Clin Orthop Surg.  2019 Sep;11(3):275-281. 10.4055/cios.2019.11.3.275.

Arthroscopic Treatment for Femoroacetabular Impingement with Extraspinal Diffuse Idiopathic Skeletal Hyperostosis

Affiliations
  • 1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea. dshwang@cnu.ac.kr

Abstract

BACKGROUND
Patients with extraspinal diffuse idiopathic skeletal hyperostosis (DISH) involving the hip joint have symptoms like femoroacetabular impingement (FAI). To date, no reported study has determined the clinical outcomes of arthroscopic treatment in extraspinal DISH involving the hip joint.
METHODS
A total of 421 hips with FAI that underwent arthroscopic treatment were reviewed retrospectively. We determined the extraspinal involvement of DISH with three-dimensional computed tomography (3D-CT) and simple radiography of the pelvis and hip joint. Clinical outcomes were evaluated at a minimum of 2 years postoperatively. The visual analog scale score (VAS), modified Harris hip score (MHHS), and hip outcome score-activity of daily living scale (HOS-ADL) were used, and hip range of motion (ROM) was evaluated pre- and postoperatively and at the time of the final follow-up.
RESULTS
Among the 421 hips (372 patients) with FAI that underwent arthroscopic treatment, 17 hips (12 patients, 4.04%) had extraspinal DISH on the hip joints. The mean age of the patients was 51.5 years. The 3D-CT scans and simple radiographs showed extraspinal DISH on multiple points around the pelvis and hip joint. Nine of the 17 hips (seven of 12 patients) had spinal DISH. At the final follow-up, VAS, MHHS, and HOS-ADL improved significantly from 6.5, 65.3, and 66.6, respectively, to 1.2, 87.8, and 89.5, respectively, and hip flexion and internal rotation improved significantly from 97.7° and 7.9°, respectively, to 117.1° and 18.2°, respectively.
CONCLUSIONS
This study has demonstrated that extraspinal DISH involving the hip joint could lead to FAI, and arthroscopic treatment could result in relief of symptoms, including pain and ROM limitation, in extraspinal DISH patients.

Keyword

Arthroscopy; Hip; Diffuse idiopathic skeletal hyperostosis

MeSH Terms

Arthroscopy
Femoracetabular Impingement*
Follow-Up Studies
Hip
Hip Joint
Humans
Hyperostosis, Diffuse Idiopathic Skeletal*
Pelvis
Radiography
Range of Motion, Articular
Retrospective Studies
Visual Analog Scale

Figure

  • Fig. 1 Preoperative simple anteroposterior (A) and frog-leg (B) radiographs of the hip joint showing hyperostosis on the anterosuperior acetabular rim (arrows) of both sides with sparing of the joint space and surface.

  • Fig. 2 Arthroscopic views from the anterolateral portal. (A) Hyperostosis on the anterosuperior side of the acetabular rim (asterisk). (B) Decompression of hyperostosis using a burr (asterisk). (C) After decompression of hyperostosis.

  • Fig. 3 (A) Preoperative three-dimensional computed tomography (3D-CT) view of the hip joint in 30° internal rotation showing mixed-type femoroacetabular impingement and hyperostosis (arrow) on the anterosuperior acetabulum below the anterior inferior iliac spine. (B) Postoperative 3D-CT view of the hip joint in 30° internal rotation showing the results of femoroplasty (arrowhead) and acetabuloplasty with decompression of hyperostosis (arrow).


Reference

1. Mader R, Buskila D, Verlaan JJ, et al. Developing new classification criteria for diffuse idiopathic skeletal hyperostosis: back to square one. Rheumatology (Oxford). 2013; 52(2):326–330. PMID: 23024057.
Article
2. Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis. 1950; 9(4):321–330. PMID: 14800245.
Article
3. Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976; 119(3):559–568. PMID: 935390.
Article
4. Utsinger PD, Resnick D, Shapiro R. Diffuse skeletal abnormalities in Forestier disease. Arch Intern Med. 1976; 136(7):763–768. PMID: 938166.
Article
5. Haller J, Resnick D, Miller CW, et al. Diffuse idiopathic skeletal hyperostosis: diagnostic significance of radiographic abnormalities of the pelvis. Radiology. 1989; 172(3):835–839. PMID: 2788894.
Article
6. Littlejohn GO, Urowitz MB. Peripheral enthesopathy in diffuse idiopathic skeletal hyperostosis (DISH): a radiologic study. J Rheumatol. 1982; 9(4):568–572. PMID: 6813470.
7. Mata S, Fortin PR, Fitzcharles MA, et al. A controlled study of diffuse idiopathic skeletal hyperostosis: clinical features and functional status. Medicine (Baltimore). 1997; 76(2):104–117. PMID: 9100738.
Article
8. Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology. 1975; 115(3):513–524. PMID: 1129458.
Article
9. Utsinger PD. Diffuse idiopathic skeletal hyperostosis. Clin Rheum Dis. 1985; 11(2):325–351. PMID: 3899489.
Article
10. Sarzi-Puttini P, Atzeni F. New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol. 2004; 16(3):287–292. PMID: 15103260.
Article
11. Mader R, Sarzi-Puttini P, Atzeni F, et al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology (Oxford). 2009; 48(12):1478–1481. PMID: 19783587.
Article
12. Terzi R. Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis. World J Clin Cases. 2014; 2(9):422–425. PMID: 25232544.
Article
13. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome: a clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991; 73(3):423–429. PMID: 1670443.
Article
14. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976; (119):39–47.
15. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987; 3(1):4–12. PMID: 3566894.
Article
16. Ide T, Akamatsu N, Nakajima I. Arthroscopic surgery of the hip joint. Arthroscopy. 1991; 7(2):204–211. PMID: 2069633.
Article
17. Kang C, Hwang DS, Hwang JM, Park EJ. Usefulness of the medial portal during hip arthroscopy. Clin Orthop Surg. 2015; 7(3):392–395. PMID: 26330964.
Article
18. Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007; 15(7):908–914. PMID: 17479250.
Article
19. Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty. 2001; 16(5):575–580. PMID: 11503116.
20. Martin RL, Philippon MJ. Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy. 2007; 23(8):822–826. PMID: 17681202.
Article
21. Holton KF, Denard PJ, Yoo JU, et al. Diffuse idiopathicskeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011; 41(2):131–138. PMID: 21377195.
22. Mader R. Diffuse idiopathic skeletal hyperostosis: time for a change. J Rheumatol. 2008; 35(3):377–379. PMID: 18322973.
23. Julkunen H, Heinonen OP, Knekt P, Maatela J. The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol. 1975; 4(1):23–27. PMID: 1153976.
Article
24. Resnick D, Shapiro RF, Wiesner KB, Niwayama G, Utsinger PD, Shaul SR. Diffuse idiopathic skeletal hyperostosis (DISH) [ankylosing hyperostosis of Forestier and Rotes-Querol]. Semin Arthritis Rheum. 1978; 7(3):153–187. PMID: 341323.
Article
25. Forestier J, Lagier R. Ankylosing hyperostosis of the spine. Clin Orthop Relat Res. 1971; 74:65–83. PMID: 4993095.
Article
26. Forestier J, Lagier R, Certonciny A. Concept of vertebral ankylosing hyperostosis: anatomo-radiological approach. Rev Rhum Mal Osteoartic. 1969; 36(12):655–661. PMID: 5380931.
27. Harris J, Carter AR, Glick EN, Storey GO. Ankylosing hyperostosis, I: clinical and radiological features. Ann Rheum Dis. 1974; 33(3):210–215. PMID: 4276454.
Article
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr