In a significant percentage of cases the hip pathology may not be straightforward, coexisting in the same hip, on one hand insufficient coverage of the femoral head (dysplasia) (@2A) and reduced contact area in a given region and on other hand excessive focal acetabular coverage (pincer) (see section "What hip dysplasia is?") ou área de contacto reduzida numa determinada região e noutra excesso de cobertura acetabular focal (pincer) (see section "What femoroacetabular impingement is?" or increased contact pressure due to the existence of the non-spherical sector of the femoral head (cam) (see section "What femoroacetabular impingement is?")
Diagnosis of these conditions is sometimes rather complex and is often impossible to make one solely on clinical history.
High quality radiographs, arthroradial MRI and three-dimensional CT scan are essential to exclude these combined cases which always require an individualized approach.
The most frequent combinations are acetabular dysplasia associated with acetabular retroversion (see section "How to diagnose femoroacetabular impingement?") and anterior "cam" deformity of the femoral head.
The periacetabular osteotomy technique "bernese"(see section ""Bernese" Periacetabular Osteotomy") allows solving all the problems of the hip joint in a single approach. The three-dimensional spatial re-orientation of the acetabular cavity fixes the position changing of the walls of the acetabulum (acetabular retroversion) and during surgery is possible to correct the sphericity of the femoral head using the same approach.
After having made the full correction, the surgeon can confirm the normal mobility of the hip under direct visualization.
As imagens mostram uma displasia acetabular bilateral grave num jovem antes e depois da correcção e uma TAC tridimensional feita durante esta cirurgia. Na anca esquerda observamos a regularização da esfericidade da cabeça efectuada simultaneamente com a correcção da posição do acetábulo (circulo verde)
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