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International Orthopaedics

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Open Access 10-01-2024 | Femuroacetabular Impingement | Review

Current concepts in the diagnosis and management of Os Acetabuli

Authors: Junya Yoshitani, Benjamin Schoyer, Anand Shah, Vikas Khanduja

Published in: International Orthopaedics | Issue 3/2024

Abstract

Purpose

The aim of this review is to appraise the current evidence on the epidemiology, pathophysiology, diagnosis and management of os acetabuli.

Methods

A scoping review was conducted according to the Joanna Briggs Institute guidelines. A systematic search was performed on Medline (PubMed), Embase and Cochrane Library. Inclusion criteria comprised observational and interventional studies and review articles published in the English language that focused on patients with os acetabuli according to the PRISMA extension of scoping reviews checklist using the terms ‘Os Acetabuli’ or ‘os acetabula’ or ‘acetabular ossicles’. A narrative synthesis of results was undertaken, and the included articles were divided into (i) definition, (ii) aetiology, (iii) diagnosis and imaging and (iv) management of os acetabuli.

Results

107 articles were screened, with 22 meeting the eligibility criteria. A total of 8836 patients were considered, of which 604 had os acetabuli. The mean age was 32.8 years. The prevalence of os acetabuli ranged from 3.4 to 7.7%, with a higher prevalence in males compared to females. True os acetabuli was defined as an unfused secondary ossification centre along the acetabular rim. The aetiology of os acetabuli is thought to be secondary to acetabular dysplasia and/or femoroacetabular impingement. Standard of care for management of symptomatic os acetabuli is considered to be arthroscopic excision unless the excision results in acetabular undercoverage and/or instability, in which case, fixation is recommended.

Conclusions

Successful management of os acetabuli depends on understanding the pathology and treating the underlying cause rather than treating the os acetabuli in isolation. Future work needs to focus on establishing clear diagnostic criteria, consensus on definition and an evidence-based treatment algorithm.

Addai D, Zarkos J, Pettit M, Sunil Kumar KH, Khanduja V (2021) Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques. Bone Joint Res 10:574–590. https://doi.org/10.1302/2046-3758.109.Bjr-2020-0443.R1CrossRefPubMedPubMedCentral

Lu V, Andronic O, Zhang JZ, Khanduja V (2023) Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification. Bone Joint J 105-b:751–759. https://doi.org/10.1302/0301-620x.105b7.Bjj-2022-0989.R1CrossRefPubMed

Holleyman R, Sohatee MA, Lyman S, Malviya A, Khanduja V (2023) Hip arthroscopy for femoroacetabular impingement is associated with significant improvement in early patient reported outcomes: analysis of 4963 cases from the UK non-arthroplasty registry (NAHR) dataset. Knee Surg Sports Traumatol Arthrosc 31:58–69. https://doi.org/10.1007/s00167-022-07042-yCrossRefPubMed

Jackson TJ, Stake CE, Stone JC, Lindner D, El Bitar YF, Domb BG (2014) Radiographic, histologic, and arthroscopic findings in amorphous calcifications of the hip labrum. Arthroscopy 30:456–461. https://doi.org/10.1016/j.arthro.2013.12.019CrossRefPubMed

Giordano BD, Suarez-Ahedo C, Gui C, Darwish N, Lodhia P, Domb BG (2018) Clinical outcomes of patients with symptomatic acetabular rim fractures after arthroscopic FAI treatment. J Hip Preserv Surg 5:66–72. https://doi.org/10.1093/jhps/hnx031CrossRefPubMed

Hergan K, Oser W, Moriggl B (2000) Acetabular ossicles: normal variant or disease entity? Eur Radiol 10:624–628. https://doi.org/10.1007/s003300050974CrossRefPubMed

Pruneski JA, Chan JJ, Wang KC, Matheney T, Bharam S (2023) Acetabular rim disorders: epidemiology, etiology, management, and outcomes. JBJS Rev 11(8):e23.00058. https://doi.org/10.2106/jbjs.Rvw.23.00058CrossRef

Aromataris E, Munn Z (eds) JBI Manual for Evidence Synthesis. JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-01

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473. https://doi.org/10.7326/m18-0850CrossRefPubMed

10.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan-a web and mobile app for systematic reviews. Syst Rev 5:210. https://doi.org/10.1186/s13643-016-0384-4CrossRefPubMedPubMedCentral

11.

Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 73:423–429. https://doi.org/10.1302/0301-620x.73b3.1670443CrossRefPubMed

12.

Djaja YP, Kim S, Lee GY, Ha YC (2020) Acetabular ossicles: epidemiology and correlation with femoroacetabular impingement. Arthroscopy - J Arthrosc Relat Surg 36:1063–1073. https://doi.org/10.1016/j.arthro.2019.11.123CrossRef

13.

Pöschl M (1971) Juvenile Osteo-Chondro-Nekrosen: Anhang: Coxa Vara Congenita und Protrusio Acetabuli Coxae. Springer Berlin Heidelberg

14.

Martinez AE, Li SM, Ganz R, Beck M (2006) Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim? Hip Int 16:281–286. https://doi.org/10.5301/HIP.2008.5507CrossRefPubMed

15.

Ponseti IV (1978) Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg - Ser A 60:575–585. https://doi.org/10.2106/00004623-197860050-00001CrossRef

16.

Plotz GMJ, Prymka M, Knoch MV, Markova B, Ulrich HW (2002) Spontaneous fusion of ‘os acetabuli’ after triple pelvic osteotomy. Arch Orthop Trauma Surg 122:526–529. https://doi.org/10.1007/s00402-002-0431-6CrossRefPubMed

17.

Randelli F, Maglione D, Favilla S, Capitani P, Menon A, Randelli P (2019) Os acetabuli and femoro-acetabular impingement: aetiology, incidence, treatment, and results. Int Orthop 43:35–38. https://doi.org/10.1007/s00264-018-4151-0CrossRefPubMed

18.

Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2005) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236:588–592. https://doi.org/10.1148/radiol.2362041987CrossRefPubMed

19.

Salvador J, Seijas R, Ferré-Aniorte A, Laiz P, Barastegui D, Cugat R (2022) Arthroscopic resection as a rapid recovery treatment for Os acetabuli in soccer players who had undergone hip arthroscopy: a case series with 1-year follow-up. Arch Orthop Trauma Surg 142:2295–2301. https://doi.org/10.1007/s00402-021-04229-9CrossRefPubMed

20.

Djaja YP, Kim S, Lee GY, Ha YC (2020) Acetabular ossicles: epidemiology and correlation with femoroacetabular impingement. Arthroscopy 36:1063–1073. https://doi.org/10.1016/j.arthro.2019.11.123CrossRefPubMed

21.

Aprato A, Massè A, Faletti C, Valente A, Atzori F, Stratta M, Jayasekera N (2013) Magnetic resonance arthrography for femoroacetabular impingement surgery: is it reliable? J Orthop Traumatol 14:201–206. https://doi.org/10.1007/s10195-013-0227-1CrossRefPubMedPubMedCentral

22.

Jackson TJ, Stake CE, Stone JC, Lindner D, El Bitar YF, Domb BG (2014) Radiographic, histologic, and arthroscopic findings in amorphous calcifications of the hip labrum. Arthroscopy - J Arthrosc Relat Surg 30:456–461. https://doi.org/10.1016/j.arthro.2013.12.019CrossRef

23.

Singh PJ, O'Donnell JM (2010) The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy - J Arthrosc Relat Surg 26:743–749. https://doi.org/10.1016/j.arthro.2009.10.010CrossRef

24.

Larson CM, Stone RM (2011) The rarely encountered rim fracture that contributes to both femoroacetabular impingement and hip stability: a report of 2 cases of arthroscopic partial excision and internal fixation. Arthroscopy - J Arthrosc Relat Surg 27:1018–1022. https://doi.org/10.1016/j.arthro.2011.04.006CrossRef

25.

Cuellar A, Ruiz-Iban MA, Marin-Pena O, Cuellar R (2015) Rapid development of osteoarthritis following arthroscopic resection of an “os acetabuli” in a mildly dysplastic hip–a case report: author’s reply. Acta Orthop 86:760CrossRefPubMed

26.

Lund B (2021) Os acetabuli-a new arthroscopic treatment option for the acetabular rim fracture. J Hip Preserv Surg 8:I46–I50. https://doi.org/10.1093/jhps/hnab036CrossRefPubMedPubMedCentral

27.

Rafols C, Monckeberg JE, Numair J (2015) Unusual bilateral rim fracture in femoroacetabular impingement. Case Rep Orthop 2015:210827. https://doi.org/10.1155/2015/210827CrossRefPubMedPubMedCentral

28.

Pascual-Garrido C, Schrock JB, Mitchell JJ, Camino Willhuber G, Mei-Dan O, Chahla J (2016) Arthroscopic fixation of os acetabuli technique: when to resect and when to fix. Arthrosc Tech 5:e1155–e1160. https://doi.org/10.1016/j.eats.2016.07.001CrossRefPubMedPubMedCentral

29.

Cuéllar A, Albillos X, Cuéllar A, Cuéllar R (2017) Screw fixation of os acetabuli: an arthroscopic technique. Arthrosc Tech 6:e801–e806. https://doi.org/10.1016/j.eats.2017.02.012CrossRefPubMedPubMedCentral

30.

Perez Carro L, Sa Rodrigues A, Ortiz Castillo A, Patnaik S, Sumillera Garcia M, Fernandez AA, Clemente AG (2017) Suture-on-screw technique for os acetabuli fixation and labral repair. Arthrosc Tech 6:e107–e112. https://doi.org/10.1016/j.eats.2016.09.008CrossRefPubMedPubMedCentral

31.

DeFroda SF, Wichman D, Browning R, Alter TD, Nho SJ (2021) Arthroscopic fixation of os acetabuli and labral repair: suture-on-screw technique. Arthrosc Tech 10:e1491–e1496. https://doi.org/10.1016/j.eats.2021.02.015CrossRefPubMedPubMedCentral

32.

Yin QF, Liu WG, Fu YQ (2022) Arthroscopic suture fixation of os acetabuli with absorbable suture anchors-a double-pulley technique. Arthrosc Tech 11:e1493–e1498. https://doi.org/10.1016/j.eats.2022.03.041CrossRefPubMedPubMedCentral

33.

Cuellar A, Ruiz-Iban MA, Marin-Pena O, Cuellar R (2015) Rapid development of osteoarthritis following arthroscopic resection of an “os acetabuli” in a mildly dysplastic hip-a case report. Acta Orthop 86:396–398. https://doi.org/10.3109/17453674.2015.1025199CrossRefPubMedPubMedCentral

Title: Current concepts in the diagnosis and management of Os Acetabuli
Authors: Junya Yoshitani
Benjamin Schoyer
Anand Shah
Vikas Khanduja
Publication date: 10-01-2024
Publisher: Springer Berlin Heidelberg
Keywords: Femuroacetabular Impingement
Hip Arthroscopy
Published in: International Orthopaedics / Issue 3/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-023-06078-0

At a glance: The STEP trials

Springer Medicine

Current concepts in the diagnosis and management of Os Acetabuli

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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