AANA Lab Course 914 - Advanced Hip Arthroscopy-Decision Making for Complex Rim Disorders, Srino Bharam, MD

Decision Making for Complex Rim Disorders, Srino Bharam, MD

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This document summarizes findings from presentations at the AANA HIP Course held in November 2019, focusing on hip preservation surgery, particularly arthroscopic management of hip pathologies including femoroacetabular impingement (FAI), os acetabuli, and borderline hip dysplasia.<br /><br />Dr. Srino Bharam and colleagues presented a retrospective review of 20 os acetabuli cases identified in 19 patients undergoing hip arthroscopy for FAI. Key points include a predominance in males (7.5:1 ratio), mean patient age of 36.4 years, and use of radiographs, MRI, and 3D CT imaging for diagnosis. Os acetabuli were classified into five types based on fragmentation and attachment to the acetabulum. 3D CT was found to be the most sensitive imaging modality (100% detection), compared to 55% on X-ray and 20% on MRI. Surgical management included primary labral repair and open reduction/internal fixation (ORIF) for rim fractures in cases with inadequate coverage (CEA <25 degrees).<br /><br />Another focus was on outcomes after arthroscopic treatment of subspinous impingement in patients with borderline hip dysplasia (LCEA 18-24 degrees). In a retrospective case series of 19 hips, significant improvements were observed in patient-reported outcomes (HOS-ADL, HOS-SSS, mHHS) over an average 44-month follow-up, with all changes exceeding clinically important difference thresholds. Preoperative imaging relied heavily on 3D CT for identifying rim deformities and subspinous prominence, which may cause false-positive crossover signs; emphasis was placed on avoiding over-resection.<br /><br />Overall, the course highlighted the importance of advanced imaging techniques, precise classification of osseous lesions, and tailored arthroscopic interventions to improve functional outcomes in complex hip disorders like FAI and borderline dysplasia.

Keywords

AANA HIP Course 2019

hip preservation surgery

arthroscopic hip management

femoroacetabular impingement

os acetabuli

borderline hip dysplasia

3D CT imaging

labral repair

subspinous impingement

patient-reported outcomes