Healthcare Department”
Russian Federation
Russian Federation
Cherkasov Vitaly S., traumatologist-orthopedist, orthopedics department
119415, ulitsa Lobachevskogo, 42/2, Moscow
D. G. Pliev
Federal State Budgetary Institution “R.R. Vreden National medical research center of traumatology and orthopedics” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Pliev David G., Ph.D. in traumatology, head of traumatology and orthopedics department №19; head of the scientific department of hip pathology
195427, ulitsa akademika Baykova, 8, Saint Petersburg
A. N. Kovalenko
Federal State Budgetary Institution “R.R. Vreden National medical research center of traumatology and orthopedics” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Kovalenko Anton N., Ph.D. in traumatology, traumatologistorthopedist, traumatology and orthopedics department №19; researcher, scientific department of hip pathology
195427, ulitsa akademika Baykova, 8, Saint Petersburg
A. D. Sineokiy
Federal State Budgetary Institution “R.R. Vreden National medical research center of traumatology and orthopedics” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Sineokiy Andrey D., Ph.D. in traumatology, traumatologist-orthopedist, traumatology and orthopedics department №19
195427, ulitsa akademika Baykova, 8, Saint Petersburg
M. S. Guatsaev
Federal State Budgetary Institution “R.R. Vreden National medical research center of traumatology and orthopedics” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Guatsaev Maxim S., traumatologist-orthopedist, traumatology and orthopedics department №19
195427, ulitsa akademika Baykova, 8, Saint Petersburg
G. A. Airapetov
State Budgetary Healthcare Institution of the City of Moscow “City clinical hospital №31 named after academician G.M. Savelyeva of the Moscow Healthcare Department”; Federal State Autonomous Educational Institution of Higher Education “Peoples' Friendship University of Russia named after Patrice Lumumba”,
Russian Federation
Russian Federation
Airapetov Georgy A., doctor of traumatology and orthopedics, deputy chief physician for traumatology and orthopedics; professor, department of traumatology
and orthopedics
117198, ulitsa Miklukho-Maklaya, 6, Moscow
K. A. Dzampaev
3Federal State Autonomous Educational Institution of Higher Education “Peoples' Friendship University of Russia named after Patrice Lumumba”,
Russian Federation
Russian Federation
Dzampaev Konstantin A., resident, department of traumatology and orthopedics
117198, ulitsa Miklukho-Maklaya, 6, Moscow
References
1. Bayliss L.E., Culliford D., Monk A.P., Glyn-Jones S., Prieto Alhambra D., Judge A., Cooper C., Carr A.J., Arden N.K., Beard D.J., Price A.J. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017 Apr 8;389(10077):1424-1430. doi: 10.1016/S0140-6736(17)30059-4.
2. Ganz R., Leunig M., Leunig-Ganz K., Harris W.H. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008 Feb;466(2):264-72. doi: 10.1007/s11999-007-0060-z.
3. Tomé I., Alves-Pimenta S., Sargo R., Pereira J., Colaço B., Brancal H., Costa L., Ginja M. Mechanical osteoarthritis of the hip in a one medicine concept: a narrative review. BMC Vet Res. 2023 Oct 24;19(1):222. doi: 10.1186/s12917-023-03777-z.
4. Cho Y.J., Rhyu K.H., Chun Y.S., Kim M.S. Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia. J Hip Preserv Surg. 2022 Jun 30;9(3):151-157. doi: 10.1093/jhps/hnac026.
5. Bardakos N.V., Villar R.N. Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br. 2009 Feb;91(2):162-9. doi: 10.1302/0301-620X.91B2.21137.
6. Clohisy J.C., Beaulé P.E., O'Malley A., Safran M.R., Schoenecker P. AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am. 2008 Oct;90(10):226781. doi: 10.2106/JBJS.G.01267.
7. Shubnyakov I. I. Justification of the optimized system of primary hip joint endoprosthesis. Dissertation for the degree of Doctor of Medical Sciences, 2017.
8. Zusmanovich M., Haselman W., Serrano B., Banffy M. The Incidence of Hip Arthroscopy in Patients With Femoroacetabular Im pingement Syndrome and Labral Pathology Increased by 85% Between 2011 and 2018 in the United States. Arthroscopy. 2022 Jan;38(1):82-87. doi:10.1016/j.arthro.2021.04.049.
9. Zhu Y., Su P., Xu T., Zhang .L, Fu W. Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis. J Orthop Surg Res. 2022 Jun 3;17(1):296. doi: 10.1186/s13018-022-03187-1.
10. Yu H., Wang M., Wang L., Wang Y., Li C. Hip Arthroscopy With Fluoroscopy-Free Technique for the Treatment of Femoroacetabular Impingement. Arthrosc Tech. 2022 Dec 21;12(1):e1-e10. doi: 10.1016/j.eats.2022.08.050.
11. Savoye-Laurens T., Verdier N., Wettstein M., Baulot E., Gédouin J.E., Martz P. Labral tears in hip dysplasia and femoroacetabular impingement: A systematic review. Orthop Traumatol Surg Res. 2023 Jun;109(4):103539. doi: 10.1016/j.otsr.2022.103539.
12. Zhu X.M., Toobaie A. Iansavichene A., Khan M., Degen R.M. Improvement in pain and patient-related outcome measures following hip arthroscopy in patients with femoroacetabular impingement syndrome and concomitant generalized ligamentous laxity: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2022 Nov;30(11):3907-3915. doi: 10.1007/s00167-022-06997-2.
13. Zimmerer A., Schneider M.M., Nietschke R., Miehlke W., Sobau C. Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes. Orthop J Sports Med. 2020 May 20;8(5):2325967120920851. doi: 10.1177/2325967120920851.
14. Domb B.G., Chaharbakhshi E.O., Perets I., Yuen L.C., Walsh J.P., Ashberg L. Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes. Am J Sports Med. 2018 Feb;46(2):305-313. doi: 10.1177/0363546517743720.
15. Zeman P., Rafi M., Kautzner J. Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. Int Orthop. 2021 Oct;45(10):2525-2529. doi: 10.1007/s00264-021-05114-1.
16. Maldonado D.R., Perets I., Mu B.H., Ortiz-Declet V., Chen A.W., Lall A.C., Domb B.G. Arthroscopic Capsular Plication in Patients With Labral Tears and Borderline Dysplasia of the Hip: Analysis of Risk Factors for Failure. Am J Sports Med. 2018 Dec;46(14):3446-3453. doi: 10.1177/0363546518808033.
17. Ganz R., Gill T.J., Gautier E., Ganz K., Krügel 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 Nov;83(8):1119-24. doi: 10.1302/0301-620x.83b8.11964.
18. Ganz R., Horowitz K., Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res. 2010 Dec;468(12):3168-80. doi: 10.1007/s11999-010-1489-z.
19. Khalifa A.A., Haridy M.A., Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: a systematic review and meta-analysis. World J Orthop. 2021;12(8):604–619. doi: 10.5312/wjo.v12.i8.604
20. Halawi M.J., Brigati D.P., Brooks P.J. Surgical hip dislocation through a modified direct lateral approach: real-time perfusion monitoring. Arthroplast Today. 2019 Apr 20;5(3):316-319. doi: 10.1016/j.artd.2019.03.005.
21. Ahmad S.S., Heilgemeir M., Anwander H., Beck M. Surgical hip dislocation is more powerful than arthroscopy for achieving high degrees of acetabular correction in pincer type impingement. Orthop Traumatol Surg Res. 2019 Nov;105(7):1339-1344. doi: 10.1016/j.otsr.2019.08.009.
22. Zhang D., Chen L., Wang G. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement: A systematic review and meta-analysis. Medicine (Baltimore). 2016 Oct;95(41):e5122. doi: 10.1097/MD.0000000000005122.
23. Sink E.L, Beaulé P.E. Sucato D., Kim Y.J., Millis M.B., Dayton M., Trousdale R.T., Sierra R.J., Zaltz I., Schoenecker P., Monreal A., Clohisy J. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011;93(12):1132–1136. doi: 10.2106/jbjs.J.00794.
24. Kargin D., Albayrak A., Atici Y., Yapici F., İlvan G., Balioğlu M.B. The complications after open hip dislocation in hip surgery. Acta Orthop Belg. 2017 Mar;83(1):74-80.
25. Peng P., Wei T., Fang W., Xiao F., He X., He W., Wei Q., He M. A bibliometric analysis and visualization of research trends on surgical hip dislocation. J Hip Preserv Surg. 2022 Dec 31;10(1):8-16. doi: 10.1093/jhps/hnac049.
26. Ganz R., Klaue K., Vinh T. S., & Mast, J. W. (1988). A new periacetabular osteotomy for the treatment of hip dysplasias: Technique and preliminary results. Clinical Orthopaedics and Related Research, 232, 26–36.
27. Tønning L.U., O'Brien M., Semciw A., Stewart C., Kemp J.L., Mechlenburg I. Periacetabular osteotomy to treat hip dysplasia: a systematic review of harms and benefits. Arch Orthop Trauma Surg. 2023 Jun;143(6):3637-3648. doi: 10.1007/s00402-022-04627-7.
28. Siebenrock K.A., Schöll E., Lottenbach M., Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999 Jun;(363):9-20.
29. Wei T., Xiao F., He X., Peng P., He W., He M., Wei Q. A bibliometric analysis and visualization of research trends on periacetabular osteotomy. J Hip Preserv Surg. 2023 Nov 11;10(3-4):181-191. doi: 10.1093/jhps/hnad038.
30. Ahmad S.S., Haertlé M., Konrads C., Derksen A., Windhagen H., Wirries N. The Scientific Evolution of Periacetabular Osteotomy: A Global Review. J Clin Med. 2022 Oct 17;11(20):6099. doi: 10.3390/jcm11206099.
31. Tan S.H.S., Tan J.H.I., Lim A.K.S., Hui J.H. Periacetabular osteotomy for acetabular retroversion: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2021 Dec;107(8):103078. doi: 10.1016/j.otsr.2021.103078.
32. Wilson E.S., Wagner K.R., Spiker A.M. Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy? Curr Rev Musculoskelet Med. 2024 Dec;17(12):538-547. doi: 10.1007/s12178-024-09928-5.
33. Clohisy J.C., Schutz A.L., St John L., Schoenecker P.L., Wright R.W. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009 Aug;467(8):2041-52. doi: 10.1007/s11999-009-0842-6.
34. Tan J.H.I., Tan S.H.S., Rajoo M.S., Lim A.K.S., Hui J.H. Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022 Jun;108(4):103283. doi: 10.1016/j.otsr.2022.103283.
35. Lerch T.D., Steppacher S.D., Liechti E.F., Tannast M., Siebenrock K.A. One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA. Clin Orthop Relat Res. 2017 Apr;475(4):1154-1168. doi: 10.1007/s11999-016-5169-5.
36. Matheney T., Kim Y.J., Zurakowski D., Matero C., Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009 Sep;91(9):2113-23. doi: 10.2106/JBJS.G.00143.
37. Zhang Z., Cheng N., Jia H., Cheng H., Song Y., Ren N., Li Y., Luo D., Zhang H. Is Prior Nonoperative or Operative Treatment of Dysplasia of the Hip Associated With Poorer Results of PeriacetabularOsteotomy? Clin Orthop Relat Res. 2024 Nov 1;482(11):1987-1996. doi: 10.1097/CORR.0000000000003150.
38. Steppacher S.D., Tannast M., Ganz R., Siebenrock K.A. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008 Jul;466(7):1633-44. doi: 10.1007/s11999-008-0242-3.
39. Albers C.E., Steppacher S.D., Ganz R., Tannast M., Siebenrock K.A. Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res. 2013 May;471(5):1602-14. doi: 10.1007/s11999-013-2799-8.
40. Yilmaz M., Aydin M., Capkin S. Acetabular dysplasia: a comparison of periacetabular osteotomy results of patients older and younger than 35 years. Eur Rev Med Pharmacol Sci. 2022 Nov;26(22):8303-8310. doi: 10.26355/eurrev_202211_30362.
41. Ramírez-Núñez L., Payo-Ollero J., Comas M., Cárdenas C., Bellotti V., Astarita E., Chacón-Cascio G., Ribas M. Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases. Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 MayJun;64(3):151-159. English, Spanish. doi: 10.1016/j.recot.2020.01.003.
42. Khan OH, Malviya A, Subramanian P, Agolley D, Witt JD. Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J. 2017 Jan;99B(1):22-28. doi: 10.1302/0301-620X.99B1.BJJ-2016-0439.R1.
43. Ali M., Malviya A. Complications and outcome after periacetabular osteotomy - influence of surgical approach. Hip Int. 2020 Jan;30(1):4-15. doi: 10.1177/1120700019871195.
44. Novais E.N., Duncan S., Nepple J., Pashos G., Schoenecker P.L., Clohisy J.C. Do Radiographic Parameters of Dysplasia Improve to Normal Ranges After Bernese Periacetabular Osteotomy? Clin Orthop Relat Res. 2017 Apr;475(4):1120-1127. doi: 10.1007/s11999-016-5077-8.
45. Zeng G., Schmaranzer F., Degonda C., Gerber N., Gerber K., Tannast M., Burger J., Siebenrock K.A., Zheng G., Lerch T.D. MRIbased 3D models of the hip joint enables radiation-free computer-assisted planning of periacetabular osteotomy for treatment of hip dysplasia using deep learning for automatic segmentation. Eur J Radiol Open. 2020 Dec 18;8:100303. doi: 10.1016/j.ejro.2020.100303.
Review
For citations:
Cherkasov V.S., Pliev D.G., Kovalenko A.N., Sineokiy A.D., Guatsaev M.S., Airapetov G.A., Dzampaev K.A. Hip preservation surgery for young adults with femoroacetabular impingement, hip dysplasia, and acetabular retroversion. Literature review. Department of Traumatology and Orthopaedics. 2025;(3):83-90. (In Russ.) https://doi.org/10/17238/issn2226-2016.2025.3.83-90
Views:
40
JATS XML
Email this article 