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Sample records for anterior hip impingement

  1. Malunited anterior inferior iliac spine fracture as a cause of hip impingement: A case report and review of literature.

    PubMed

    Pingal, Desai; Marqueen, Timothy; Prakash, Karanvir

    2016-04-01

    Apophyseal injuries of the pelvis have increased recently with increased participation of teenagers in contact sports. Apophyseal fractures of the pelvis should be ruled out from apophysitis, os acetabuli and bony tumors. We report a case of fracture of anterior-inferior iliac spine following indirect injury to the hip in a young football player. The patient failed to get better with nonoperative management and continued to have pain in the left hip and signs and symptoms of impingement. He improved following surgical excision of the heterotopic bone and did not have any evidence of recurrence at 2 years follow- up. PMID:27140222

  2. Hip impingement: beyond femoroacetabular

    PubMed Central

    Bardakos, Nikolaos V.

    2015-01-01

    In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known ‘impingement’ syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms. PMID:27011843

  3. Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

    PubMed

    Nabhan, Dustin C; Moreau, William J; McNamara, Shannen C; Briggs, Karen K; Philippon, Marc J

    2016-01-01

    Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury. PMID:27618239

  4. Femoroacetabular impingement and osteoarthritis of the hip

    PubMed Central

    Zhang, Charlie; Li, Linda; Forster, Bruce B.; Kopec, Jacek A.; Ratzlaff, Charles; Halai, Lalji; Cibere, Jolanda; Esdaile, John M.

    2015-01-01

    Objective To outline the clinical presentation, physical examination findings, diagnostic criteria, and management options of femoroacetabular impingement (FAI). Sources of information PubMed was searched for relevant articles regarding the pathogenesis, diagnosis, treatment, and prognosis of FAI. Main message In recent years, FAI has been increasingly recognized as a potential precursor and an important contributor to hip pain in the adult population and idiopathic hip osteoarthritis later in life. Femoroacetabular impingement is a collection of bony morphologic abnormalities of the hip joint that result in abnormal contact during motion. Cam-type FAI relates to a non-spherical osseous prominence of the proximal femoral neck or head-neck junction. Pincer-type FAI relates to excessive acetabular coverage over the femoral head, which can occur owing to several morphologic variants. Patients with FAI present with chronic, deep, or aching anterior groin pain most commonly in the sitting position, or during or after activity. Patients might also experience occasional sharp pains during activity. A thorough history should be taken that includes incidence of trauma and exercise frequency. A physical examination should be performed that includes a full hip, low back, and abdominal examination to assess for alternate causes of anterior groin pain. Diagnosis of FAI should be confirmed with radiography. Femoroacetabular impingement can be managed conservatively with rest, modification of activities, medications, and physiotherapy, or it can be treated surgically. Conclusion Femoroacetabular impingement is an important cause of anterior groin pain. Early recognition and intervention by the primary care provider might be critical to alleviating morbidity and preventing FAI progression. PMID:26668284

  5. Hip labral cyst caused by psoas impingement.

    PubMed

    Tey, Marc; Alvarez, Sonia; Ríos, Jose L

    2012-08-01

    Hip labral impingement can cause labral tears and secondary paralabral cyst formation. Femoroacetabular impingement is the main cause of labral impingement, but other conditions such as iliopsoas tendon impingement are described. There is no description of labral cyst resulting from psoas impingement treated arthroscopically in the literature. We present the case of a young sportsman with groin pain caused by psoas impingement with a labral tear and secondary paralabral cyst who was treated arthroscopically by cyst debridement, psoas tenotomy, and labral repair. PMID:22840990

  6. [Athletic pubalgia and hip impingement].

    PubMed

    Berthaudin, A; Schindler, M; Ziltener, J-L; Menetrey, J

    2014-07-16

    Athletic pubalgia is a painful and complex syndrom encountered by athletes involved in pivoting and cutting sports such as hockey and soccer. To date, there is no real consensus on the criteria for a reliable diagnostic, the different investigations, and the appropriate therapy. Current literature underlines intrinsic and extrinsic factors contributing to athletic pubalgia. This review article reports upon two novelties related to the issue: the importance and efficience of prevention program and the association of femoro-acetabular impingement with the pubalgia. PMID:25141564

  7. Anterior hip pain.

    PubMed

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity. PMID:10537384

  8. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. PMID:26451254

  9. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain.

    PubMed

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. PMID:26451254

  10. The Modified Mid-Anterior Portal for Hip Arthroscopy

    PubMed Central

    Matsuda, Dean K.; Villamor, Angel

    2014-01-01

    The modified mid-anterior portal is a utilitarian hip arthroscopy working portal that permits dual-portal comprehensive surgery for femoroacetabular impingement and related chondrolabral procedures without the need for interportal exchange. Its distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. The relatively lateral location permits instrument navigation not only along the anterosuperior acetabular rim and anterolateral proximal femur typically required for acetabuloplasty and femoroplasty but even to the posterior regions of the hip in cases of global pincer femoroacetabular impingement and posterior extensions of cam morphology and the anteromedial proximal femur while avoiding direct injury to the lateral femoral cutaneous nerve. PMID:25276606

  11. Hip Arthroscopy for Challenging Deformities: Global Pincer Femoroacetabular Impingement

    PubMed Central

    Matsuda, Dean K.; Gupta, Nikhil; Hanami, Dylan

    2014-01-01

    Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zone-specific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35°, a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities. PMID:24904760

  12. Impingement and stability of total hip arthroplasty versus femoral head resurfacing using a cadaveric robotics model.

    PubMed

    Colbrunn, R W; Bottros, J J; Butler, R S; Klika, A K; Bonner, T F; Greeson, C; van den Bogert, A J; Barsoum, W K

    2013-07-01

    We identified and compared the impingent-free range of motion (ROM) and subluxation potential for native hip, femoral head resurfacing (FHR), and total hip arthroplasty (THA). These constructs were also compared both with and without soft tissue to elucidate the role of the soft tissue. Five fresh-frozen bilateral hip specimens were mounted to a six-degree of freedom robotic manipulator. Under load-control parameters, in vivo mechanics were recreated to evaluate impingement free ROM, and the subluxation potential in two "at risk" positions for native hip, FHR, and THA. Impingement-free ROM of the skeletonized THA was greater than FHR for the anterior subluxation position. For skeletonized posterior subluxations, stability for THA and FHR constructs were similar, while a different pattern was observed for specimens with soft tissues intact. FHR constructs were more stable than THA constructs for both anterior and posterior subluxations. When the femoral neck is intact the joint has an earlier impingement profile placing the hip at risk for subluxation. However, FHR design was shown to be more stable than THA only when soft tissues were intact. PMID:23494830

  13. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    PubMed Central

    Chaudhary, Milind M; Chaudhary, Ishani M; Vikas, KN; KoKo, Aung; Zaw, Than; Siddhartha, A

    2015-01-01

    Background: Cam femoroacetabular impingement is caused by a misshapen femoral head with a reduced head neck offset, commonly in the anterolateral quadrant. Friction in flexion, adduction and internal rotation causes limitation of the hip movements and pain progressively leading to labral and chondral damage and osteoarthritis. Surgical hip dislocation described by Ganz permits full exposure of the hip without damaging its blood supply. An osteochondroplasty removes the bump at the femoral head neck junction to recreate the offset for impingement free movement. Materials and Methods: Sixteen patients underwent surgery with surgical hip dislocation for the treatment of cam femoroacetabular impingement by open osteochondroplasty over last 6 years. Eight patients suffered from sequelae of avascular necrosis (AVN). Three had a painful dysplastic hip. Two had sequelae of Perthes disease. Three had combined cam and pincer impingement caused by retroversion of acetabulum. All patients were operated by the trochanteric flip osteotomy with attachments of gluteus medius and vastus lateralis, dissection was between the piriformis and gluteus minimus preserving the external rotators. Z-shaped capsular incision and dislocation of the hip was done in external rotation. Three cases also had subtrochanteric osteotomy. Two cases of AVN also had an intraarticular femoral head reshaping osteotomy. Results: Goals of treatment were achieved in all patients. No AVN was detected after a 6 month followup. There were no trochanteric nonunions. Hip range of motion improved in all and Harris hip score improved significantly in 15 of 16 cases. Mean alpha angle reduced from 86.13° (range 66°–108°) to 46.35° (range 39°–58°). Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term. PMID

  14. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP. PMID:27247817

  15. ISCHIOFEMORAL IMPINGEMENT – AN ETIOLOGY OF HIP PAIN: CASE REPORT

    PubMed Central

    Yanagishita, Carlos Massao Aramaki; Falótico, Guilherme Guadagnini; Rosário, Davi Araújo Veiga; Pugina, Gustavo Gambuggi; Wever, André Azambuja Neves; Takata, Edmilson Takehiro

    2015-01-01

    An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause. PMID:27047901

  16. Atraumatic Anterior Dislocation of the Hip Joint

    PubMed Central

    Ohtsuru, Tadahiko; Morita, Yasuyuki; Murata, Yasuaki; Itou, Junya; Morita, Yuji; Munakata, Yutaro; Kato, Yoshiharu

    2015-01-01

    Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case. PMID:26819791

  17. Impingement and Dislocation in Total HIP Arthroplasty: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J

    2014-01-01

    In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body

  18. Impingement in Total Hip Replacement: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D.; Callaghan, John J.

    2009-01-01

    The occurrence of total hip impingement, whether or not accompanied by frank dislocation, holds substantial untoward clinical consequences, especially as less-forgiving advanced bearing implant designs come into ever more widespread use. Biomechanical aspects of impingement and dislocation have historically received relatively little scientific attention, although that situation is now rapidly changing. The present article reviews contemporary laboratory and clinical research on the impingement/dislocation phenomena, focusing particularly on how implant design variables, surgical implantation factors and patient activity each act individually and in concert to pose impingement and dislocation challenges. In recent years, several powerful new research methodologies have emerged that have greatly expanded the scope for clinical translation of systematic laboratory study. Transferring the findings from such research into yet better implant designs, and even better surgical procedures, offers encouragement that the clinical impact of this troublesome complication can be further reduced. PMID:19956356

  19. Effect of Hip Angle on Anterior Hip Joint Force during Gait

    PubMed Central

    Lewis, Cara L.; Sahrmann, Shirley A.; Moran, Daniel W.

    2010-01-01

    Anterior hip or groin pain is a common complaint for which people are referred for physical therapy. We have observed that people with anterior hip pain often walk in greater hip extension than people without anterior hip pain, and that the pain is reduced when they walk in less hip extension. Therefore, we investigated anterior hip joint forces which may contribute to anterior hip pain and examined the effect of end range hip extension on the anterior hip joint force during gait. To do this, we used a 6 degree of freedom, 3-dimensional musculoskeletal model to estimate hip joint forces during gait. Within subjects, the maximum anterior hip joint force for gait trials with the most hip extension was compared to the anterior hip joint force for gait trials with the least hip extension. The musculoskeletal model indicated that increasing the maximum end range hip extension when walking results in an increase in the anterior hip joint force when compared to walking in less hip extension. Walking in greater hip extension may result in an increase in the anterior hip joint force, and thereby contribute to anterior hip pain. The findings of this study provide some evidence supporting the use of gait modification to reduce anterior hip force when treating people with anterior hip pain. PMID:20934338

  20. Hip replacement by a minimal anterior approach.

    PubMed

    Paillard, P

    2007-08-01

    The mini-incision anterior approach in total hip replacement is not new, but uses a shorter incision than the traditional Hueter approach, typically only 6-8 cm in length. Despite its size, the single anterior incision allows good exposure. It is very atraumatic, preserves muscles and tendons, and allows the patient early mobilisation and fast postoperative recovery. Although, a special table (e.g., a Judet table) and specific tools (e.g., a curved reamer) are needed to perform hip replacement via the mini-anterior approach, any kind of hip prosthesis (cemented or uncemented) can be implanted. As there is a significant learning curve in mastering the mini-incision anterior approach, surgeons are advised to start with a longer incision and then to decrease its length with increasing experience. PMID:17657491

  1. Anterior Hip Joint Force Increases with Hip Extension, Decreased Gluteal Force, or Decreased Iliopsoas Force

    PubMed Central

    Lewis, Cara L.; Sahrmann, Shirley A.; Moran, Daniel W.

    2008-01-01

    Abnormal or excessive force on the anterior hip joint may cause anterior hip pain, subtle hip instability and a tear of the acetabular labrum. We propose that both the pattern of muscle force and hip joint position can affect the magnitude of anterior joint force and thus possibly lead to excessive force and injury. The purpose of this study was to determine the effect of hip joint position and of weakness of the gluteal and iliopsoas muscles on anterior hip joint force. We used a musculoskeletal model to estimate hip joint forces during simulated prone hip extension and supine hip flexion under 4 different muscle force conditions and across a range of hip extension and flexion positions. Weakness of specified muscles was simulated by decreasing the modeled maximum force value for the gluteal muscles during hip extension and the iliopsoas muscle during hip flexion. We found that decreased force contribution from the gluteal muscles during hip extension and the iliopsoas muscle during hip flexion resulted in an increase in the anterior hip joint force. The anterior hip joint force was greater when the hip was in extension than when the hip was in flexion. Further studies are warranted to determine if increased utilization of the gluteal muscles during hip extension and of the iliopsoas muscle during hip flexion, and avoidance of hip extension beyond neutral would be beneficial for people with anterior hip pain, subtle hip instability, or an anterior acetabular labral tear. PMID:17707385

  2. The Fate of the Contralateral Hip in Femoroacetabular Impingement

    PubMed Central

    Nepple, Jeffrey J.; Louer, Craig; Clohisy, John C.

    2016-01-01

    Objectives: The pathophysiology of femoroacetabular impingement (FAI) remains to be better understood. Only a fraction of all individuals with bony FAI morphology will ever develop hip symptoms or osteoarthritis. The purpose of the current study was to determine (1) rates of initial and subsequent symptom development in the contralateral hip of patients with symptomatic ipsilateral FAI and (2) to identify predictors of symptomatic contralateral FAI. Methods: The study cohort included 179 consecutive patients presenting for surgical treatment of FAI. Patients were excluded if they had previously underwent contralateral surgery. At baseline and postoperative follow-up time points, patients recorded standardized outcome questionnaires, including the presence of symptoms in the contralateral hip. Significant symptoms were defined as the presence of at least mild pain, while none or slight pain was not included. All patients underwent AP pelvis and bilateral 45 degree Dunn lateral radiographs at baseline. Patients developing symptoms in the contralateral hip were subclassified as having symptoms at presentation (initial symptoms) or developing symptoms during the follow-up period (symptom development). Patients were followed over a minimum of one year time period postoperatively. Multivariate logistic regression was performed to identify independent predictors of symptoms development. Results: The study cohort had a mean age of 30.2 years and included 60.3% females. FAI was classified as isolated cam in 63.1% (n=113), isolated pincer 1.1% (n=2), and combined type in 35.8% (n=64). Forty-two (23.5%) of patients had initial symptoms in the contralateral hip. Twenty-two additional hips developed symptoms during the follow-up period (16.1% of initially asymptomatic hips). For multivariate logistic regression of any symptoms development (initial or subsequent), competitive athletes (p=0.041) and contralateral HNO ratio on AP pelvis (p=0.009). However, the overall model poorly

  3. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  4. The Anterior Approach for Total Hip Replacement.

    PubMed

    Hochfelder, Jason P; Davidovitch, Roy I

    2016-03-01

    The anterior approach for total hip replacements has recently gained popularity. Some authors report faster recoveries and decreased dislocation rated with no increased risk of complications. However others claim no difference in outcomes when compared to other approaches yet an increase in complication rates. This paper provides a brief history of the approach, discusses various indications and contraindications, preoperative considerations, surgical techniques, and postoperative protocols. PMID:26977549

  5. Extra-articular hip impingement: a narrative review of the literature

    PubMed Central

    Cheatham, Scott W.

    2016-01-01

    There is growing subgroup of patients with poor outcomes after hip arthroscopy for intra-articular pathology suggesting unrecognized cause(s) of impingement may exist. Extra-articular hip impingement (EHI) is an emerging group of conditions that have been associated with intra-articular causes of impingement and may be an unrecognized source of pain. EHI is caused by abnormal contact between the extra-articular regions of the proximal femur and pelvis. This review discusses the most common forms for EHI including: central iliopsoas impingement, subspine impingement, ischiofemoral impingement, and greater trochanteric-pelvic impingement. The clinical presentation of each pathology will be discussed since EHI conditions share similar clinical features as the intra-articular pathology but also contain some unique characteristics. PMID:27069266

  6. Hip contact stress and femoral neck retroversion: a biomechanical study to evaluate implication of femoroacetabular impingement

    PubMed Central

    Satpathy, Jibanananda; Kannan, Arun; Owen, John R.; Wayne, Jennifer S.; Hull, Jason R.; Jiranek, William A.

    2015-01-01

    The current literature on femoroacetabular impingement (FAI) is focused on acetabular orientation and femoral head asphericity, with little emphasis on the effect of version of the femoral neck. A biomechanical model was developed to determine the causative effect, if any, of femoral retroversion on hip contact stress and, if present, delineate the type of FAI with femoral neck retroversion. Five pairs of cadaveric hips (n = 10) were tested by loading the hip in 90° of flexion and measured the peak joint pressure and the location of the peak joint pressure. The experiment was repeated after performing a subtrochanteric osteotomy and retroverting the proximal femur by 10°. Ten hips were successfully tested, with one hip excluded due to an outlier value for peak joint pressure. Retroversion of the proximal femur significantly increased the magnitude of mean peak joint pressure. With retroversion, the location of the peak joint pressure was shifted posteroinferiorly in all cases. In conclusion, femoral neck retroversion increases peak joint pressure in the flexed position and may act as a cause of femoroacetabular impingement. The location of peak joint pressure suggests a pincer-type impingement with retroversion. The version of femoral neck should be assessed as a possible causative factor in patients with FAI, especially those with pincer-type impingement. PMID:27011851

  7. [Femoroacetabular impingement: a new direction in the diagnosis and treatment of the hip joint].

    PubMed

    Hellmann, Ory; Cohen, Eugen; Rath, Ehud

    2011-02-01

    Femoroacetabular impingement is a relatively recently described condition in which an abnormally shaped proximal part of the femur or acetabular overcoverage causes interference between the femoral head-neck junction and the acetabular rim. These disorders are now recognized as common causes of prearthritic hip pain and secondary osteoarthritis. Two mechanisms have been described. Cam-type impingement is caused by insufficient concavity of the femoral head-neck junction. Pincer-type impingement is caused by overcoverage of the femoral head by the acetabulum. Abnormal femoroacetabular abutment predisposes affected patients to labral tears, articular cartilage damage, and premature osteoarthritis. Early diagnosis of hip disease and referral for specialized care may optimize clinical outcomes and alter the natural history of these disorders. This review aims to describe this syndrome and to review the contemporary concepts of the etiology and surgical treatment of the disorder. PMID:22164944

  8. Management of Incarcerating Pincer-Type Femoroacetabular Impingement With Hip Arthroscopy

    PubMed Central

    Jamali, Amir A.; Palestro, Andrea; Meehan, John P.; Sampson, Meghan

    2014-01-01

    This report describes the arthroscopic management of a case of incarcerating pincer-type femoroacetabular impingement. The hip joint had a marked restriction of range of motion and secondary pain as a result of osteophytes wrapping around the femoral head down the femoral neck. The patient was treated with staged bilateral hip arthroscopy. The procedures were initially performed through the peripheral compartment to remove the incarcerating acetabular rim, followed by arthroscopy of the central compartment with acetabuloplasty and femoral head osteochondroplasty. The patient's treatment has led to an excellent clinical and radiographic result at 24 months' follow-up despite an unrelated pelvic fracture sustained in the postoperative period. This technique emphasizes the capabilities of hip arthroscopy in advanced cases of femoroacetabular impingement as an alternative to arthroplasty for patients with healthy articular cartilage. PMID:24749038

  9. Open Anterior Dislocation of the Hip in Togo

    PubMed Central

    Anani, Abalo; Yannick, Dellanh; Gamal, Ayouba; Assang, Dossim

    2016-01-01

    Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours. PMID:27247749

  10. The Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

    PubMed Central

    Royer, Nathaniel K.

    2012-01-01

    Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement (FAI) have been recently implicated as risk factors for hip osteoarthritis (OA). The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search using PubMed, Embase and Central was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and FAI and hip OA and preliminary evidence suggests that AD is a risk factor for OA, however these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA. PMID:22108232

  11. Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

    PubMed Central

    Elkins, Jacob M.; O’Brien, Megan K.; Stroud, Nicholas J.; Pedersen, Douglas R.; Callaghan, John J.

    2010-01-01

    Background Impingement events, in addition to their role immediately proximate to frank dislocation, hold the potential to damage new-generation hard-on-hard bearings as a result of the relatively unforgiving nature of the materials and designs. Because of the higher stiffness and tighter design tolerances of metal-on-metal and ceramic implants, surgical positioning plausibly has become even more important. Questions/purposes We asked (1) whether, and under what cup orientation conditions, hard-on-hard impingements might challenge implant material failure strength; and (2) whether particle generation propensity at impingement and egress sites would show similar dependence on cup orientation. Methods Realistic computational simulations were enabled by multistage finite element analyses, addressing both global construct motion and loading, and focal stress concentrations at neck impingement and rim egress sites. The global model, validated by a cadaveric simulation in a servohydraulic hip simulator, included both hardware components and advanced anisotropic capsule characterization. Parametric computational runs explored the effect of cup orientation for both ceramic-on-ceramic and metal-on-metal bearing couples for two distinct motion sequences associated with dislocation. Results Stress concentrations from impingement increased nearly linearly with increased cup tilt and with cup anteversion. In some situations, peak values of stress approached or exceeded 1 GPa, levels challenging the yield strength of cobalt-chromium implants, and potentially the fracture strength of ceramics. The tendency for impingement events to generate debris, indexed in terms of a new scraping severity metric, showed orientation dependences similar to that for bulk material failure. Conclusions Damage propensity arising from impingement events in hard total hip bearings is highly orientation-dependent. PMID:20953853

  12. Impingement.

    ERIC Educational Resources Information Center

    Uziel, Mary S.

    1978-01-01

    Presents a literature review of the impact of impingement in fishery resources at different power plants in the United States, covering publications of 1976-77. Consideration is given to engineering studies and biological effects for reducing impingement. A list of 96 references is also presented. (HM)

  13. Anterior muscle sparing approach for total hip arthroplasty

    PubMed Central

    Moskal, Joseph T; Capps, Susan G; Scanelli, John A

    2013-01-01

    The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the “safe zone” than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the “learning curve” for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented. PMID:23362470

  14. Direct anterior total hip arthroplasty: Comparative outcomes and contemporary results

    PubMed Central

    Connolly, Keith P; Kamath, Atul F

    2016-01-01

    Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons, in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage. Several studies have now been published comparing the anterior intramuscular to other commonly used approaches, and many studies have published complication rates on large series of patients. Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home. Although some studies show evidence of early benefit in functional outcomes, there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches. Additionally, evidence to support reduced damage to soft tissue may not translate to certain clinical significance. Rates of intra-operative femur fracture, operative time and blood loss rates are notably higher for those developing familiarity with this approach. However, when surgeons have performed a modest number of procedures, the complication rates tend to markedly decrease in most studies to levels comparable to other approaches. Accuracy of component positioning also favors the anterior approach in some studies. This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications. PMID:26925380

  15. Imaging of traumatic injury and impingement of anterior knee fat.

    PubMed

    Lapègue, F; Sans, N; Brun, C; Bakouche, S; Brucher, N; Cambon, Z; Chiavassa, H; Larbi, A; Faruch, M

    2016-01-01

    Fat is not just used by the body as bulk tissue. In addition to its role in storing energy and regulating hormone action, fat is used in some parts of the body for its mechanical properties. The anatomy of anterior knee fat is more complex than it appears at first sight and is capable of withstanding considerable compressive and shear stress. Specific lesions occur when such mechanical stress exceeds the physiological limits and are yet little known. Superficial fat can be the site of either acute injury by closed degloving called the Morel-Lavallée lesion or chronic injury, when subject to repeat excessive shear forces, due to more complex and less well-defined disruptions that result in pseudo-bursitis. There are three main anterior, intracapsular and extrasynovial fat pads in the knee joint, which are the infrapatellar fat pad (IFP) or Hoffa's fat pad, the quadriceps fat pad and the prefemoral fat pad. The IFP plays an important role as a mechanical shock absorber and guides the patella tendon and even the patella itself during flexion-extension movements. In response to repeated excessive stress, an inflammatory reaction and swelling of the IFP is first observed, followed by a fibrotic reaction with metaplastic transformation into fibrous, cartilaginous or bone tissue. More rarely, the two other deep fat pads (quadriceps and prefemoral) can, if subject to repeated stress, undergo similar restructuring inflammatory reactions with metaplasia resulting in tissue hardening, anterior pain and partial loss of function. PMID:27118690

  16. Measurement of impingement heat transfer coefficient on a HIPS liner sheet

    SciTech Connect

    Fu, X.

    1999-07-01

    A test facility was built to measure the impingement convective heat transfer coefficient for a high impact polystyrene (HIPS) liner sheet which was heated by an array of air slot nozzles. A HIPS liner sheet having a thickness of 6 mm is a typical material used for inside shells of refrigerators. The nozzle geometry was optimally designed. The pressure drops through the nozzles, the velocities at the exits of nozzles, temperatures on the sheet surface and in the sheet center were measured. The impingement heat transfer coefficient on the sheet was determined using the measured sheet temperature history in conjunction with an inverse analysis which was based on a one-dimensional transient heat conduction model. The effect of air flow rate ranging from 8 to 32 m/s on the heat transfer coefficient is discussed.

  17. Combined Anterior and Posterior Approach in Total Hip Arthroplasty for Crowe IV Dysplasia or Ankylosed Hips.

    PubMed

    Lee, Young-Kyun; Kim, Ki-Choul; Ha, Yong-chan; Koo, Kyung-Hoi

    2015-05-01

    We evaluated 70 patients (71 hips) who underwent complex total hip arthroplasty (THA) through the combined anterior and posterior approach. Sixty-five patients (32 dislocated hips and 34 ankylosed hips) were followed-up at a minimum of 3 years (median, 6 years; range, 3-10 years). Seven patients (10.6%), who had transient paresthesia on the anterior thigh, recovered within 3 months. All patients had a good clinical outcome in terms of range of motion, pain and recovery of walking. At the latest follow-up, all prostheses had bone-ingrown stability without any detectable wear or osteolysis. The combined approach allows an excellent exposure of the acetabulum for accurate cup alignment, leg lengthening and mobilization of joint in complex THA without trochanteric osteotomy, excessive abductor release and femoral shortening osteotomy. PMID:25682205

  18. Surgical hip dislocation in symptomatic cam femoroacetabular impingement: what matters in early good results?

    PubMed Central

    2011-01-01

    In order to assess outcome and possible predictors of early good results, a prospective study on 22 patients who were treated with save surgical hip dislocation for symptomatic isolated cam-type femoroacetabular impingement (FAI) was performed. After a follow-up of 6 and 12 months, standard clinical and radiographic parameters were recorded. A statistically significant improvement of the clinical status according to the Harris hip score could be assessed at six months (p-value = 0.003) and 12 months (p-value = 0.001) post-surgery. By comparing standard clinical and radiographic preoperative parameters with various follow-up outcomes, we revealed no specific parameter with predictive value. These findings are important for centers that have just started to use this surgical technique and are still identifying their learning curve. PMID:21719395

  19. Surgical hip dislocation in symptomatic cam femoroacetabular impingement: what matters in early good results?

    PubMed

    Jäger, M; Bittersohl, B; Zilkens, Christoph; Hosalkar, H S; Stefanovska, K; Kurth, S; Krauspe, R

    2011-05-12

    In order to assess outcome and possible predictors of early good results, a prospective study on 22 patients who were treated with save surgical hip dislocation for symptomatic isolated cam-type femoroacetabular impingement (FAI) was performed. After a follow-up of 6 and 12 months, standard clinical and radiographic parameters were recorded. A statistically significant improvement of the clinical status according to the Harris hip score could be assessed at six months (p-value = 0.003) and 12 months (p-value = 0.001) post-surgery. By comparing standard clinical and radiographic preoperative parameters with various follow-up outcomes, we revealed no specific parameter with predictive value. These findings are important for centers that have just started to use this surgical technique and are still identifying their learning curve. PMID:21719395

  20. Is there a pathological alpha angle for hip impingement? A diagnostic test study.

    PubMed

    Barrientos, Cristián; Barahona, Maximiliano; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Hinzpeter, Jaime

    2016-08-01

    The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18-1.39] was obtained. A ROC curve of 0.96 [0.93-0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain. PMID:27583162

  1. Is there a pathological alpha angle for hip impingement? A diagnostic test study

    PubMed Central

    Barrientos, Cristián; Barahona, Maximiliano; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Hinzpeter, Jaime

    2016-01-01

    The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18–1.39] was obtained. A ROC curve of 0.96 [0.93–0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain. PMID:27583162

  2. Quantitative MRI Evaluation of Articular Cartilage Using T2 Mapping Following Hip Arthroscopy for Femoroacetabular Impingement

    PubMed Central

    Mayer, Stephanie W.; Wagner, Naomi; Fields, Kara G.; Wentzel, Catherine; Burge, Alissa; Potter, Hollis G.; Lyman, Stephen; Kelly, Bryan T.

    2016-01-01

    Objectives: Cam-type femoroacetabular impingement (FAI) causes a shearing and delamination injury to the acetabular articular cartilage due to a mismatch between the size of the femoral head and the acetabulum. This mechanism is thought to lead to early osteoarthritis in this population. Cam decompression has been advocated to eliminate impingement, with the ultimate goal of halting the progression of articular cartilage delamination. Although outcomes following this procedure in the young adult population have been favorable at short and medium term follow up, it is not known whether the articular cartilage itself is protected from further injury by changing the biomechanics of the joint with decompression of the cam morphology. The purpose of this study is to compare the pre- and post-operative integrity of the acetabular articular cartilage using T2 mapping to determine if hip arthroscopy is protective of the articular cartilage at short- to medium term follow up. Methods: Males between 18 and 35 years of age who had pre-operative T2 mapping MRIs, underwent hip arthroscopy for cam or mixed-type FAI with an alpha angle greater than 50°, and had at least 2 year follow-up were identified. Post-operative MRIs were performed and T2 relaxation times in the transition zone and weight bearing articular cartilage in the anterosuperior acetabulum at deep and superficial chondral layers were recorded at nine points on three sagittal sequences on pre and post-operative MRIs. A paired t-test was used to compare T2 relaxation values between pre-operative and post-operative scans. Results: Eleven hips were evaluated. Mean age was 26.3 years (range 21 - 35). Mean follow up time to post-operative T2 mapping MRI was 2.6 years (range 2.4 - 2.7). The change in T2 relaxation time was not significantly different between pre- and post-operative MRI scans for any of the nine regions in the deep zone of the acetabular cartilage (p=0.065 - 0.969) or the superficial zone of the

  3. Predictors of Length of Career Following Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players

    PubMed Central

    Menge, Travis; Briggs, Karen K.; Philippon, Marc J.

    2016-01-01

    Objectives: Previous studies have shown that professional hockey players return to sport at a high rate following hip arthroscopy. The average length of a National Hockey League (NHL) career has been reported to be 5.5 years, and it is unknown how long players continue to play after hip arthroscopy. The purpose of this study was 1) to determine predictors of length of career in players following hip arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI), and 2) investigate the rate of those who continue to play professional hockey a minimum of 5 years after hip arthroscopy. Methods: Seventy professional hockey players underwent hip arthroscopy for FAI between 2005 and 2010 by a single surgeon. Data was retrieved from NHL.com regarding the duration of each player’s professional career. In addition, position played, draft position, age at time of surgery, and surgical details were also used in data analysis. Results: Our cohort included thirteen players that were centers, 15 defensemen, 20 goalies, and 22 wings. The average overall draft number was 57 (range 1 to 228), and average age at surgery was 27 years (range 17 to 38). Forty of the 70 athletes (57%) continued to play professionally a minimum of 5 years after hip arthroscopy. As of the most recent 2015 season, the average NHL length of career was 13 years (range 8 to 23 years), with an average of 6.9 years played following hip arthroscopy. Therre was no different in length of career and years played when goalies were compared to other players(p=0.760). Length of career and years played after arthroscopy correlated with age at surgery (r=0.799 and r=-0.408). Players who played 5 or more years after arthroscopy were significantly younger than those who did not (25 vs. 30 years, p=0.001). Sixty-five players (93%) had labral repair and 5 (7%) had labral reconstruction. There were no differences in length of career or years played after arthroscopy based on type of labral treatment (p=0

  4. A Knee-Specific Finite Element Analysis of the Human Anterior Cruciate Ligament Impingement against the Femoral Intercondylar Notch

    PubMed Central

    Park, Hyung-Soon; Ahn, Chulhyun; Fung, David T.; Ren, Yupeng; Zhang, Li-Qun

    2010-01-01

    This work presents a finite element analysis of Anterior Cruciate Ligament (ACL) impingement against the intercondylar notch during tibial external rotation and abduction, as a mechanism of noncontact ACL injuries. Experimentally, ACL impingement was measured in a cadaveric knee in terms of impingement contact pressure and six degrees-of-freedom tibiofemoral kinematics. Three-dimensional geometries of the ACL, femur and tibia were incorporated into the finite element model of the individual knee specimen. A fiber-reinforced model was adopted, which accounts for the anisotropy, large deformation, nonlinearity and incompressibility of the ACL. With boundary conditions specified based on the experimental tibiofemoral kinematics, the finite element analysis showed that impingement between the ligament and the lateral wall of intercondylar notch could occur when the knee 45° was externally rotated at 29.1° and abducted at 10.0°. Strong contact pressure and tensile stress occurred at the impinging and nonimpinging sides of the ligament, respectively. The impingement force and contact area estimated from the model matched their counterparts from the corresponding cadaver experiment. The modeling and experimental approach provides a useful tool to characterize potential ACL impingement on a knee-specific basis, which may help elucidate the ACL injury mechanism and develop more effective treatments. PMID:20413123

  5. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-01-01

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed. PMID:27608626

  6. Good Results After Hip Arthroscopy for Femoroacetabular Impingement in Top-Level Athletes

    PubMed Central

    Sansone, Mikael; Ahldén, Mattias; Jonasson, Pall; Thomeé, Christoffer; Swärd, Leif; Baranto, Adad; Karlsson, Jón; Thomeé, Roland

    2015-01-01

    Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction among athletes. Although arthroscopic surgery is an established treatment option for FAI, there are few studies reporting detailed outcomes using validated outcome measurements specifically designed for young and active athletes. Purpose: To report outcomes 1 year after arthroscopic treatment of FAI in top-level athletes using validated outcome measurements adapted for a young and active population. Study Design: Case series; Level of evidence, 4. Methods: A total of 85 top-level athletes (68 males, 17 females) with a mean (±SD) age of 25 ± 5 years underwent arthroscopic surgery for FAI. All athletes who reported Hip Sports Activity Scale (HSAS) levels 7 or 8 (range, 0-8) prior to symptom onset were included. The cohort was prospectively evaluated using online web-based validated health-related patient-reported outcomes measures (HR-PROMs), including the short version of the International Hip Outcome Tool (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS; 6 subscales), the EuroQOL 5 dimensions questionnaire (EQ-5D; 2 subscales), the Hip Sports Activity Scale (HSAS) for physical activity level, and a visual analog scale (VAS) for overall hip function. Furthermore, patients reported their overall satisfaction with treatment. Results: The mean follow-up time was 12.3 ± 0.6 months. Preoperative scores compared with those obtained at the 12-month follow-up revealed statistically and clinically significant improvements (P < .0001) for all measured outcomes: iHOT-12 (42 vs 73), VAS for global hip function (52 vs 77), HSAS (4.3 vs 5.7), EQ-5D index (0.60 vs 0.83), EQ-VAS (68 vs 82), and HAGOS subscales (60 vs 83, 50 vs 73, 66 vs 86, 39 vs 75, 27 vs 70, and 34 vs 67). At the 12-month follow-up, 79 athletes (93%) reported that they were satisfied with the outcome of surgery. At follow-up, 62 athletes (73%) had returned to competitive sports (HSAS levels 5-8) and 44 (52

  7. Open-configuration MRI study of femoro-acetabular impingement.

    PubMed

    Yamamura, Mitsuyoshi; Miki, Hidenobu; Nakamura, Nobuo; Murai, Masakazu; Yoshikawa, Hideki; Sugano, Nobuhiko

    2007-12-01

    Femoro-acetabular impingement has been proposed as a causative factor of primary hip osteoarthritis. However, primary osteoarthritis of the hip is infrequent in Japan and other Asian countries, even though the hips of Asians frequently sustain impingement, since the Asian lifestyle commonly requires a larger range of hip motion than the Western lifestyle. Therefore, using open-configuration MRI, we investigated whether impingement actually occurs during some traditional Japanese hip positions. The hips of 5 healthy Japanese females were examined in 5 sitting postures: 1) sitting straight; 2) bowing while sitting straight; 3) sitting cross-legged; 4) W-sitting; and 5) squatting. The impingement point was detected by multiple plane reconstructed (MPR) views along with the acetabular rim depicted circumferentially. Impingement was considered to have occurred when, on MRI, the anterior femoral head-neck junction approached the acetabular rim and the femoral head was seen to float from the bottom of the acetabulum with the acetabular rim acting as a fulcrum. Impingement was observed in all volunteers in the W-sitting position, and in 2 of 5 volunteers during squatting. These findings show that impingement occurs frequently during daily Japanese activities. Thus, depending on race, femoro-acetabular impingement might not always cause primary osteoarthritis of the hip. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1582-1588, 2007. PMID:17600811

  8. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint.

    PubMed

    Alshameeri, Zeiad; Khanduja, Vikas

    2014-08-01

    Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to reconcile the contradictions in some of these results, and therefore no coherent conclusions could be drawn. In this short article, we attempt to explain some of the abnormal kinematic and kinetic patterns associated with FAI by highlighting similarities between the gait seen in early osteoarthritis (OA) and that of FAI. We also propose an approach for future research in this field and emphasise the importance of quantifying early OA in FAI based on magnetic resonance imaging (MRI) scans and the amount of chondral damage seen during open or arthroscopic surgery. PMID:24687267

  9. Mucoid Degeneration of Posterior Cruciate Ligament with Secondary Impingement of Anterior Cruciate Ligament: A Rare Case Report

    PubMed Central

    Wang, Joon Ho; Jangir, Rajat R

    2015-01-01

    Introduction: Mucoid degeneration of cruciate ligament is well known entity, but symptomatic lesions are rare. It is even rarer to find a symptomatic posterior cruciate ligament mucoid degeneration than anterior cruciate ligament. Case Report: A 65-years-old female presented to our hospital complaining of pain in right knee joint on terminal extension since 6 months. On clinical examination, there was a flexion deformity of 5 degree and a further flexion of 150 degree with mild pain exacerbated by extension. MRI of the right knee joint showed a diffusely thickened posterior cruciate ligament (PCL) with increased intra ligamentous signal intensity on T2-weighted images. The arthroscopic findings of grossly thickened PCL with a yellowish hue are characteristic and the PCL was filled with a yellowish substance. We excised the yellowish substance from the PCL as precisely as possible not to damage the remaining PCL fiber (Limited Debulking). We did notchplasty of lateral wall and roof to accommodate the Anterior Cruciate Ligament and avoid impingement. Conclusion: Posterior cruciate ligament may enlarge significantly and may push the Anterior Cruciate Ligament in the notch and may lead to the anterior cruciate ligament (ACL) impingement symptoms. Partial Debulking of Posterior Cruciate Ligament and notchplasty is effective treatment with immediate postoperative pain relief and good functional results. PMID:27299097

  10. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

    2015-01-01

    Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

  11. Ultrasonography in the Assessment of Lateral Ankle Ligament Injury, Instability, and Anterior Ankle Impingement: A Diagnostic Case Report

    PubMed Central

    Battaglia, Patrick J.; Craig, Kate; Kettner, Norman W.

    2015-01-01

    Objective The purpose of this case report is to describe the diagnostic value of ultrasonography (US) in a patient with injury to the lateral ligaments of the ankle with concomitant ankle joint osteoarthritis and anterior impingement. Clinical Features A 28-year-old male had a history of an inversion injury of the left ankle. Diagnostic US of the left ankle using an 8- to 15-MHz linear array transducer demonstrated a full thickness tear of the anterior talofibular ligament, partial thickness tearing of the calcaneofibular ligament, and laxity of the ankle with varus stress testing. In addition, US was able to demonstrate degeneration of the ankle and talonavicular joints and anterior impingement with dorsiflexion. Osteoarthritic changes were confirmed with radiography. Other US findings included remote deltoid ligamentous complex injury, multiple sites of tenosynovitis, and a large ankle joint effusion with synovial hypertrophy and synovitis. Intervention and Outcome Using US, an accurate diagnosis was established with respect to the pathology and functional impairments of the patient’s ankle. Conclusion This case report exemplifies the value and utility of US in diagnosing derangement in ligamentous, tendinous, articular, and osseous injuries of the ankle. PMID:26793038

  12. Changes in the stress in the femoral head neck junction after osteochondroplasty for hip impingement: a finite element study.

    PubMed

    Alonso-Rasgado, Teresa; Jimenez-Cruz, David; Bailey, Colin G; Mandal, Parthasarathi; Board, Tim

    2012-12-01

    The surgical treatment of femoroacetabular impingement (FAI) often involves femoral osteochondroplasty. One risk of this procedure is fracture of the femoral neck. We developed a finite element (FE) model to investigate the relationship between depth of resection and femoral neck stress. CT data were used to obtain the geometry of a typical cam-type hip, and a 3D FE model was constructed to predict stress in the head-neck after resection surgery. The model accounted for the forces acting on the head and abductor muscular forces. Bone resection was performed virtually to incremental resection depths. The stresses were calculated for five resection depths and for five different activities (i) standing on one leg (static case); (ii) two-to-one-to-two leg standing; (iii) normal walking; (iv) walking down stairs; and (v) a knee bend. In general, both the average Von Mises stresses and the area of bone that yielded significantly increased at a resection depth of ≥10 mm. The knee bend and walking down stairs demonstrated the highest stresses. The FE model predicts that fracture is likely to occur in the resection area first following removal of a third (10 mm) or more of the diameter of the femoral neck. We suggest that when surgeons perform osteochondroplasty for hip impingement, the depth of resection should be limited to 10 mm. PMID:22707347

  13. Anterior Hip Fracture Dislocation with Intrapelvic Retention of the Femoral Head and Ureter Fistula

    PubMed Central

    Patrascanu, Calin; Cibu, Dan

    2014-01-01

    Introduction: The anterior dislocation of the hip represents only a small percentage of all hip dislocations: 85% are posterior. Most commonly associated with this dislocation is a fracture of the femoral head and, in rare cases, a femoral neck fracture. We have found in literature no report of an anterior dislocation of the hip associated with femoral neck fracture, pelvic retention of the head and ureteral fistula. We report such a case of a 68 year old male. Case Report: A 68 year old male was presented to our attention, following a severe injury of the hip when falling from a high bridge, with severe pain in the hip and a clinical aspect of femoral neck fracture. The X-ray confirmed the femoral neck fracture but following an anterior dislocation with the head retained into the pelvis. The patient also had hematuria. An Austin Moore prosthesis was implanted for the femoral neck fracture and the head was extracted by the urologist by a new abdominal incision. Urological evaluation revealed a fistula of the ureter, treated by an internal drainage for three months. One month later the Moore prosthesis was extracted and the patient had a Girldestone hip for 5 months. Revision with a Muller cemented prosthesis had a normal evolution. Conclusion: The anterior fracture dislocation of the hip with pelvic retention of the femoral head and ureteral fistula is a rare condition resulting from high energy trauma. A multidisciplinary team is necessary to diagnose and treat fracture and soft tissue lesions. Early diagnosis and treatment is necessary to avoid septic complications. PMID:27298980

  14. Femoroacetabular Impingement (FAI)

    MedlinePlus

    ... FAI. Because athletically active people may work the hip joint more vigorously, they may begin to experience pain ... the impingement can prevent future damage to the hip joint. However, not all of the damage can be ...

  15. Hip Joint Stresses Due to Cam-Type Femoroacetabular Impingement: A Systematic Review of Finite Element Simulations

    PubMed Central

    Ng, K. C. Geoffrey; Lamontagne, Mario; Labrosse, Michel R.; Beaulé, Paul E.

    2016-01-01

    Background The cam deformity causes the anterosuperior femoral head to obstruct with the acetabulum, resulting in femoroacetabular impingement (FAI) and elevated risks of early osteoarthritis. Several finite element models have simulated adverse loading conditions due to cam FAI, to better understand the relationship between mechanical stresses and cartilage degeneration. Our purpose was to conduct a systematic review and examine the previous finite element models and simulations that examined hip joint stresses due to cam FAI. Methods The systematic review was conducted to identify those finite element studies of cam-type FAI. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and studies that reported hip joint contact pressures or stresses were included in the quantitative synthesis. Results Nine articles studied FAI morphologies using finite element methods and were included in the qualitative synthesis. Four articles specifically examined contact pressures and stresses due to cam FAI and were included in the quantitative synthesis. The studies demonstrated that cam FAI resulted in substantially elevated contact pressures (median = 10.4 MPa, range = 8.5–12.2 MPa) and von Mises stresses (median 15.5 MPa, range = 15.0–16.0 MPa) at the acetabular cartilage; and elevated maximum-shear stress on the bone (median = 15.2 MPa, range = 14.3–16.0 MPa), in comparison with control hips, during large amplitudes of hip motions. Many studies implemented or adapted idealized, ball-and-cup, parametric models to predict stresses, along with homogeneous bone material properties and in vivo instrumented prostheses loading data. Conclusion The formulation of a robust subject-specific FE model, to delineate the pathomechanisms of FAI, remains an ongoing challenge. The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early

  16. Recreational Athletes Return to Sport at a Comparable Rate to Elite Athletes Following Hip Arthroscopy for Femoroacetabular Impingement

    PubMed Central

    Weber, Alexander E.; Kuhns, Benjamin; Cvetanovich, Gregory; Levy, David; Nho, Shane Jay

    2016-01-01

    Objectives: The objective of the current study was to evaluate patient reported outcomes and return to sport in a cohort of distinctly recreational and amateur level athletes following hip arthroscopy for femoroacetabular impingement (FAI). Methods: Following IRB approval, clinical data was retrospectively retrieved for 66 consecutive FAI patients (26 men, 40 women) who had undergone hip arthroscopy and identified themselves as recreational or amateur athletes on intake forms. Two-year patient-reported outcomes (PRO) included a sport-specific questionnaire, modified Harris Hip Score (mHHS), and Hip Outcome Scores with Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales were analyzed. Results: The mean age and BMI of all subjects was 26.8 ± 7.6 years and 23.9 ± 3.2 kg/m2, respectively. Athletes had withdrawn from sport for an average of 9.5 ± 6.7 months prior to surgery and on average required 9.7 ± 5.1 months to return to sport. After two years, all mean PRO scores had improved significantly (Figure 1), and 57 patients (92%) had returned to play and continued participation. Patients who had withdrawn from sport for greater than 8 months before surgery returned to sport significantly more slowly than those who had withdrawn for less than 8 months (p=0.01). Greater withdrawal from sport prior to surgery also correlated with lower postoperative improvements in HOS-ADL and HOS-SS scores. Bivariate analysis revealed that increasing body-mass index (BMI) was associated with lower improvements in PROs. Conclusion: Recreational athletes, following hip arthroscopy for FAI, return to play at a high rate. Increasing BMI and preoperative withdrawal from sport both significantly prolong return to play and diminish two-year PROs. Most return-to-play studies following hip arthroscopy for FAI have focused on professional athletes, with limited generalizability to the average sports medicine surgeon practice. This is the first study of its kind to focus

  17. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique

    PubMed Central

    Connolly, Keith P; Kamath, Atul F

    2016-01-01

    The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval between the tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimally-invasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure. Additionally, improved understanding of relevant soft tissue constraints and anatomic variants has provided improved margin of safety for patients. The procedure may be performed using specially-designed instruments and a fracture table, however many authors have also described equally efficacious performance using a regular table and standard arthroplasty tools. The capacity to utilize fluoroscopy intra-operatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons gaining familiarity. Proper management of patient and limb positioning are vital to reducing risk of intra-operative complications. An understanding of its limitations and challenges are also critical to safe employment. This review summarizes the key features of the direct anterior approach for total hip arthroplasty as an aid to improving the understanding of this important and effective method for modern hip replacement surgeons. PMID:26807354

  18. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique.

    PubMed

    Connolly, Keith P; Kamath, Atul F

    2016-01-18

    The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval between the tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimally-invasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure. Additionally, improved understanding of relevant soft tissue constraints and anatomic variants has provided improved margin of safety for patients. The procedure may be performed using specially-designed instruments and a fracture table, however many authors have also described equally efficacious performance using a regular table and standard arthroplasty tools. The capacity to utilize fluoroscopy intra-operatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons gaining familiarity. Proper management of patient and limb positioning are vital to reducing risk of intra-operative complications. An understanding of its limitations and challenges are also critical to safe employment. This review summarizes the key features of the direct anterior approach for total hip arthroplasty as an aid to improving the understanding of this important and effective method for modern hip replacement surgeons. PMID:26807354

  19. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases

    PubMed Central

    de SA, Darren; Stephens, Kellee; Kuang, Michelle; Simunovic, Nicole; Karlsson, Jon; Ayeni, Olufemi R.

    2016-01-01

    Health care facilities produce significant waste (2200 kg/bed/year) creating 2% of greenhouse gas emissions and 1% total solid waste nationwide, with 20–70% of waste coming from operating rooms. We performed a waste audit of hip arthroscopy for femoroacetabular impingement (FAI) to understand its environmental impact and identify areas for greening practices. A waste audit of five hip arthroscopy procedures for FAI was performed. All waste was collected and separated into six waste streams in real time: (i) normal/landfill waste; (ii) recyclable cardboards and plastics; (iii) biohazard waste; (iv) sharp items; (v) linens and (vi) sterile wrapping. The surgical waste (except laundered linens) from five FAI surgeries totaled 47.4 kg, including 21.7 kg (45.7%) of biohazard waste, 11.7 kg (24.6%) of sterile wrap, 6.4 kg (13.5%) of normal/landfill waste, 6.4 kg (13.5%) of recyclable plastics and 1.2 kg (2.6%) of sharp items. An average of 9.4 kg (excluding laundered linens) of waste was produced per procedure. Given the considerable biohazard waste produced by FAI procedures, additional recycling programs, continued adherence to proper waste segregation and an emphasis on ‘green outcomes’ is encouraged to demonstrate environmental responsibility and effectively manage and allocate finite resources. PMID:27583149

  20. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases.

    PubMed

    de Sa, Darren; Stephens, Kellee; Kuang, Michelle; Simunovic, Nicole; Karlsson, Jon; Ayeni, Olufemi R

    2016-07-01

    Health care facilities produce significant waste (2200 kg/bed/year) creating 2% of greenhouse gas emissions and 1% total solid waste nationwide, with 20-70% of waste coming from operating rooms. We performed a waste audit of hip arthroscopy for femoroacetabular impingement (FAI) to understand its environmental impact and identify areas for greening practices. A waste audit of five hip arthroscopy procedures for FAI was performed. All waste was collected and separated into six waste streams in real time: (i) normal/landfill waste; (ii) recyclable cardboards and plastics; (iii) biohazard waste; (iv) sharp items; (v) linens and (vi) sterile wrapping. The surgical waste (except laundered linens) from five FAI surgeries totaled 47.4 kg, including 21.7 kg (45.7%) of biohazard waste, 11.7 kg (24.6%) of sterile wrap, 6.4 kg (13.5%) of normal/landfill waste, 6.4 kg (13.5%) of recyclable plastics and 1.2 kg (2.6%) of sharp items. An average of 9.4 kg (excluding laundered linens) of waste was produced per procedure. Given the considerable biohazard waste produced by FAI procedures, additional recycling programs, continued adherence to proper waste segregation and an emphasis on 'green outcomes' is encouraged to demonstrate environmental responsibility and effectively manage and allocate finite resources. PMID:27583149

  1. MAGNETIC RESONANCE IMAGING OF THE HIP FOR THE EVALUATION OF FEMOROACETABULAR IMPINGEMENT; PAST, PRESENT, AND FUTURE

    PubMed Central

    Riley, Geoffrey M.; McWalter, Emily J.; Stevens, Kathryn J.; Safran, Marc R.; Lattanzi, Riccardo; Gold, Garry E.

    2014-01-01

    The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition. PMID:25155435

  2. MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future.

    PubMed

    Riley, Geoffrey M; McWalter, Emily J; Stevens, Kathryn J; Safran, Marc R; Lattanzi, Riccardo; Gold, Garry E

    2015-03-01

    The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition. PMID:25155435

  3. Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty

    PubMed Central

    Kobayashi, Hiroki; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Kanazawa, Masayuki; Takagishi, Kenji; Iwamoto, Yukihide

    2016-01-01

    Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients. PMID:27398108

  4. Feasibility of a Randomized Clinical Trial for Treatment of Femoroacetabular Impingement of the Hip

    PubMed Central

    Boye, Gloria N.; Murray, Kerri; Clohisy, John C.; Kim, Young-Jo

    2015-01-01

    Background: Symptomatic femoroacetabular impingement (FAI) is currently corrected by surgery. However, it is possible that nonsurgical treatment could resolve symptomatic FAI in some patients; thus, uncertainty about the necessity of surgical treatment exists. The current equipoise concerning FAI treatment presents an opportunity to conduct a randomized controlled trial (RCT) of surgical and nonsurgical treatment options. Given the unique challenge of adequate patient enrollment in RCTs, it is important that a preliminary study is done to appraise the feasibility of conducting an RCT. Purpose: To estimate enrollment rates of a planned future RCT to compare surgical and nonsurgical treatments for symptomatic FAI and to identify factors associated with patients’ willingness to participate in the randomized trial. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients diagnosed with FAI at 2 orthopaedic centers were presented with a hypothetical randomized trial comparing 2 treatment options for FAI. All patients completed forms providing information regarding their willingness to participate and treatment preferences. Results: A total of 75 patients participated in the study: 53 and 22 from 2 centers, respectively. Twenty-eight percent indicated absolute willingness to participate in the trial, 40% were probably willing or unsure, and 32% were definitely not willing; 18.7% had a strong preference for surgery while 2.7% strongly preferred nonsurgical treatment. The majority (78.6%) had no strong preference for either treatment arm. There were correlations between treatment preferences and willingness to participate. Patients with a strong treatment preference and/or a preference for surgery were less likely to be willing to participate. Conclusion: The study findings suggest that sufficient patient accrual for a randomized trial of FAI treatment is currently feasible while equipoise still exists among patients and surgeons. PMID:26673688

  5. Optimal acetabular component orientation estimated using edge-loading and impingement risk in patients with metal-on-metal hip resurfacing arthroplasty.

    PubMed

    Mellon, Stephen J; Grammatopoulos, George; Andersen, Michael S; Pandit, Hemant G; Gill, Harinderjit S; Murray, David W

    2015-01-21

    Edge-loading in patients with metal-on-metal resurfaced hips can cause high serum metal ion levels, the development of soft-tissue reactions local to the joint called pseudotumours and ultimately, failure of the implant. Primary edge-loading is where contact between the femoral and acetabular components occurs at the edge/rim of the acetabular component whereas impingement of the femoral neck on the acetabular component's edge causes secondary or contrecoup edge-loading. Although the relationship between the orientation of the acetabular component and primary edge-loading has been identified, the contribution of acetabular component orientation to impingement and secondary edge-loading is less clear. Our aim was to estimate the optimal acetabular component orientation for 16 metal-on-metal hip resurfacing arthroplasty (MoMHRA) subjects with known serum metal ion levels. Data from motion analysis, subject-specific musculoskeletal modelling and Computed Tomography (CT) measurements were used to calculate the dynamic contact patch to rim (CPR) distance and impingement risk for 3416 different acetabular component orientations during gait, sit-to-stand, stair descent and static standing. For each subject, safe zones free from impingement and edge-loading (CPR <10%) were defined and, consequently, an optimal acetabular component orientation was determined (mean inclination 39.7° (SD 6.6°) mean anteversion 14.9° (SD 9.0°)). The results of this study suggest that the optimal acetabular component orientation can be determined from a patient's motion and anatomy. However, 'safe' zones of acetabular component orientation associated with reduced risk of dislocation and pseudotumour are also associated with a reduced risk of edge-loading and impingement. PMID:25482661

  6. Biometry of the anterior border of the human hip bone: normal values and their use in sex determination.

    PubMed Central

    Gómez Pellico, L; Fernández Camacho, F J

    1992-01-01

    Sixteen different variables and 3 indices for the anterior border of 42 human hip bones from a Spanish skeletal collection were studied. Values for 15 of these variables and for the 3 indices are reported. We were unable to detect statistically significant differences between means relating to side in any of the variables and indices studied. Statistically significant differences were detected between means in relation to sex for 4 variables (distance from the anterior superior iliac spine to the pubic tubercle, distance from the anterior inferior iliac spine to the iliopubic eminence, distance from the anterior inferior iliac spine to the pubic tubercle, length of the notch between the anterior inferior iliac spine and the iliopubic eminence). These variables could be used for sex determination from the human hip bone or its fragments. PMID:1304579

  7. Evaluating online information regarding the direct anterior approach for total hip arthroplasty.

    PubMed

    Mohan, Rohith; Yi, Paul H; Hansen, Erik N

    2015-05-01

    We evaluated the quality of information available on the Internet regarding the direct anterior approach (DAA). The top 50 Web sites from three major search engines (Google, Yahoo!, and Bing) were tabulated utilizing the search term direct anterior hip replacement. Of these, only 22% were authored by a hospital/university, while 60% were by a private physician/clinic. Most Web sites presented the DAA as "better" than other surgical approaches describing benefits, such as accelerated recovery though only 35% described risks of the approach. While only 39% of sites presented patient eligibility criteria, greater than 75% had the ability to make an appointment. Web sites regarding the DAA provide patients with a limited perspective and may be focused on attracting new patients, as opposed to accurately educating them. PMID:25697892

  8. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

    PubMed Central

    Alexandrov, Tamara; Ahlmann, Elke R.; Menendez, Lawrence R.

    2014-01-01

    We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery. PMID:24715984

  9. Open anterior dislocation of the hip in an adult: a case report and review of literature☆☆☆

    PubMed Central

    de Oliveira, Anderson Luiz; Machado, Eduardo Gomes

    2014-01-01

    Open anterior hip dislocation is a rare condition and results from high‐energy trauma. Ten cases of open anterior dislocation have been described in the literature so far. Its rarity is due to the inherent stability of the joint, its deep position in the pelvis, with strong ligaments and bulky muscles around the articulation. Several factors influence the prognosis, such as the degree of compounding, the associated soft tissue injuries, the age of the patient and, mainly, the delay in reduction. The main complications are: arthrosis of the hip, with incidence of 50% of cases, when associated with fractures of the femoral head; and osteonecrosis of the femoral head, with incidence between 1.7 and 40% (in closed anterior dislocation). Because of the rarity and the potential disability of this lesion, we report a case in a 46‐year‐old man, involved in an automobile accident. The hip was reduced (anterior superior dislocation) in the first three hours of the trauma. The patient was kept non‐weight bearing until sixth week, with complete weight bearing after 10th week. After one year follow‐up, the functional result was poor (Harris Hip Score: 52), probably because of the associated labral tear, but without signs of osteonecrosis of the femoral head in magnetic resonance imaging. PMID:26229781

  10. Evaluation of the patient with hip pain.

    PubMed

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. PMID:24444505

  11. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report.

    PubMed

    Devitt, Brian M; Smith, Bjorn; Stapf, Robert; O'Donnell, John M

    2016-04-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  12. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report

    PubMed Central

    Devitt, Brian M.; Smith, Bjorn; Stapf, Robert; O’Donnell, John M.

    2016-01-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  13. One-stage bilateral open reduction using the anterior iliofemoral approach in developmental dysplasia of the hip.

    PubMed

    Gem, Mehmet; Arslan, Hüseyin; Ozkul, Emin; Alemdar, Celil; Azboy, Ibrahim; Demirtaş, Abdullah

    2014-06-01

    The aim of this study was to investigate the safety of one-stage bilateral open reduction using the anterior approach in the treatment of patients with bilateral Tönnis Type III and IV Developmental Dysplasia of the Hip (DDH). Forty-six patients were retrospectively evaluated. Thirty-eight were female, eight were male. The mean age was 16.63 (11-29) months. The mean follow-up period was 27.18 (12-65) months. The mean hospitalization period after surgery was 1.91 (1-5) days. The mean pre-operative hematocrit level was 35.14% (28.1-44.1) and the mean pre-operative hemoglobin level was 11.75 g/dl (9.3-13.6). The mean post-operative hematocrit level was 32.54% (26.7-40.4) and the mean post-operative hemoglobin level was 10.80 g/dl (8.78-12.3). None of the patients required blood transfusion. The mean anesthesia duration was 133.30 (95-180) minutes, and the mean operation duration was 107.58 (70-145) minutes. According to the modified scoring system by Trevor et al, excellent results were obtained in 66 hips of 46 patients (71.8%), and good results were obtained in 26 hips (28.2%). Twenty two hips (23.91%), which developed acetabular dysplasia in the follow-up period required a secondary acetabular intervention. According to the Kalamchi and MacEwen classification, Type I avascular necrosis developed in ten hips, Type II in one hip, and Type IV in two hips. One-stage bilateral open reduction using the anterior iliofemoral approach in Tönnis Type III and IV DDH at walking age is a safe, time-saving treatment method that shortens the hospitalization and immobilization periods. PMID:25090794

  14. The Recognition and Evaluation of Patterns of Compensatory Injury in Patients With Mechanical Hip Pain

    PubMed Central

    Hammoud, Sommer; Bedi, Asheesh; Voos, James E.; Mauro, Craig S.; Kelly, Bryan T.

    2014-01-01

    Context: In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. Evidence Acquisition: A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level of Evidence: Level 4. Results: Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o’clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Conclusion: Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre

  15. PRE- AND POST-OPERATIVE SELF-REPORTED FUNCTION AND QUALITY OF LIFE IN WOMEN WITH AND WITHOUT GENERALIZED JOINT LAXITY UNDERGOING HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Pontiff, Mattie; Ithurburn, Matthew P.; Ellis, Thomas; Cenkus, Kathleen

    2016-01-01

    ABSTRACT Background Generalized joint laxity is more prevalent in women than men and may lead to poorer post-operative outcomes in select orthopedic populations. There are no studies examining peri-operative function in patients with generalized joint laxity (GJL) and femoroacetabular impingement (FAI). Purpose The purpose of this study was to determine the difference in perceived function and quality of life as measured by the Hip Outcome Score ADL subscale (HOS-ADL), International Hip Outcomes Tool (iHOT-33) and the Short Form 12-Item Health Survey (SF-12) in women with and without GJL prior to and six months after undergoing hip arthroscopy for FAI. Study Design Cohort Study Methods Peri-operative data were collected from women with FAI from November 2011-September 2014. Lax subjects were women with laxity scores ≥4/9 on the Beighton and Horan Joint Mobility Index; Nonlax subjects were women with laxity scores <4/9. Functional outcomes were evaluated using the HOS-ADL, iHOT-33, PCS-12, and the MCS-12 pre-operatively and at 6 months post-operatively. Change scores (post-score – pre-score) were calculated for each outcome measure and compared between groups, along with pre-operative and post-operative means, using Mann-Whitney U tests. Results 166 women met the inclusion criteria: Nonlax (n = 131), Lax (n = 35). There were no statistically significant differences between groups in pre-operative functional outcomes (all p > .05). Additionally, there were no statistically significant differences between groups in post-operative means or change scores, respectively, for HOS-ADL (p = .696, .358), iHOT-33 (p = .550, .705), PCS-12 (p = .713, .191), and MCS-12 (p = .751, .082). Laxity score was not associated with any post-operative functional outcome score or change score (all p > .05). Conclusion Women with and without generalized joint laxity do not appear to report differences in hip function in the 6-month peri-operative period before and after hip

  16. UK FASHIoN: feasibility study of a randomised controlled trial of arthroscopic surgery for hip impingement compared with best conservative care.

    PubMed Central

    Griffin, Damian; Wall, Peter; Realpe, Alba; Adams, Ann; Parsons, Nick; Hobson, Rachel; Achten, Juul; Fry, Jeremy; Costa, Matthew; Petrou, Stavros; Foster, Nadine; Donovan, Jenny

    2016-01-01

    BACKGROUND Femoroacetabular impingement (FAI) is a syndrome of hip or groin pain associated with shape abnormalities of the hip joint. Treatments include arthroscopic surgery and conservative care. This study explored the feasibility of a randomised controlled trial to compare these treatments. OBJECTIVES The objectives of this study were to estimate the number of patients available for a full randomised controlled trial (RCT); to explore clinician and patient willingness to participate in such a RCT; to develop consensus on eligibility criteria, surgical and best conservative care protocols; to examine possible outcome measures and estimate the sample size for a full RCT; and to develop trial procedures and estimate recruitment and follow-up rates. METHODS Pre-pilot work: we surveyed all UK NHS hospital trusts (n = 197) to identify all FAI surgeons and to estimate how much arthroscopic FAI surgery they performed. We interviewed a purposive sample of 18 patients, 36 physiotherapists, 18 surgeons and two sports physicians to explore attitudes towards a RCT and used consensus-building methods among them to develop treatment protocols and patient information. Pilot RCT: we performed a pilot RCT in 10 hospital trusts. Patients were randomised to receive either hip arthroscopy or best conservative care and then followed up at 3, 6 and 12 months using patient-reported questionnaires for hip pain and function, activity level, quality of life, and a resource-use questionnaire. Qualitative recruitment intervention: we performed semistructured interviews with all researchers and clinicians involved in the pilot RCT in eight hospital trusts and recorded and analysed diagnostic and recruitment consultations with eligible patients. RESULTS We identified 120 surgeons who reported treating at least 1908 patients with FAI by hip arthroscopy in the NHS in the financial year 2011/12. There were 34 hospital trusts that performed ≥ 20 arthroscopic FAI operations in the year

  17. Is there a relationship between psoas impingement and increased trochanteric retroversion?

    PubMed Central

    Gómez-Hoyos, Juan; Schröder, Ricardo; Reddy, Manoj; Palmer, Ian J.; Khoury, Anthony; Martin, Hal David

    2015-01-01

    The concept of psoas impingement secondary to a tight or inflamed iliopsoas tendon causing impingement of the anterior labrum during hip extension has been suggested. The purpose of this study was to assess the relationship between the lesser trochanteric version (LTV) in symptomatic patients with psoas impingement as compared with asymptomatic hips. The femoral neck version (FNV) and LTV were evaluated on axial magnetic resonance imaging, as well as the angle between LTV and FNV. Data from 12 symptomatic patients and 250 asymptomatic patients were analysed. The mean, range and standard deviations were calculated. Independent t-tests were used to determine differences between groups. The lesser trochanteric retroversion was significantly increased in patients with psoas impingement as compared with asymptomatic hips (−31.1° SD ± 6.5 versus −24.2° ± 11.5, P < 0.05). The FNV (9° ± 8.8 versus 14.1° ± 10.7, P > 0.05) and the angle between FNV and LTV (40.2° ± 9.7 versus 38.3° ± 9.6, P > 0.05) were not significantly different between groups. In conclusion, the lesser trochanteric retroversion is significantly increased in patients with psoas impingement as compared with asymptomatic hips. PMID:27011834

  18. [Shoulder impingement].

    PubMed

    Wurnig, C

    2000-10-01

    The impingement syndrome is a common disorder of the shoulder girdle. The causes for this syndrome may be anatomic changes in the coracoacromial arch, also within the ultrastructural regions, on the one hand, or changes in the biomechanics which have developed for various reasons, on the other. Diagnosis is based on roentgenograms using the appropriate technique. In large-scale-studies, sonography has proved to be an extremely sensitive screening method for differential diagnosis of rupture of the rotator cuff. Magnetic resonance imaging might gain in value in the diagnosis of impingement as regards differential diagnosis of rupture of the rotator cuff because this technique--when employed appropriately--allows exact viewing of the soft tissue and the anterior part of the acromion. In the majority of cases conservative treatment is the method of choice. Methods of treatment are sonography, galvanization, and application of heat. Physiotherapy should not be initiated until pain relief has been achieved by other measures. Infiltration therapy is of considerable value in the management of pain due to impingement. Application of cortisone into the subacromial space must also be considered critically. As regards conservative therapy, only few evidence-based publications provide information on the effectiveness of different treatment regimens. Surgical therapy is only indicated in cases of pain resistant to the conservative therapy for a certain period. Furthermore, only an outlet impingement can be treated successfully by surgical decompression. The surgeon decides on the surgical method--open surgery or arthroscopy. Of course, arthroscopic methods are less invasive; however, up to now the superiority of one of the surgical methods over the other could not yet be proven by mid-term clinical results. Other surgical methods such as wedge osteotomy in the region of the spina scapulae are still in the experimental stage. By surgical and conservatives methods, good and even

  19. Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study.

    PubMed

    Parvizi, Javad; Restrepo, Camilo; Maltenfort, Mitchell G

    2016-07-01

    Studies suggest that total hip arthroplasty (THA) performed through direct anterior (DA) approach has better functional outcomes than other surgical approaches. The immediate to very early outcomes of DA THA are not known. A prospective, randomized study examined the very early outcome of THA performed through DA versus direct lateral approach. The functional outcomes on day 1, day 2, week 6, week 12, 6 months, and 1 year were measured. Patients receiving DA THA had significantly higher functional scores during the early period following surgery. The difference in functional scores leveled out at 6 months. PMID:27241374

  20. Reducing the distal profile of dual mobility liners can mitigate soft-tissue impingement and liner entrapment without affecting mechanical performance.

    PubMed

    Varadarajan, Kartik Mangudi; Zumbrunn, Thomas; Duffy, Michael Patrick; Patel, Rajan; Freiberg, Andrew A; Rubash, Harry E; Malchau, Henrik; Muratoglu, Orhun K

    2016-05-01

    Soft-tissue impingement with dual mobility liners can cause anterior hip pain and intra-prosthetic dislocation. The hypothesis of this study was that reducing liner profile below the equator (contoured design) can mitigate soft-tissue impingement without compromising inner-head pull-out resistance and hip joint stability. The interaction of conventional and contoured liners with anterior soft tissues was evaluated in cadaver specimens via visual observation and fluoroscopic imaging. Resistance to inner-head pull-out was evaluated via finite element analyses, and hip joint stability was evaluated by rigid-body mechanics simulation of dislocation in two modes (A, B). Cadaveric experiments showed that distal portion of conventional liners impinge on anterior hip capsule and cause iliopsoas tenting at low flexion angles (≤30°). During hip extension, the rotation imparted to the liner from posterior engagement with femoral neck was impeded by anterior soft-tissue impingement. The iliopsoas tenting was significantly reduced with contoured liners (p ≤ 0.04). Additionally, the contoured and conventional liners had identical inner-head pull-out resistance (901 N vs. 909 N), jump distance (9.4 mm mode-A, 11.7 mm mode-B) and impingement-free range of motion (47° mode-A, 29° mode-B). Thus, soft-tissue impingement with conventional dual mobility liners may be mitigated by reducing liner profile below the equator, without affecting mechanical performance. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:889-897, 2016. PMID:26496522

  1. ACL Roof Impingement Revisited

    PubMed Central

    Tanksley, John Anthony; Conte, Evan J.; Werner, Brian C.; Gwathmey, Frank Winston; Brockmeier, Stephen F.; Miller, Mark D.

    2015-01-01

    Objectives: Anatomic femoral tunnel placement for single-bundle ACL reconstruction is now well accepted. The ideal location for the tibial tunnel, however, has not been studied extensively. A wide range of anterior to posterior (A-P) tibial tunnel locations are considered acceptable. Biomechanical data suggests that the anterior fibers of the native ACL are more functional. Similarly, ACL grafts placed more anteriorly in the footprint have resulted in improved clinical results in at least one study. However, the concern for intercondylar roof impingement has tempered enthusiasm for a more anterior tibial tunnel placement. Investigations by Howell and others on roof impingement have focused only on the transtibial technique. Our study seeks to characterize intercondylar roof impingement in a 3-D cadaveric model with both transtibial and independent femoral tunnel drilling techniques in the setting of an anteriorly positioned tibial tunnel. Methods: Twelve fresh frozen cadaver knees (six matched pairs) were randomized to either a transtibial or an independent femoral (IF) drilling technique. Tibial guide pins were placed in the anterior half of the ACL tibial footprint following arthroscopic debridement of the native ACL. A fluoroscopic calculation of the tibial guide pin location using the technique described by Staubli was used to ensure a relatively anterior position of the tibial tunnel (Staubli < 35). All efforts were made to place the femoral tunnel anatomically in the center of the footprint. An 8 mm Gore-Tex smoother was passed into the knee to function as a radiopaque surrogate graft, and the knees then underwent computed tomography in maximal extension. Graft-visualized 3D-CT reformatting was used to evaluate for roof impingement by analyzing the Impingement Review Index (IRI) as described by Iriuchishima. Tunnel morphology, knee flexion, and intra-articular graft angles were also recorded. Results: Two grafts (2/6, 33.3 %) in the TT group impinged upon the

  2. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Frank, Barnett S.; Gilsdorf, Christine M.; Goerger, Benjamin M.; Prentice, William E.; Padua, Darin A.

    2014-01-01

    Background: Females with history of anterior cruciate ligament (ACL) injury and subsequent ligament reconstruction are at high risk for future ACL injury. Fatigue may influence the increased risk of future injury in females by altering lower extremity biomechanics and postural control. Hypothesis: Fatigue will promote lower extremity biomechanics and postural control deficits associated with ACL injury. Study Design: Descriptive laboratory study. Methods: Fourteen physically active females with ACL reconstruction (mean age, 19.64 ± 1.5 years; mean height, 163.52 ± 6.18 cm; mean mass, 62.6 ± 13.97 kg) volunteered for this study. Postural control and lower extremity biomechanics were assessed in the surgical limb during single-leg balance and jump-landing tasks before and after a fatigue protocol. Main outcome measures were 3-dimensional hip and knee joint angles at initial contact, peak angles, joint angular displacements and peak net joint moments, anterior tibial shear force, and vertical ground reaction force during the first 50% of the loading phase of the jump-landing task. During the single-leg stance task, the main outcome measure was center of pressure sway speed. Results: Initial contact hip flexion angle decreased (t = −2.82, P = 0.01; prefatigue, 40.98° ± 9.79°; postfatigue, 36.75° ± 8.61°) from pre- to postfatigue. Hip flexion displacement (t = 2.23, P = 0.04; prefatigue, 45.19° ± 14.1°; postfatigue, 47.48° ± 14.21°) and center of pressure sway speed (t = 3.95, P < 0.05; prefatigue, 5.18 ± 0.96 cm/s; postfatigue, 6.20 ± 1.72 cm/s) increased from pre- to postfatigue. There was a trending increase in hip flexion moment (t = 2.14, P = 0.05; prefatigue, 1.66 ± 0.68 Nm/kg/m; postfatigue, 1.91 ± 0.62 Nm/kg/m) from pre- to postfatigue. Conclusion: Fatigue may induce lower extremity biomechanics and postural control deficits that may be associated with ACL injury in physically active females with ACL reconstruction. Clinical Relevance

  3. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    PubMed

    Almeida, Gabriel Peixoto Leão; Carvalho E Silva, Ana Paula de Moura Campos; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS. PMID:26118529

  4. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test.

    PubMed

    Vigotsky, Andrew D; Lehman, Gregory J; Contreras, Bret; Beardsley, Chris; Chung, Bryan; Feser, Erin H

    2015-01-01

    Background. Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test. Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated. Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08; p = 0.0372; Pearson's r = 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = -1.39° (-5.53, +2.75); t(22) = -0.70; p = 0.4933; Cohen's d = - 0.15 (-0.58, 0.29)) or rectus femoris length (change = -0.005 (-0.013, +0.003); t(22) = -1.30; p = 0.2070; Cohen's d = - 0.27 (-0.70, 0.16)) were not due to chance alone. Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol. PMID:26421244

  5. Hip instability.

    PubMed

    Smith, Matthew V; Sekiya, Jon K

    2010-06-01

    Hip instability is becoming a more commonly recognized source of pain and disability in patients. Traumatic causes of hip instability are often clear. Appropriate treatment includes immediate reduction, early surgery for acetabular rim fractures greater than 25% or incarcerated fragments in the joint, and close follow-up to monitor for avascular necrosis. Late surgical intervention may be necessary for residual symptomatic hip instability. Atraumatic causes of hip instability include repetitive external rotation with axial loading, generalized ligamentous laxity, and collagen disorders like Ehlers-Danlos. Symptoms caused by atraumatic hip instability often have an insidious onset. Patients may have a wide array of hip symptoms while demonstrating only subtle findings suggestive of capsular laxity. Traction views of the affected hip can be helpful in diagnosing hip instability. Open and arthroscopic techniques can be used to treat capsular laxity. We describe an arthroscopic anterior hip capsular plication using a suture technique. PMID:20473129

  6. Prevalence of Radiographic Parameters Predisposing to Femoroacetabular Impingement in Young Asymptomatic Chinese and White Subjects

    PubMed Central

    Van Houcke, Jan; Yau, Wan Pan; Yan, Chun Hoi; Huysse, Wouter; Dechamps, Hannes; Lau, Wing Hang; Wong, Chun Sing; Pattyn, Christophe; Audenaert, Emmanuel Albert

    2015-01-01

    Background: Osteoarthritis of the hip is five to ten times more common in white people than in Chinese people. Little is known about the true prevalence of femoroacetabular impingement or its role in the development of osteoarthritis in the Chinese population. A cross-sectional study of both white and Chinese asymptomatic individuals was conducted to compare the prevalences of radiographic features posing a risk for femoroacetabular impingement in the two groups. It was hypothesized that that there would be proportional differences in hip anatomy between the white and Asian populations. Methods: Pelvic computed tomography scans of 201 subjects (ninety-nine white Belgians and 102 Chinese; 105 men and ninety-six women) without hip pain who were eighteen to forty years of age were assessed. The original axial images were reformatted to three-dimensional pelvic models simulating standardized radiographic views. Ten radiographic parameters predisposing to femoroacetabular impingement were measured: alpha angle, anterior offset ratio, and caput-collum-diaphyseal angle on the femoral side and crossover sign, ischial spine projection, acetabular anteversion angle, center-edge angle, acetabular angle of Sharp, Tönnis angle, and anterior acetabular head index on the acetabular side. Results: The white subjects had a less spherical femoral head than the Chinese subjects (average alpha angle, 56° compared with 50°; p < 0.001). The Chinese subjects had less lateral acetabular coverage than the white subjects, with average center-edge angles of 35° and 39° (p < 0.001) and acetabular angles of Sharp of 38° and 36° (p < 0.001), respectively. A shallower acetabular configuration was predominantly present in Chinese women. Conclusions: Significant differences in hip anatomy were demonstrated between young asymptomatic Chinese and white subjects. However, the absolute size of the observed differences appears to contrast with the reported low prevalence of femoroacetabular

  7. Effect of an on-hip load-carrying belt on physiological and perceptual responses during bimanual anterior load carriage.

    PubMed

    Gao, Z G; Sun, S Q; Goonetilleke, R S; Chow, D H K

    2016-07-01

    Manual load carriage continues to be a major contributor of musculoskeletal injury. This study investigates the physiological and subjective effects of an on-hip load-carrying belt (HLCB) during bimanual anterior load carriage. Fifteen healthy male participants walked on a level ground treadmill at 4.5 km/h for 5 min carrying 5, 10 and 15 kg loads with hands and arms in front of the body, with and without using the HLCB (WD and ND). Heart rate, normalized oxygen uptake, minute ventilation and, central and peripheral ratings of perceived exertion were the dependent variables. The mean heart rate, normalized oxygen uptake, minute ventilation and peripheral rating of perceived exertion increased significantly with load under both WD and ND conditions. At a load of 15 kg, the mean heart rate, normalized oxygen uptake, minute ventilation and peripheral rating of perceived exertion were significantly lower by 6.6%, 8.0%, 11.8% and 13.9% respectively in WD condition when compared to the ND condition. There was no significant difference between WD and ND conditions with 5 or 10 kg load. It can be concluded that the HLCB could reduce a person's physiological and peripheral perceptual responses when walking on a level ground treadmill at 4.5 km/h with a load of 15 kg. Using a HLCB or similar device is therefore recommended for bimanual anterior load carriage for loads of 15 kg or probably larger. PMID:26995043

  8. Relationship Between Hip and Knee Kinematics In Athletic Women During Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate Ligament Injury and Prevention

    PubMed Central

    Imwalle, Lauren E.; Myer, Gregory D.; Ford, Kevin R.; Hewett, Timothy E.

    2013-01-01

    The purposes of this study were to compare lower-extremity kinematics during a 45° and 90° cutting maneuver and to examine the relationships between lower-extremity rotations during these maneuvers. The hypotheses tested were that greater internal hip and knee rotation angles would be observed during the cutting maneuver at a 90° angle (90° cut) compared with the maneuver performed at a 45° angle (45° cut) and that the increased internal hip and knee rotation would be related to increased knee abduction measures. Nineteen athletes from women’s soccer teams (17.6 ± 2.1 yr, 165.6 ± 8.2 cm, 60.2 ± 5.6 kg) were instructed to jump across a line and cut at the appropriate angle (either 45° or 90° side-step cut) and in the appropriate direction. Lower-extremity kinematic measures were taken at peak force during the stance phase. Hip internal rotation and knee internal rotation (p = 0.008) were increased during the 90° cut compared with the 45° cut. Mean hip flexion (p < 0.001) was also greater in the 90° cut. The only significant predictor of knee abduction during both tasks was hip adduction (R = 0.49). The findings indicate that the mechanisms underlying increased knee abduction measures in athletic women during cutting tasks were primarily coronal plane motions at the hip. Trunk and hip focused strength neuromuscular training may improve the ability of athletic women to increase control of lower-extremity alignment. Therefore, these women may decrease dangerous knee loads that result from increased hip adduction during dynamic tasks, thus decreasing anterior cruciate ligament injury risk. PMID:19826304

  9. Relationship between hip and knee kinematics in athletic women during cutting maneuvers: a possible link to noncontact anterior cruciate ligament injury and prevention.

    PubMed

    Imwalle, Lauren E; Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

    2009-11-01

    The purposes of this study were to compare lower-extremity kinematics during a 45 degrees and 90 degrees cutting maneuver and to examine the relationships between lower-extremity rotations during these maneuvers. The hypotheses tested were that greater internal hip and knee rotation angles would be observed during the cutting maneuver at a 90 degrees angle (90 degrees cut) compared with the maneuver performed at a 45 degrees angle (45 degrees cut) and that the increased internal hip and knee rotation would be related to increased knee abduction measures. Nineteen athletes from women's soccer teams (17.6 +/- 2.1 yr, 165.6 +/- 8.2 cm, 60.2 +/- 5.6 kg) were instructed to jump across a line and cut at the appropriate angle (either 45 degrees or 90 degrees side-step cut) and in the appropriate direction. Lower-extremity kinematic measures were taken at peak force during the stance phase. Hip internal rotation and knee internal rotation (p = 0.008) were increased during the 90 degrees cut compared with the 45 degrees cut. Mean hip flexion (p < 0.001) was also greater in the 90 degrees cut. The only significant predictor of knee abduction during both tasks was hip adduction (R = 0.49). The findings indicate that the mechanisms underlying increased knee abduction measures in athletic women during cutting tasks were primarily coronal plane motions at the hip. Trunk and hip focused strength neuromuscular training may improve the ability of athletic women to increase control of lower-extremity alignment. Therefore, these women may decrease dangerous knee loads that result from increased hip adduction during dynamic tasks, thus decreasing anterior cruciate ligament injury risk. PMID:19826304

  10. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test

    PubMed Central

    Lehman, Gregory J.; Contreras, Bret; Beardsley, Chris; Chung, Bryan; Feser, Erin H.

    2015-01-01

    Background. Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test. Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated. Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08; p = 0.0372; Pearson’s r = 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = −1.39° (−5.53, +2.75); t(22) = −0.70; p = 0.4933; Cohen’s d = − 0.15 (−0.58, 0.29)) or rectus femoris length (change = −0.005 (−0.013, +0.003); t(22) = −1.30; p = 0.2070; Cohen’s d = − 0.27 (−0.70, 0.16)) were not due to chance alone. Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol. PMID:26421244

  11. ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Polesello, Giancarlo C.; Queiroz, Marcelo C.; Ono, Nelson K.; Honda, Emerson K.; Guimarāes, Rodrigo P; Junior, Walter Ricioli

    2015-01-01

    Objective: The purpose of this study is to evaluate the short-term follow-up results of arthroscopic treatment of femoroacetabular impingement. Our hypothesis is that arthroscopic treatment results are favorable. Methods: Between August 2003 and August 2007, 28 hips had femoroacetabular impingement treated by hip arthroscopy. The mean age was 34 years, with mean follow-up period of 27 months. Clinical results were graded with the modified Harris hip score, which was measured pre- and postoperatively. Patients had also their internal rotation analyzed. These parameters were calculated by using Wilcoxon's t test for analysis of nonparametric paired samples performed. Results: The mean preoperative Harris Hip Score was 54.2, improving to 94.8 postoperatively (p<0,001). The mean increase was 37.5 points. We had 4 good results (15%) and 24 excellent results (85%). Preoperatively, the patients had a mean internal rotation of 17°, and, postoperatively, 36°. The average internal rotation increase was 19° (p<0,001). Conclusions: The arthroscopic treatment of femoroacetabular impingement presents satisfactory results. PMID:27004177

  12. Femoroacetabular Impingement: A Retrospective Case Study With 8-Year Follow-Up

    PubMed Central

    Stobert, Julia R.; Emary, Peter C.; Taylor, John A.

    2015-01-01

    Objective The purpose of this case report is to describe a patient with femoroacetabular impingement (FAI) who was initially misdiagnosed and treated for a hip flexor strain. Clinical Features A 36-year-old male patient presented with insidious onset of progressive anterior right hip and groin pain of 7 years' duration. He was diagnosed with a right-sided hip flexor muscle strain and was discharged from care 1 month later. The patient then returned to the office 8 years later for treatment of unrelated lower back pain. This time, the doctor of chiropractic learned that the patient was misdiagnosed years before. The patient's past radiographs in fact revealed FAI, including severe hip joint osteoarthritis on the right and mild osteoarthritis on the left. As a result, the patient had undergone right hip joint replacement surgery. Recent radiographs also revealed FAI in the contralateral hip. Intervention and Outcome After investigating for FAI, the doctor of chiropractic was able to identify through symptomatology, history, physical examination, and radiographs the presence of FAI in the patient's left hip. An “active surveillance” approach is being taken. Conclusion This case illustrates the importance of an increasing awareness of FAI, as doctors of chiropractic are frequently the primary contact for patients with this condition. PMID:26793042

  13. Hip arthroscopy☆

    PubMed Central

    de Amorim Cabrita, Henrique Antônio Berwanger; de Castro Trindade, Christiano Augusto; de Campos Gurgel, Henrique Melo; Leal, Rafael Demura; de Souza Marques, Ricardo da Fonseca

    2014-01-01

    Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff), although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve. PMID:26229924

  14. Pincer Impingement.

    PubMed

    Hadeed, Michael M; Cancienne, Jourdan M; Gwathmey, F Winston

    2016-07-01

    This article presents a brief review of pincer impingement pathomechanics and the current methods of diagnosis, followed by a discussion of many of the current controversies in addressing pincer morphology. These controversies include controversial surgical indications such as global acetabular retroversion and the role of prophylactic surgery, controversial surgical techniques to address the acetabular labrum, as well as the best methods for intraoperative evaluation of the arthroscopic acetabuloplasty. PMID:27343393

  15. The Accuracy of the Physical Examination for the Diagnosis of Midlumbar and Low Lumbar Nerve Root Impingement

    PubMed Central

    Suri, Pradeep; Rainville, James; Katz, Jeffrey N.; Jouve, Cristin; Hartigan, Carol; Limke, Janet; Pena, Enrique; Li, Ling; Swaim, Bryan; Hunter, David J

    2010-01-01

    Study Design Cross-sectional study with prospective recruitment. Objective To determine the accuracy of the physical examination for the diagnosis of midlumbar nerve root impingement (L2, L3, or L4), low lumbar nerve root impingement (L5 or S1) and level-specific lumbar nerve root impingement on magnetic resonance imaging (MRI), using individual tests and combinations of tests. Summary of Background Data The sensitivity and specificity of the physical examination for the localization of nerve root impingement has not been previously studied. Methods Sensitivities, specificities and LRs were calculated for the ability of individual tests and test combinations to predict the presence or absence of nerve root impingement at midlumbar, low lumbar, and specific nerve root levels. Results LRs ≥5.0 indicate moderate to large changes from pre-test probability of nerve root impingement to post-test probability. For the diagnosis of midlumbar impingement, the femoral stretch test (FST), crossed femoral stretch test (CFST), medial ankle pinprick sensation, and patellar reflex testing demonstrated LRs ≥5.0 (LR ∞). LRs ≥5.0 were seen with the combinations of FST and either patellar reflex testing (LR 7.0; 95% CI 2.3–21), or the sit-to-stand test (LR ∞). For the diagnosis of low lumbar impingement, the Achilles reflex test demonstrated a LR ≥5.0 (LR 7.1; CI 0.96–53); test combinations did not increase LRs. For the diagnosis of level-specific impingement, LRs ≥5.0 were seen for anterior thigh sensation at L2 (LR 13; 95% CI 1.8–87); FST at L3 (LR 5.7 ; 95% CI 2.3–4.4); patellar reflex testing (LR 7.7; 95% CI 1.7–35), medial ankle sensation (LR ∞), or CFST (LR 13; 95% CI 1.8–87) at L4; and hip abductor strength at L5(LR 11; 95% CI 1.3–84). Test combinations increased LRs for level-specific root impingement at the L4 level only. Conclusions Individual physical examination tests may provide clinical information which substantially alters the likelihood

  16. Delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) of hip joint cartilage in femoroacetabular impingement (FAI): Are pre- and postcontrast imaging both necessary?

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Kim, Young-Jo; Werlen, Stefan; Siebenrock, Klaus A; Mamisch, Tallal C

    2009-12-01

    The purpose of this study was to assess if delayed gadolinium MRI of cartilage using postcontrast T(1) (T(1Gd)) is sufficient for evaluating cartilage damage in femoroacetabular impingement without using noncontrast values (T(10)). T(1Gd) and DeltaR(1) (1/T(1Gd) - 1/T(10)) that include noncontrast T(1) measurements were studied in two grades of osteoarthritis and in a control group of asymptomatic young-adult volunteers. Differences between T(1Gd) and DeltaR(1) values for femoroacetabular impingement patients and volunteers were compared. There was a very high correlation between T(1Gd) and DeltaR(1) in all study groups. In the study cohort with Tonnis grade 0, correlation (r) was -0.95 and -0.89 with Tonnis grade 1 and -0.88 in asymptomatic volunteers, being statistically significant (P < 0.001) for all groups. For both T(1Gd) and DeltaR(1), a statistically significant difference was noted between patients and control group. Significant difference was also noted for both T(1Gd) and DeltaR(1) between the patients with Tonnis grade 0 osteoarthritis and those with grade 1 changes. Our results prove a linear correlation between T(1Gd) and DeltaR(1), suggesting that T(1Gd) assessment is sufficient for the clinical utility of delayed gadolinium MRI of cartilage in this setting and additional time-consuming T(10) evaluation may not be needed. PMID:19859935

  17. The use of ultrasound in acquisition of the anterior pelvic plane in computer-assisted total hip replacement: a cadaver study.

    PubMed

    Parratte, S; Kilian, P; Pauly, V; Champsaur, P; Argenson, J-N A

    2008-02-01

    We have evaluated in vitro the accuracy of percutaneous and ultrasound registration as measured in terms of errors in rotation and version relative to the bony anterior pelvic plane in computer-assisted total hip replacement, and analysed the intra- and inter-observer reliability of manual or ultrasound registration. Four clinicians were asked to perform registration of the landmarks of the anterior pelvic plane on two cadavers. Registration was performed under four different conditions of acquisition. Errors in rotation were not significant. Version errors were significant with percutaneous methods (16.2 degrees; p < 0.001 and 19.25 degrees with surgical draping; p < 0.001), but not with the ultrasound acquisition (6.2 degrees, p = 0.13). Intra-observer repeatability was achieved for all the methods. Inter-observer analysis showed acceptable agreement in the sagittal but not in the frontal plane. Ultrasound acquisition of the anterior pelvic plane was more reliable in vitro than the cutaneous digitisation currently used. PMID:18256101

  18. The Natural History of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Weber, Alexander E.; Levy, David M.; Wuerz, Thomas H.

    2015-01-01

    Femoroacetabular impingement (FAI) is a clinical syndrome resulting from abnormal hip joint morphology and is a common cause of hip pain in young adults. FAI has been posited as a precursor to hip osteoarthritis (OA); however, conflicting evidence exists and the true natural history of the disease is unclear. The purpose of this article is to review the current understanding of how FAI damages the hip joint by highlighting its pathomechanics and etiology. We then review the current evidence relating FAI to OA. Lastly, we will discuss the potential of hip preservation surgery to alter the natural history of FAI, reduce the risk of developing OA and the need for future arthroplasty. PMID:26636088

  19. The Hyperflexible Hip

    PubMed Central

    Weber, Alexander E.; Bedi, Asheesh; Tibor, Lisa M.; Zaltz, Ira; Larson, Christopher M.

    2015-01-01

    Context: Dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion. Athletes who participate in these sports use their hips in a mechanically complex manner. Evidence Acquisition: A search of the entire PubMed database (through December 2013) and additional searches of the reference lists of pertinent articles. Study Design: Systematic review. Level of Evidence: Level 3. Results: Whether innate or acquired, dancers and gymnasts have some hypermobility that allows their hips to be placed in potentially impinging or unstable positions required for their given activity. Such extremes of motion can result in both intra-articular and extra-articular impingement as well as compensatory osseous and muscular pathology. In addition, dancers and gymnasts are susceptible to impingement-induced instability. Dancers with innate generalized hyperlaxity are at increased risk of injury because of their activities and may require longer recovery times to return to play. Both nonoperative and operative treatments (arthroscopic and open) have an important role in returning flexibility athletes to their preoperative levels of sport and dance. Conclusion: Because of the extreme hip motion required and the compensatory soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both. This frequently occurs in the setting of subtle pathoanatomy or in patients with normal bony anatomy. With appropriate surgical indications and the correct operative technique, the treating surgeon can anticipate high levels of return to play for the gymnast and dancer with hip pain. PMID:26137181

  20. Arthroscopic hip labral repair.

    PubMed

    Philippon, Marc J; Faucet, Scott C; Briggs, Karen K

    2013-05-01

    Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature. PMID:23875153

  1. Kinematic radiography of the hip joint after hip resurfacing arthroplasty.

    PubMed

    Kawashima, Hiroki; Kajino, Yoshitomo; Kabata, Tamon; Tsuchiya, Hiroyuki; Sanada, Shigeru; Ichikawa, Katsuhiro

    2016-07-01

    This study aimed to evaluate the usefulness of dynamic radiography using a dynamic flat-panel detector (FPD) system after hip resurfacing arthroplasty (HRA). A total of 32 hips of 26 patients who underwent HRA were included. Sequential images of active abduction in the supine position and flexion in the 45° semilateral position were obtained using the FPD system. We examined the imaging findings of impingement between the acetabular component and femoral neck with cooperative motion at maximal exercise. Moreover, the central component coordinate of the acetabulum and femoral head sides was measured. For abduction motion, impingement was detected in two (6.3 %) hips between the superior portion of the femoral neck and acetabular component. For flexion motion, impingement was detected in 19 (59.4 %) hips. There were no findings of subluxation between the acetabular component and femoral neck after impingement, but cooperative motion of lumbar and pelvic flexion was observed. There was no significant difference in the center-to-center distance regardless of the presence or absence of impingement. Detailed postoperative kinematics of the hips after HRA showed that the proposed dynamic FPD system could reveal acquired impingement and cooperative motion as dynamic images and possibly reveal findings that would be unobservable using static images. PMID:27207072

  2. Postural correction reduces hip pain in adult with acetabular dysplasia: a case report

    PubMed Central

    Lewis, Cara L.; Khuu, Anne; Marinko, Lee

    2015-01-01

    Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient’s posture, the patient’s pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology. PMID:25731688

  3. The anterior supine intermuscular approach for total hip arthroplasty: reducing the complication rate by improving the procedure.

    PubMed

    den Hartog, Yvon M; Mathijssen, Nina M C; Peters, Sebastian J; Vehmeijer, Stephan B W

    2015-01-01

    This study describes specific complications noticed during the first unselected cases operated by anterior approach for THA in our hospital and specific adjustments that were applied on the procedure to prevent these complications. We retrospectively analysed the differences between 202 patients who were operated by a standardised approach and 248 patients who were operated after adjustments were implemented with the procedure. Injury to the lateral femoral cutaneous nerve (LFCN), fractures of the greater trochanter and dislocation were specific complications that were noticed with the initial technique.Prevalence of injury to the LFCN decreased from 7.9% to 0.8% (p<0.001), fractures of the greater trochanter decreased from 5.4% to 0.8% (p = 0.004) and the incidence of dislocation decreased from 4.5% to 1.6% (p = 0.074). PMID:25198300

  4. The athlete's hip and groin.

    PubMed

    Tammareddi, Kumar; Morelli, Vincent; Reyes, Miguel

    2013-06-01

    Groin and hip injuries are seen in athletes who perform quick directional changes and cutting movements. Because forces generated through athletic performance are transferred through the hip, injuries to these areas may limit athletes with mild pain or lead to career-ending injuries. The anatomy of the hip and groin is complex and symptoms often overlap. This article discusses some athletic causes, but other medical conditions may be associated with hip and groin pain as well. Updates in evaluation and treatment are discussed for adductor strains, hip osteoarthritis, femoroacetabular impingement, sports hernia, osteitis pubis, and obturator nerve entrapment. PMID:23668647

  5. Assessment of adult hip dysplasia and the outcome of surgical treatment.

    PubMed

    Troelsen, Anders

    2012-06-01

    Hip dysplasia and hip joint deformities in general are recognized as possible precursors of osteoarthritic development. Early and correct identification of hip dysplasia is important in order to offer timely joint preserving treatment. In the contemporary literature, several controversies exist, and some of these were the focus of this doctoral thesis. Categorized into subjects, the major findings and their possible importance are listed below. DIAGNOSTIC ASSESSMENT OF HIP DYSPLASIA: A multi-observer study quantified the variability of different methods for diagnostic assessment of hip dysplasia and osteoarthritis and resulted in general recommendations regarding diagnostic assessment of hip dysplasia. Pelvic tilt was shown to differ significantly between the supine and weight-bearing positions in patients with dysplastic hip joints. This is a finding that adds controversy to the application of neutral pelvic positioning during assessment of hip deformities because pelvic tilt affects the appearance of acetabular version. Weight-bearing assessment of acetabular version showed the presence of retroversion in 33% of dysplastic hips. The establishment of retroversion as a rather frequent entity in dysplastic hips is contradictory to the historical finding that hip dysplasia is characterized by insufficient anterior and lateral coverage. In general, the findings have important implications for orthopedic surgeons and radiologists dealing with diagnostic assessment of painful hips in young adults, and for surgeons planning and performing joint-preserving periacetabular osteotomies. ASSESSMENT OF ACETABULAR LABRAL TEARS IN HIP DYSPLASIA: The roles of ultrasound and clinical tests in acetabular labral tear diagnostics were established. After overcoming an initial learning curve, ultrasound investigation was highly reliable in diagnosing labral tears, whereas only a positive impingement or FABER test was reliable in identifying a labral tear. It seems that non-invasive and

  6. Magnetic resonance imaging of hip joint cartilage and labrum

    PubMed Central

    Zilkens, Christoph; Miese, Falk; Jäger, Marcus; Bittersohl, Bernd; Krauspe, Rüdiger

    2011-01-01

    Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage. PMID:22053256

  7. Hip Imaging in Athletes: Sports Imaging Series.

    PubMed

    Agten, Christoph A; Sutter, Reto; Buck, Florian M; Pfirrmann, Christian W A

    2016-08-01

    Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016. PMID:27429142

  8. Editorial Commentary: Ligamentum Teres Tears and Femoroacetabular Impingement: Complex Coexistence of Impingement and Instability.

    PubMed

    Larson, Christopher M

    2016-07-01

    In a large Level IV case series of 2,213 hip arthroscopies with the diagnosis of femoroacetabular impingement, the intraoperative status of the ligamentum teres (LT) was recorded as normal in 11%, frayed and/or partially torn in 88%, and completely torn in 1.5% of hips. Although specific physical examination maneuvers for detecting LT tears were not available early in the study period, thus limiting a detailed assessment of such tests, the authors identified that female gender, a lower lateral center edge angle, a higher Tonnis angle, and capsular laxity were all associated with complete LT tears. This study further supports the complex coexistence of impingement and instability. PMID:27373179

  9. Hip dysplasia in the skeletally mature patient.

    PubMed

    Goldstein, Rachel Y; Kaye, Ian David; Slover, James; Feldman, David

    2014-01-01

    Abnormal hip development causes one-quarter to one-half of all hip disease. Dysplastic hips typically share characteristic anatomic abnormalities. The dysplastic acetabulum is typically shallow, lateralized, and anteverted with insufficient coverage anteriorly, superiorly, and laterally. The dysplastic proximal femur has a small femoral head with excessive femoral neck anteversion and a short neck with an increased neck shaft angle. These characteristic changes result in intraarticular pathology leading to hip arthritis. A variety of treatment options exist based on the degree of dysplasia and the amount of concomitant hip arthritis. Treatment options include hip arthroscopy, acetabular or femoral osteotomies, hip arthrodesis, and total hip arthroplasty. PMID:25150325

  10. Psoas tunnel perforation-an unreported complication of hip arthroscopy.

    PubMed

    Degen, Ryan M; O'Sullivan, Eilish; Sink, Ernest L; Kelly, Bryan T

    2015-10-01

    The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion. PMID:27011849

  11. Psoas tunnel perforation—an unreported complication of hip arthroscopy

    PubMed Central

    Degen, Ryan M.; O’Sullivan, Eilish; Sink, Ernest L.; Kelly, Bryan T.

    2015-01-01

    The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion. PMID:27011849

  12. Anterior Approach Total Hip Replacement

    MedlinePlus Videos and Cool Tools

    ... this view, I mean this is the traditional Smith Meet Jeu De view of the acetabulum,. I ... re using only part of what’s called the “Smith-Peterson approach.” The true Smith- Peterson, you would ...

  13. Impingement syndrome (image)

    MedlinePlus

    ... arch of the shoulder blade, it can cause shoulder pain called impingement syndrome. The tendons become compressed, damaged, and inflamed leading to rotator cuff tendonitis. This can occur ... use of the shoulder like baseball pitching, or from an injury.

  14. Rose Hip

    MedlinePlus

    ... a chemical found in rose hip, might slow blood clotting. Taking rose hip might increase the risk of ... a chemical found in rose hip, might slow blood clotting. There is concern that rose hip might cause ...

  15. Hip pain

    MedlinePlus

    ... the bones or cartilage of your hip, including: Hip fractures – can cause sudden hip pain. These injuries can be serious and lead to major problems. Hip fractures are more common as people get older because ...

  16. Treatment of cam-type femoroacetabular impingement

    PubMed Central

    FIORENTINO, GENNARO; FONTANAROSA, ALBERTO; CEPPARULO, RICCARDO; GUARDOLI, ALBERTO; BERNI, LUCA; COVIELLO, GIANLUCA; GUARDOLI, ALDO

    2015-01-01

    Purpose the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frog-leg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5–82.5) to a mean of 85.6 postoperatively (range: 45.1–100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of cam-type impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence Level IV, therapeutic case series. PMID:26605253

  17. Femoroacetabular Impingement in Athletes, Part 1

    PubMed Central

    Byrd, J. W. Thomas

    2010-01-01

    Context: Femoroacetabular impingement (FAI) is a common cause of intra-articular hip pathology and secondary osteoarthritis. It affects athletes at a young age as they push their bodies beyond the diminished physiologic limits imposed by the altered joint morphology. Understanding the cause of this condition and its assessment in athletes is important. Evidence Acquisition: The scientific literature was reviewed to reflect the current understanding of hip joint pathology among athletic individuals. Focus is given to the literature since 2003, when FAI was first reported as a cause of joint damage in the native hip. Results: There are 3 types of FAI: pincer, cam, and combined. The pathomechanics and pattern of secondary intra-articular pathology are different among the types. History and examination usually reflect findings of joint damage among athletes, and radiographs can reveal the presence of underlying FAI. Other imaging studies may variably aid in detecting the pathology. Conclusions: FAI is a common cause of hip problems in athletes. Early recognition is an important first step in order to avoid the severe secondary damage that can occur. PMID:23015955

  18. Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.

  19. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

    PubMed Central

    Nevitt, Michael C; Niu, Jingbo; Clancy, Mary M; Lane, Nancy E; Link, Thomas M; Vlad, Steven; Tolstykh, Irina; Jungmann, Pia M.; Felson, David T; Guermazi, Ali

    2015-01-01

    Study question Is there concordance between hip pain and radiographic hip osteoarthritis? Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most days and the location of the pain: anterior, groin, lateral, buttocks, or low back. In the Framingham study, participants with hip pain were also examined for hip pain with internal rotation. The authors analysed the agreement between radiographic hip osteoarthritis and hip pain, and for those with hip pain suggestive of hip osteoarthritis they calculated the sensitivity, specificity, positive predictive value, and negative predictive value of radiographs as the diagnostic test. Study answer and limitations In the Framingham study (n=946), only 15.6% of hips in patients with frequent hip pain showed radiographic evidence of hip osteoarthritis, and 20.7% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of radiographic hip osteoarthritis for hip pain localised to the groin was 36.7%, specificity 90.5%, positive predictive value 6.0%, and negative predictive value 98.9%. Results did not differ much for hip pain at other locations or for painful internal rotation. In the Osteoarthritis Initiative study (n=4366), only 9.1% of hips in patients with frequent pain showed radiographic hip osteoarthritis, and 23.8% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of definite radiographic hip osteoarthritis for hip pain localised to the groin was 16.5%, specificity 94.0%, positive predictive value 7.1%, and negative predictive value 97.6%. Results also did not differ much for hip pain at other locations. What this

  20. Direct Flame Impingement

    SciTech Connect

    2005-09-01

    During the DFI process, high velocity flame jets impinge upon the material being heated, creating a high heat transfer rate. As a result, refractory walls and exhaust gases are cooler, which increases thermal efficiency and lowers NOx emissions. Because the jet nozzles are located a few inches from the load, furnace size can be reduced significantly.

  1. MR imaging of extrasynovial inflammation and impingement about the knee.

    PubMed

    Grando, Higor; Chang, Eric Y; Chen, Karen C; Chung, Christine B

    2014-11-01

    The knee has unique anatomy regarding the relationship between the synovial and capsular layers, with interposed fat pads at certain locations. The extrasynovial impingement and inflammation syndromes about the knee are underdiagnosed and should be included in the differential diagnosis of anterior knee pain. MR imaging is the best imaging modality for evaluation of the anatomy and disorders of these extrasynovial compartments. PMID:25442030

  2. Management of Hip Pain in Young Adults.

    PubMed

    Ward, Derek; Parvizi, Javad

    2016-07-01

    The diagnosis and treatment of hip pain in the young adult remains a challenge. Recently, understanding of a few specific hip conditions has improved; most notably femoroacetabular impingement. The differential diagnosis of hip pain has also expanded significantly, offering new challenges and opportunities. Along with the diagnostic dilemma, optimal treatment strategies for many conditions have yet to be proven and are current areas of important inquiry. This article reviews the current research on hip pain in the young adult and presents an overview of diagnostic and management strategies. PMID:27241373

  3. Techniques and Results for Open Hip Preservation

    PubMed Central

    Levy, David M.; Hellman, Michael D.; Haughom, Bryan; Stover, Michael D.; Nho, Shane J.

    2015-01-01

    While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg–Calve–Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy. PMID:26649292

  4. Capsular Plication for Treatment of Iatrogenic Hip Instability

    PubMed Central

    Levy, David M.; Grzybowski, Jeffrey; Salata, Michael J.; Mather, Richard C.; Aoki, Stephen K.; Nho, Shane J.

    2015-01-01

    The most commonly reported reasons for persistent hip pain after hip arthroscopy are residual femoroacetabular impingement, dysplasia and dysplasia variants, or extra-articular impingement. There are some cases in which the underlying osseous pathomorphology has been appropriately treated, and the cause of persistent hip pain can be soft-tissue injuries such as chondrolabral tears or capsular abnormalities. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the iliofemoral ligament and lead to iatrogenically induced hip instability. There are a growing number of biomechanical and clinical studies showing the importance of capsular management during hip arthroscopy. We describe the workup, examination under anesthesia, diagnostic arthroscopy, and technique of capsular plication for iatrogenic instability of the hip. PMID:26870636

  5. Hip Replacement

    MedlinePlus

    ... surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts. A hip replacement can Relieve pain Help your hip joint work better Improve walking and other movements The ...

  6. Subacromial impingement syndrome

    PubMed Central

    Umer, Masood; Qadir, Irfan; Azam, Mohsin

    2012-01-01

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality randomized controlled trials are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS. PMID:22802986

  7. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

  8. Comparison of Head Center Position and Screw Fixation Options Between a Jumbo Cup and an Offset Center of Rotation Cup in Revision Total Hip Arthroplasty: A Computer Simulation Study.

    PubMed

    Faizan, Ahmad; Black, Brandon J; Fay, Brian D; Heffernan, Christopher D; Ries, Michael D

    2016-01-01

    Jumbo acetabular cups are commonly used in revision total hip arthroplasty (THA). A straightforward reaming technique is used which is similar to primary THA. However, jumbo cups may also be associated with hip center elevation, limited screw fixation options, and anterior soft tissue impingement. A partially truncated hemispherical shell was designed with an offset center of rotation, thick superior rim, and beveled anterior and superior rims as an alternative to a conventional jumbo cup. A three dimensional computer simulation was used to assess head center position and safe screw trajectories. Results of this in vitro study indicate that a modified hemispherical implant geometry can reduce head center elevation while permitting favorable screw fixation trajectories into the pelvis in comparison to a conventional jumbo cup. PMID:26253481

  9. Femoroacetabular impingement mimicking avascular osteonecrosis on bone scintigraphy

    PubMed Central

    Suarez, Juan Pablo; Domínguez, María Luz; Nogareda, Zulema; Gómez, María Asunción; Muñoz, Jose

    2016-01-01

    Femoroacetabular impingement (FAI) is a structural abnormality of proximal femur and/or acetabulum. It has been recently described, and there are limited reports in nuclear medicine literature because bone scintigraphy is not listed in its diagnostic protocol, but it should be included on differential diagnosis when evaluating patients, with hip-related symptoms because it may be misinterpreted as degenerative changes or avascular necrosis, and its early treatment avoid progression to osteoarthritis. We describe the case of a male who suffered from hip pain. Bone planar scintigraphic appearance mimicked avascular necrosis, but single photon emission computed tomography (CT) imaging and CT examination confirmed the diagnosis of FAI. PMID:27095871

  10. [Arthroscopic treatment of femoroacetabular impingement. Technique and results].

    PubMed

    Dienst, M; Kohn, D

    2009-05-01

    Hip arthroscopy has become an effective and reliable operative technique for treating femoroacetabular impingement (FAI). This report presents the latest arthroscopic technique, including positioning, portal placement, and treatment of the femoral and acetabular deformity and secondary lesions at the chondrolabral rim complex. After a review of the literature, the results of arthroscopic versus open treatment of FAI are compared, and an algorithm is suggested for deciding between these two types of FAI treatment. PMID:19415235

  11. MRI for the preoperative evaluation of femoroacetabular impingement.

    PubMed

    Li, Angela E; Jawetz, Shari T; Greditzer, Harry G; Burge, Alissa J; Nawabi, Danyal H; Potter, Hollis G

    2016-04-01

    Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head-neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery. Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions. • Morphological abnormalities, labral lesions, and cartilage status should be assessed. • In cam impingement, chondral wear most commonly occurs anterosuperiorly.• Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery. • Injury to muscles and tendons or other pelvic structures can coexist with FAI. PMID:26715128

  12. Femoroacetabular impingement: A classic case of cam-type impingement in a 21-year-old soldier

    PubMed Central

    Royston, Eric; Bush, Lisabeth

    2015-01-01

    We describe a case of femoroacetabular impingement (FAI) in a 21-year-old male U.S. Army Private. Pre-operative radiographs demonstrated a dysplastic bump at the right head-neck junction. The patient underwent arthroscopy and resection of the bump, resulting in a improved contour of the femoral head-neck junction. After standard recovery, he is now able to ambulate and flex his right hip without pain and has returned to full duty. PMID:27186247

  13. [Hip arthroscopy].

    PubMed

    Gollwitzer, H; Banke, I J; Schauwecker, J

    2016-02-01

    Hip arthroscopy represents an important component in the treatment of diseases of the hip joint and is nowadays an indispensible tool in modern hip-preserving surgery. This article provides a review of the basic technical principles, typical indications and complications of hip arthroscopy. Furthermore, current developments as well as possibilities and limitations of the arthroscopic technique are reviewed. PMID:26781702

  14. Rose Hip

    MedlinePlus

    ... de l’Églantier, Gulab, Heps, Hip, Hip Fruit, Hip Sweet, Hipberry, Hop Fruit, Persian Rose, Phool Gulab, Pink Rose, Poire d’oiseaux, Rosa alba, Rosa centifolia, Rosa damascena, Rosa de castillo, Rosa ... Rose Hips, Rosa lutetiana, Rosa pomifera, Rosa rugosa, Rosa villosa, ...

  15. T1 assessment of hip joint cartilage following intra-articular gadolinium injection: a pilot study.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Kim, Young-Jo; Werlen, Stefan; Trattnig, Siegfried; Siebenrock, Klaus A; Mamisch, Tallal C

    2010-10-01

    This pilot study defines the feasibility of cartilage assessment in symptomatic femoroacetabular impingement patients using intra-articular delayed gadolinium-enhanced MRI of cartilage (ia-dGEMRIC). Nine patients were scanned preliminary to study the contrast infiltration process into hip joint cartilage. Twenty-seven patients with symptomatic femoroacetabular impingement were subsequently scanned with intra-articular delayed gadolinium-enhanced MRI of cartilage. These T(1) findings were correlated to morphological findings. Zonal variations were studied. This pilot study demonstrates a significant difference between the pre- and postcontrast T(1) values (P < 0.001) remaining constant for 45 min. We noted higher mean T(1) values in morphologically normal-appearing cartilage than in damaged cartilage, which was statistically significant for all zones except the anterior-superior zone. Intraobserver (0.972) and interobserver correlation coefficients (0.933) were statistically significant. This study outlines the feasibility of intra-articular delayed gadolinium-enhanced MRI of cartilage for assessment of cartilage changes in patients with femoroacetabular impingement. It can also define the topographic extent and differing severities of cartilage damage. PMID:20872764

  16. Liquid film target impingement scrubber

    DOEpatents

    McDowell, William J.; Coleman, Charles F.

    1977-03-15

    An improved liquid film impingement scrubber is provided wherein particulates suspended in a gas are removed by jetting the particle-containing gas onto a relatively small thin liquid layer impingement target surface. The impingement target is in the form of a porous material which allows a suitable contacting liquid from a pressurized chamber to exude therethrough to form a thin liquid film target surface. The gas-supported particles collected by impingement of the gas on the target are continuously removed and flushed from the system by the liquid flow through each of a number of pores in the target.

  17. Current concepts in the treatment of adolescent femoroacetabular impingement.

    PubMed

    Ramachandran, Manoj; Azegami, Shin; Hosalkar, Harish S

    2013-03-01

    There is growing evidence that symptomatic femoroacetabular impingement leads to intra-articular damage and the development of early-onset osteoarthritis. Symptoms of femoroacetabular impingement often do not manifest until adulthood, but have been increasingly recognised in the paediatric and adolescent population. The surgical treatment of femoroacetabular impingement is aimed at restoring a more normal femoral head-neck offset in order to increase the clearance and prevent femoral abutment against the acetabular edge. Current methods include open and arthroscopic techniques. The latter has been combined with an open approach to gain access to the head-neck junction for osteochondroplasty. Proximal femoral and/or periacetabular osteotomies are used to treat femoroacetabular impingement associated with deformity secondary to childhood hip conditions, such as slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Some adolescents have severe degenerative joint disease at the time of presentation and may require arthroplasty or arthrodesis. The aim of this review is to identify the major trends and advancements in the management of femoroacetabular impingement in adolescents, including the outcome of studies of the surgical treatment modalities used. PMID:24432063

  18. Hip Morphology Characterization

    PubMed Central

    Barrientos, Cristián; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Barahona, Maximiliano; Salazar, Alfonso; Hinzpeter, Jaime

    2014-01-01

    Background: Femoroacetabular impingement (FAI) is the result of a mechanical conflict in the hip joint, and its diagnosis is based on clinical and radiological parameters. To our knowledge, there are no published studies describing the radiologic characteristics of FAI in Latin American populations. Purpose: To describe the radiological features associated with FAI in an asymptomatic Chilean population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We prospectively recruited asymptomatic patients with no history or symptoms of hip pathology who underwent abdomen-pelvis computed tomography (CT) for a nonorthopaedic indication. The acetabular and femoral parameters related to FAI were measured. Results: We studied 101 subjects (202 hips) with a mean age of 36.8 ± 14.4 years. The mean center-edge angle was 39.4° ± 7.2°. The crossover sign was present in 34 cases (33.7%). The mean alpha angle was 49.7° ± 8.3°. Depending on the cut points chosen for FAI-related parameters, between 39.6% and 69.3% of an asymptomatic Chilean population were found to have morphological features related to FAI. Conclusion: Our findings suggest that the proposed pathological threshold values in the literature cannot be extrapolated to a Chilean population, and this must be taken into consideration when evaluating Latin American patients with hip pain. PMID:26535273

  19. [Femoroacetabular impingement as a cause of inguinal pain].

    PubMed

    Mardones R, Rodrigo; Barrientos C, Víctor; Nemtala U, Fernando; Tomic, Alexander; Salineros U, Matías

    2010-01-01

    Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15% and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90 degrees . Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical. PMID:20361159

  20. Femoroacetabular impingement syndrome: a narrative review for the chiropractor

    PubMed Central

    Emary, Peter

    2010-01-01

    Objective: To familiarize the chiropractic clinician with the clinical presentation, radiographic features, and conservative versus surgical treatment options for managing femoroacetabular impingement (FAI) syndrome. Background: FAI syndrome is a relatively new clinical entity to be described in orthopedics, and has been strongly linked with pain and early osteoarthritis of the hip in young adults. Hip joint radiographs in these patients often appear normal at first—particularly if the clinician is unfamiliar with FAI. The role of conservative therapy in managing this disorder is questionable. Surgical treatment ultimately addresses any acetabular labral or articular cartilage damage, as well as the underlying osseous abnormalities associated with FAI. The most commonly used approach is open surgical hip dislocation; however, more recent surgical procedures also involve arthroscopy. Conclusion: In FAI syndrome—a condition unknown to many clinicians (including medical)—chiropractors can play an important role in its diagnosis and referral for appropriate management. PMID:20808616

  1. Review on squeaking hips.

    PubMed

    Levy, Yadin David; Munir, Selin; Donohoo, Shane; Walter, William Lindsay

    2015-11-18

    Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4(th) generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking. PMID:26601063

  2. Review on squeaking hips

    PubMed Central

    Levy, Yadin David; Munir, Selin; Donohoo, Shane; Walter, William Lindsay

    2015-01-01

    Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4th generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking. PMID:26601063

  3. Contemporary impingements on mothering.

    PubMed

    Tummala-Narra, Pratyusha

    2009-03-01

    Mothering in contemporary Western society needs to be understood in the context of a rapidly changing social context. Increased geographic mobility, improved access to child-related information through the media, and scientific and technological progress have contributed to significant shifts in cultural views on mothering. Several contextual impingements on mothering, including changing family structure, economic pressures, decreased social support, cultural ideals of the perfect mother, and increased awareness of interpersonal and global trauma impact mothers' internal worlds. These societal changes often reinforce mothers' fear of losing their children and an idealization of intensive mothering, and evoke challenges in reorganizing their sense of personal identity. Implications for psychoanalytic theory and practice, and specifically the need to integrate individual and contextual forces related to experiences of mothers will be explored. PMID:19295618

  4. The combined use of simulation and navigation to demonstrate hip kinematics.

    PubMed

    Thornberry, Robert L; Hogan, Andrew J

    2009-02-01

    Computer navigation of total hip arthroplasty and computer simulation of hip motions based on collision detection were both introduced more than ten years ago. Neither of these promising technologies has achieved its full potential to improve patient outcomes. Combining these two technologies allows the individual strengths of each to more easily demonstrate hip kinematics in a clinically useful way. All normal and pathologic combined hip motions must be clearly and accurately reported to fully evaluate the kinematics involved in total hip arthroplasty, femoroacetabular impingement syndrome, and other hip disorders. The use of three-dimensional data graphs allows for a rapid and thorough evaluation of the very large data sets that are required for the purpose of making a complete report of all combined hip motions. Data can be obtained from simulations made with use of high-resolution computed tomographic scans and computer-aided implant-design files or from clinically obtained motion analysis on fresh cadavers or normal subjects. The use of these methods and graphics allows for the thorough evaluation of the geometries of current implant designs and will help improve future implant designs. The pathologic structures in hips with femoroacetabular impingement can be modeled in three dimensions, and surgical treatment plans can be developed to provide impingement-free normal hip motion without excessive osseous resection. The combination of these technologies provides hope for the improved surgical placement of total hip implants by providing the basis for a kinematic, impingement-based total hip navigation system. PMID:19182043

  5. Endoscopic pubic symphysectomy for reclacitrant osteitis pubis associated with bilateral femoroacetabular impingement.

    PubMed

    Matsuda, Dean K

    2010-03-01

    This is the first reported case of the completely endoscopic management of osteitis pubis with pubic symphysectomy. A 31-year-old woman suffered from recalcitrant osteitis pubis that had progressed to an end-stage auto-fused condition. Ossified pubic symphyseal fibrocartilage and adjacent heterotopic bone were endoscopically removed as part of a comprehensive surgery that also involved bilateral arthroscopic surgery for symptomatic femoroacetabular impingement. An innovative dual-portal (anterior and supra-pubic) endoscopic technique is presented along with the rationale for the preservation of the inferior (arcuate) pubic ligament and the posterior pubic ligament. Twelve months following this single-stage surgery, the patient reported high satisfaction with decreased pain, improved function, and resolution of a classic waddling gait. The association of intra-articular hip pathology with osteitis pubis is noted. We believe that this minimally invasive bone-conserving surgery may be useful in the management of recalcitrant osteitis pubis and perhaps find broader application in the outpatient endoscopic treatment of athletes afflicted with this condition. PMID:20349875

  6. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

    PubMed Central

    Rafols, Claudio; Monckeberg, Juan Edo; Numair, Jorge

    2015-01-01

    This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI), which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson. PMID:25722907

  7. Hip Problems

    MedlinePlus

    ... HIPS. See your doctor. Use ice and an anti-inflammatory medicine to relieve the pain. *3. Do you ... hip pain may be from ARTHRITIS. Try an anti-inflammatory medicine. If you don't feel better, see ...

  8. Hip Replacement

    MedlinePlus

    ... replacement is an operation in which a damaged hip joint is removed and replaced with an artificial joint. ... are many medical conditions that can damage the hip joint. (Watch the video to learn about what goes ...

  9. Correlation of Structural Bony Abnormalities and Mechanical Symptoms of Hip Joints

    PubMed Central

    Lyu, Sung-Hwa; Kwak, Yoon-Ho; Lee, Young-Kyun; Koo, Kyung-Hoi

    2014-01-01

    Purpose The purpose of this study is to determine structural bony abnormalities predisposing for femoroacetabular impingement by comparison of patients with and without mechanical symptoms. Materials and Methods We conducted this comparative study on 151 patients (151 hips; mean age 44.8 years; range 16-73 years) with mechanical symptoms with results of multi-detector computed tomography (MDCT) arthrography (the symptomatic group). Each patient was matched with a control who underwent MDCT due to ureter stone (the asymptomatic group) in terms of age, gender, site (right or left), and time at diagnosis. Acetabular evaluations, which included cranial and central anteversion and anterior and lateral center edge angles and femoral measurements, were performed. In addition, we evaluated the prevalence and characteristics of structural bone abnormalities between the two groups. Results The prevalence for patients who had at least one structural bony abnormality in the symptomatic and asymptomatic groups was 80.1% (121/151) and 54.3% (82/151), respectively (odds ratio: 3.39, 95% confidence interval: 2.30-5.66; P<0.001). The most common osseous abnormality was the isolated Pincer type in both groups: 89 (73.6%) of 121 hips with an osseous abnormality in the symptomatic group and 57 (69.5%) of 82 hips with an osseous abnormality in the asymptomatic group. By analysis of CT arthrography in symptomatic patients, a labral tear was found in 107 hips (70.9%), and 86 (80%) of these hips had a structural bony abnormality. Conclusion A significantly greater prevalence rate of structural bony abnormality was observed for the symptomatic group than for the asymptomatic group. These findings are helpful for development of appropriate treatment plans.

  10. COMPARISON OF RANGE OF MOTION, STRENGTH, AND HOP TEST PERFORMANCE OF DANCERS WITH AND WITHOUT A CLINICAL DIAGNOSIS OF FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Carcia, Christopher R.; Christoforetti, John J.; Martin, RobRoy L.

    2016-01-01

    ABSTRACT Background Dancers commonly experience anterior hip pain caused by femoroacetabular impingement (FAI) that interrupts training and performance in dance. A paucity of literature exists to guide appropriate evaluation and management of FAI among dancers. Purpose The purpose of this study was to determine if dancers with clinical signs of FAI have differences in hip range of motion, strength, and hop test performance compared to healthy dancers. Study Design Quasi-experimental, cohort comparison. Methods Fifteen dancers aged between 18- 21 years with clinical signs of FAI that included anterior hip pain and provocative impingement tests were compared to 13 age-matched dancers for passive hip joint range of motion, isometric hip strength, and performance of the medial triple hop, lateral triple hop, and cross-over hop tests. Results No statistically significant differences in range of motion were noted for flexion (Healthy = 145° + 7°; FAI = 147° + 10°; p=0.59), internal rotation (Healthy = 63° + 7°; FAI = 61° + 11°; p=0.50), and external rotation (Healthy = 37° + 9°; FAI = 34° + 12°; p=0.68) between the two groups. Hip extension strength was significantly less in the dancers with FAI (224 + 55 Newtons) compared to the healthy group (293 ± 58 Newtons; F(1,26) = 10.2; p=0.004). No statistically significant differences were noted for flexion, internal rotation, external rotation, abduction, or adduction isometric strength. The medial triple hop test was significantly less in the FAI group (354 ± 43 cm) compared to the healthy group (410 ± 50 cm; F(1,26) = 10.3; p = 0.004). Similar results were observed for the lateral hop test, as the FAI group (294 ± 38 cm) performed worse than the healthy controls (344 ± 54cm; F(1,26) = 7.8; p = 0.01). There was no statistically significant difference between the FAI group (2.7 ± 0.92 seconds) and the healthy

  11. Descriptive Epidemiology of Symptomatic Femoroacetabular Impingement in Young Athlete: Single Center Study

    PubMed Central

    Lee, Woo-Yong; Kang, Chan; Jeon, Je-Hyung; Zheng, Long

    2016-01-01

    Purpose The purpose of this study was to determine the prevalence of symptomatic femoroacetabular impingement (FAI) in athletic patients. Materials and Methods From July 2003 to May 2013, 388 patients (422 hips) who underwent arthroscopic surgery for FAI were evaluated demographic characteristics. The patients' age, gender, diagnosis, and type of sports were analyzed using medical records and radiography. Results Among 422 hips in 388 patients, 156 hips were involved with sports. Among the 156 hips, 86, 43, and 27 hips were categorized as cam, pincer, and mixed type, respectively. Types of sports were soccer, baseball and taekwondo which showed 44, 36 and 35 hips, respectively. Also, cases related to sports according to age were 63 hips for twenties and 12 hips for teenagers in which the two showed highest association to FAI. The kinds of sports that showed high association were 28 hips of soccer and 20 cases of martial arts such as taekwondo and judo for twenties and 9 hips of martial arts for teenagers which was the highest. Conclusion FAI usually occurs in young adults and is highly related to sports activity. Most of the FAI type related to sports activity was cam type, and soccer and martial arts such as taekwondo were the most common cause of it. PMID:27536641

  12. Histology of damaged acetabular cartilage in symptomatic femoroacetabular impingement: an observational analysis.

    PubMed

    Kohl, Sandro; Hosalkar, Harish S; Mainil-Varlet, P; Krueger, Andreas; Buechler, Lorenz; Siebenrock, Klaus

    2011-01-01

    This prospective study on symptomatic adult patients with femoroacetabular impingement (FAI) who underwent open surgical intervention for management was designed to identify any obvious histological differences in the damaged acetabular cartilage within different subgroups of FAI. 20 patients underwent surgical intervention following safe surgical dislocation of the hip. There were 6 cases of cam impingement, 5 cases of pincer impingement and 9 of the mixed type. Pincer impingement cases demonstrated a characteristic focal, well-circumscribed and localized area of severe damage. On the other hand, cases with cam impingement showed a diffuse area of involvement affecting a larger surface of the acetabular cartilage, with degenerative changes, superficial erosions and some discontinuities. A small biopsy specimen of the acetabular rim including bone, cartilage and labrum from the affected zone was obtained in all cases. Histological evaluation was performed under normal and polarized light microscopy. Histological findings helped corroborate the pre-operative diagnosis and also define the unique nature of impingement and specific damage according to the type of impingement. PMID:21484743

  13. The pathoanatomy and arthroscopic management of femoroacetabular impingement

    PubMed Central

    Tibor, L. M.; Leunig, M.

    2012-01-01

    Femoroacetabular impingement (FAI) causes pain and chondrolabral damage via mechanical overload during movement of the hip. It is caused by many different types of pathoanatomy, including the cam ‘bump’, decreased head–neck offset, acetabular retroversion, global acetabular overcoverage, prominent anterior–inferior iliac spine, slipped capital femoral epiphysis, and the sequelae of childhood Perthes’ disease. Both evolutionary and developmental factors may cause FAI. Prevalence studies show that anatomic variations that cause FAI are common in the asymptomatic population. Young athletes may be predisposed to FAI because of the stress on the physis during development. Other factors, including the soft tissues, may also influence symptoms and chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated arthroscopically. Although the results are favourable, morphologies can be complex, patient expectations are high and the surgery is challenging. The long-term outcomes of hip arthroscopy are still forthcoming and it is unknown if treatment of FAI will prevent arthrosis. PMID:23610655

  14. BLEEDING OF FEMORAL HEAD DURING TOTAL HIP ARTHROPLASTY FOR OSTEOARTHROSIS

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Sotomayor, Marco Yánez; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Objective: To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty. Methods: One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB). Results: We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05). Conclusions: The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study. PMID:26981036

  15. Effect of Posture on Hip Angles and Moments during Gait

    PubMed Central

    Lewis, Cara L.; Sahrmann, Shirley A.

    2014-01-01

    Anterior hip pain is common in young, active adults. Clinically, we have noted that patients with anterior hip pain often walk in a swayback posture, and that their pain is reduced when the posture is corrected. The purpose of this study was to investigate a potential mechanism for the reduction in pain by testing the effect of posture on movement patterns and internal moments during gait in healthy subjects. Fifteen subjects were instructed to walk while maintaining three postures: 1) natural, 2) swayback, and 3) forward flexed. Kinematic and force data were collected using a motion capture system and a force plate. Walking in the swayback posture resulted in a higher peak hip extension angle, hip flexor moment and hip flexion angular impulse compared to natural posture. In contrast, walking in a forward flexed posture resulted in a decreased hip extension angle and decreased hip flexion angular impulse. Based on these results, walking in a swayback posture may result in increased forces required of the anterior hip structures, potentially contributing to anterior hip pain. This study provides a potential biomechanical mechanism for clinical observations that posture correction in patients with hip pain is beneficial. PMID:25262565

  16. Low altitude plume impingement handbook

    NASA Technical Reports Server (NTRS)

    Smith, Sheldon D.

    1991-01-01

    Plume Impingement modeling is required whenever an object immersed in a rocket exhaust plume must survive or remain undamaged within specified limits, due to thermal and pressure environments induced by the plume. At high altitudes inviscid plume models, Monte Carlo techniques along with the Plume Impingement Program can be used to predict reasonably accurate environments since there are usually no strong flowfield/body interactions or atmospheric effects. However, at low altitudes there is plume-atmospheric mixing and potential large flowfield perturbations due to plume-structure interaction. If the impinged surface is large relative to the flowfield and the flowfield is supersonic, the shock near the surface can stand off the surface several exit radii. This results in an effective total pressure that is higher than that which exists in the free plume at the surface. Additionally, in two phase plumes, there can be strong particle-gas interaction in the flowfield immediately ahead of the surface. To date there have been three levels of sophistication that have been used for low altitude plume induced environment predictions. Level 1 calculations rely on empirical characterizations of the flowfield and relatively simple impingement modeling. An example of this technique is described by Piesik. A Level 2 approach consists of characterizing the viscous plume using the SPF/2 code or RAMP2/LAMP and using the Plume Impingement Program to predict the environments. A Level 3 analysis would consist of using a Navier-Stokes code such as the FDNS code to model the flowfield and structure during a single calculation. To date, Level 1 and Level 2 type analyses have been primarily used to perform environment calculations. The recent advances in CFD modeling and computer resources allow Level 2 type analysis to be used for final design studies. Following some background on low altitude impingement, Level 1, 2, and 3 type analysis will be described.

  17. Biomechanics of the Hip Capsule and Capsule Management Strategies in Hip Arthroscopy.

    PubMed

    Nepple, Jeffrey J; Smith, Matthew V

    2015-12-01

    Recent advances in our understanding of the function of the hip capsule have clarified its importance to normal hip function and kinematics. The iliofemoral ligament is the primary stabilizing structure for controlling anterior translation and external rotation of the hip, and is violated by the arthroscopic interportal capsulotomy. Microinstability of the hip occurring after surgical trauma remains a poorly defined clinical entity. In certain at-risk populations, capsular repair should be considered as part of an arthroscopic hip procedure to achieve optimal outcomes and avoid iatrogenic instability (dislocation or microinstability). Despite a lack of conclusive evidence-based indications, we recommend capsular repair in the settings of borderline hip dysplasia (or dysplastic variants such as increased femoral anteversion), hip hypermobility, connective tissue disorders, and traumatic or atraumatic instability. With careful attention to arthroscopic capsular management, adequate exposure can be achieved and reproducibly allow for an effective capsular repair when indicated. PMID:26524549

  18. Hip Squeaking after Ceramic-on-ceramic Total Hip Arthroplasty

    PubMed Central

    Wu, Guo-Liang; Zhu, Wei; Zhao, Yan; Ma, Qi; Weng, Xi-Sheng

    2016-01-01

    Objective: The present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise. Data Sources: The data analyzed in this review were based on articles from PubMed and Web of Science. Study Selection: The articles selected for review were original articles and reviews found based on the following search terms: “total hip arthroplasty”, “ceramic-on-ceramic”, “hip squeaking”, and “hip noise.” Results: The mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors. Conclusions: Most studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified. PMID:27453238

  19. Hip arthroscopy

    MedlinePlus

    Johnson D, Weiss WM. Basic arthroscopic principles. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ... 11. Sanchez VMI, Meza AO. Hip arthroscopy. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ...

  20. Hip ultrasound.

    PubMed

    Martinoli, Carlo; Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa; Valle, Maura; Tagliafico, Alberto

    2012-12-01

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up. PMID:21571471

  1. Hip flexor strain - aftercare

    MedlinePlus

    Pulled hip flexor - aftercare; Hip flexor injury - aftercare; Hip flexor tear - aftercare; Iliopsoas strain - aftercare; Strained iliopsoas muscle - aftercare; Torn iliopsoas muscle - aftercare; Psoas strain - aftercare

  2. Rotational effects on impingement cooling

    NASA Astrophysics Data System (ADS)

    Epstein, A. H.; Kerrebrock, J. L.; Koo, J. J.; Preiser, U. Z.

    The present consideration of rotation effects on heat transfer in a radially exhausted, impingement-cooled turbine blade model gives attention to experimental results for Reynolds and Rossby numbers and blade/coolant temperature ratio values that are representative of small gas turbine engines. On the basis of a model that encompasses the effects of Coriolis force and buoyancy on heat transfer, bouyancy is identified as the cause of an average Nusselt number that is 20-30 percent lower than expected from previous nonrotating data. A heuristic model is proposed which predicts that the impingement jets nearest the blade roots should deflect inward, due to a centripetal force generated by their tangential velocity counter to the blade motion. Potentially serious thermal stresses must be anticipated from rotation effects in the course of blade design.

  3. Electrical Aspects of Impinging Flames

    NASA Astrophysics Data System (ADS)

    Chien, Yu-Chien

    This dissertation examines the use of electric fields as one mechanism for controlling combustion as flames are partially extinguished when impinging on nearby surfaces. Electrical aspects of flames, specifically, the production of chemi-ions in hydrocarbon flames and the use of convective flows driven by these ions, have been investigated in a wide range of applications in prior work but despite this fairly comprehensive effort to study electrical aspects of combustion, relatively little research has focused on electrical phenomena near flame extinguishment, nor for flames near impingement surfaces. Electrical impinging flames have complex properties under global influences of ion-driven winds and flow field disturbances from the impingement surface. Challenges of measurements when an electric field is applied in the system have limited an understanding of changes to the flame behavior and species concentrations caused by the field. This research initially characterizes the ability of high voltage power supplies to respond on sufficiently short time scales to permit real time electrical flame actuation. The study then characterizes the influence of an electric field on the impinging flame shape, ion current and flow field of the thermal plume associated with the flame. The more significant further examinations can be separated into two parts: 1) the potential for using electric fields to control the release of carbon monoxide (CO) from surface-impinging flames, and 2) an investigation of controlling electrically the heat transfer to a plate on which the flame impinges. Carbon monoxide (CO) results from the incomplete oxidation of hydrocarbon fuels and, while CO can be desirable in some syngas processes, it is usually a dangerous emission from forest fires, gas heaters, gas stoves, or furnaces where insufficient oxygen in the core reaction does not fully oxidize the fuel to carbon dioxide and water. Determining how carbon monoxide is released and how heat transfer

  4. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter

    PubMed Central

    Wilson, Mark D.; Keene, James S.

    2016-01-01

    Ischiofemoral impingement (IFI) is an often unrecognized cause of hip pain caused by abnormal contact between the lesser trochanter and the ischium. To date, surgical treatment for those whose pain is not relieved by activity modification and steroid injections has not been defined. This study describes our imaging protocol and reports the results of arthroscopic, lesser trochanteric resections that were performed to treat this condition. Seven patients with symptomatic, MRI-documented IFI had ultrasound injections of ropivicaine and steroid into their ischiofemoral space. The injections provided complete but only transient relief of their groin and buttock pain and thus, all seven ultimately had an arthroscopic resection of their lesser trochanter. All hips were evaluated preoperatively and at 3, 6 and 12 months postoperatively with Byrd’s modified Harris hip scoring system. Average age of the seven patients was 46 years and there were five females and one male. Preoperative scores averaged 43 points. After surgery, all patients used crutches for 4–6 weeks, and had 6-week scores that averaged 58 points. The patients and their scores continued to improve and at 6 and 12 months, their scores averaged 86 and 91 points, and none had chronic hip flexor weakness or recurrence of their hip pain or snapping. Arthroscopic iliopsoas tenotomies in combination with a resection of the lesser trochanter will provide complete relief of the painful snapping, groin and buttock pain caused by ischiofemoral impingement. PMID:27583151

  5. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter.

    PubMed

    Wilson, Mark D; Keene, James S

    2016-07-01

    Ischiofemoral impingement (IFI) is an often unrecognized cause of hip pain caused by abnormal contact between the lesser trochanter and the ischium. To date, surgical treatment for those whose pain is not relieved by activity modification and steroid injections has not been defined. This study describes our imaging protocol and reports the results of arthroscopic, lesser trochanteric resections that were performed to treat this condition. Seven patients with symptomatic, MRI-documented IFI had ultrasound injections of ropivicaine and steroid into their ischiofemoral space. The injections provided complete but only transient relief of their groin and buttock pain and thus, all seven ultimately had an arthroscopic resection of their lesser trochanter. All hips were evaluated preoperatively and at 3, 6 and 12 months postoperatively with Byrd's modified Harris hip scoring system. Average age of the seven patients was 46 years and there were five females and one male. Preoperative scores averaged 43 points. After surgery, all patients used crutches for 4-6 weeks, and had 6-week scores that averaged 58 points. The patients and their scores continued to improve and at 6 and 12 months, their scores averaged 86 and 91 points, and none had chronic hip flexor weakness or recurrence of their hip pain or snapping. Arthroscopic iliopsoas tenotomies in combination with a resection of the lesser trochanter will provide complete relief of the painful snapping, groin and buttock pain caused by ischiofemoral impingement. PMID:27583151

  6. Statistical Shape Modeling of Cam Femoroacetabular Impingement

    SciTech Connect

    Harris, Michael D.; Dater, Manasi; Whitaker, Ross; Jurrus, Elizabeth R.; Peters, Christopher L.; Anderson, Andrew E.

    2013-10-01

    In this study, statistical shape modeling (SSM) was used to quantify three-dimensional (3D) variation and morphologic differences between femurs with and without cam femoroacetabular impingement (FAI). 3D surfaces were generated from CT scans of femurs from 41 controls and 30 cam FAI patients. SSM correspondence particles were optimally positioned on each surface using a gradient descent energy function. Mean shapes for control and patient groups were defined from the resulting particle configurations. Morphological differences between group mean shapes and between the control mean and individual patients were calculated. Principal component analysis was used to describe anatomical variation present in both groups. The first 6 modes (or principal components) captured statistically significant shape variations, which comprised 84% of cumulative variation among the femurs. Shape variation was greatest in femoral offset, greater trochanter height, and the head-neck junction. The mean cam femur shape protruded above the control mean by a maximum of 3.3 mm with sustained protrusions of 2.5-3.0 mm along the anterolateral head-neck junction and distally along the anterior neck, corresponding well with reported cam lesion locations and soft-tissue damage. This study provides initial evidence that SSM can describe variations in femoral morphology in both controls and cam FAI patients and may be useful for developing new measurements of pathological anatomy. SSM may also be applied to characterize cam FAI severity and provide templates to guide patient-specific surgical resection of bone.

  7. Unrecognized osteoid osteoma of the proximal femur with associated cam impingement

    PubMed Central

    Ly, Justin A.; Coleman, Erin M.; Cohen, Gary S.; Kropf, Eric J.

    2016-01-01

    Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain. We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation.

  8. Unrecognized osteoid osteoma of the proximal femur with associated cam impingement.

    PubMed

    Ly, Justin A; Coleman, Erin M; Cohen, Gary S; Kropf, Eric J

    2016-08-01

    Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain. We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation. PMID:27583164

  9. Hip Implant Systems

    MedlinePlus

    ... hip replacement surgery, the damaged portions of the hip joint are removed. The ball (femoral head) is removed ... hip or leg Swelling at or near the hip joint A limp or change in walking ability Noise ( ...

  10. Perthes’ disease and femoroacetabular impingement in a child with proximal femoral focal deficiency

    PubMed Central

    Pun, Terence; Stokes, Oliver M; Chow, Wang; To, Michael

    2012-01-01

    A girl with known proximal femoral focal deficiency presented with Perthes’ disease at 5 years of age. Her treatment involved a Salter osteotomy. This in conjunction with articular incongruence, due to deformity of the femoral head, resulted in mixed type femoroacetabular impingement when she was 10 years old. Surgical hip dislocation and femoral neck osteochondroplasty successfully relieved her symptoms of impingement. This is the first reported case of Perthes’ disease in a patient with proximal femoral focal deficiency. The case highlights the importance of thoroughly investigating pain in patients with proximal femoral focal deficiency, a condition which is normally painless. Timely diagnosis of Perthes’ disease and containment procedures can prevent collapse of the femoral head and the resultant sequelae. Acetabular over-coverage should be avoided in pelvic osteotomy to prevent the development of femoroacetabular impingement. PMID:23148394

  11. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings

    PubMed Central

    Hayat, Zara; Konan, Sujith; Pollock, Rob

    2014-01-01

    Significantly reduced distance between the ischium and the femur can result in symptomatic hip pain as a result of impingement. We present the case of a 16-year-old boy who presented with groin pain which had been affecting him for a year and a half following an innocuous football injury. Plain radiograph revealed a chronic apophyseal avulsion fracture of the ischium with excessive callus formation. CT scan and MRI revealed that the bony protuberance was responsible for symptomatic ischiofemoral impingement. In this case, he was successfully treated with non-operative management involving slow re-introduction to exercise. An unusual example of acquired ischiofemoral impingement, unrelated to surgery or significant trauma, this case highlights the need to consider such a diagnosis in otherwise unexplained groin pain. PMID:24966262

  12. Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement.

    PubMed

    Phadke, Vandana; Ludewig, Paula M

    2013-04-01

    Changes in muscle activities are commonly associated with shoulder impingement and theoretically caused by changes in motor program strategies. The purpose of this study was to assess for differences in latencies and deactivation times of scapular muscles between subjects with and without shoulder impingement. Twenty-five healthy subjects and 24 subjects with impingement symptoms were recruited. Glenohumeral kinematic data and myoelectric activities using surface electrodes from upper trapezius (UT), lower trapezius (LT), serratus anterior (SA) and anterior fibers of deltoid were collected as subjects raised and lowered their arm in response to a visual cue. Data were collected during unloaded, loaded and after repetitive arm raising motion conditions. The variables were analyzed using 2 or 3 way mixed model ANOVAs. Subjects with impingement demonstrated significantly earlier contraction of UT while raising in the unloaded condition and an earlier deactivation of SA across all conditions during lowering of the arm. All subjects exhibited an earlier activation and delayed deactivation of LT and SA in conditions with a weight held in hand. The subjects with impingement showed some significant differences to indicate possible differences in motor control strategies. Rehabilitation measures should consider appropriate training measures to improve movement patterns and muscle control. PMID:23137918

  13. Neurovascular Injury in Hip Arthroplasty

    PubMed Central

    2014-01-01

    Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.

  14. Cup positioning in total hip arthroplasty.

    PubMed

    Scheerlinck, T

    2014-09-01

    The "optimal" positioning of the cup in total hip arthroplasty can improve hip function and reduce wear, impingement and dislocation. The cup position is described as the spatial relation between the hip rotation centre and the pelvis and, as the cup orientation around the rotation centre. The first parameter affects hip balance and, if not managed properly, might result in poor function and leg length discrepancy. The second parameter is often "silent", unless impingement or dislocation occurs. However, inappropriate cup orientation can accelerate wear and cause early failure. As such, it is mandatory to get both right, taking into account multiple parameters: the stem position, the approach, the bearing surface, the cup coverage and the pelvic orientation during loading. In most cases a "standard" cup position is adequate. However, specific anatomic features might require an individualized approach. This paper aims at reviewing the parameters that impact on the optimal cup position. This should allow for more judicious choices in those particular cases. PMID:26280607

  15. Avoiding Hip Instability and Limb Length Discrepancy After Total Hip Arthroplasty.

    PubMed

    Sculco, Peter K; Cottino, Umberto; Abdel, Matthew P; Sierra, Rafael J

    2016-04-01

    Two complications after total hip arthroplasty (THA) are hip instability and limb length discrepancy; instability is a common indication for revision THA. The goal of a successful THA is to maximize impingement-free range of motion, recreate appropriate offset, and equalize limb length discrepancies to produce a pain-free and dynamically stable THA. In this article, the patient risk factors for dislocation and limb length discrepancy, key elements of the preoperative template, the anatomic landmarks for accurate component placement, the leg positions for soft tissue stability testing, and the management of postoperative instability are reviewed. PMID:26772941

  16. Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study

    PubMed Central

    Jackson, K A; Glyn-Jones, S; Batt, M E; Arden, N K; Newton, J L

    2015-01-01

    Objective Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. Methods This Dephi study used online surveys to gain concordance of expert opinion in a structured process of ‘rounds’. In this study, we asked ‘What outcome measures are useful in predicting hip OA in activity-related hip pain?’ The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. Results The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. Conclusions We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further

  17. Surgical hip dislocation does not result in atrophy or fatty infiltration of periarticular hip muscles

    PubMed Central

    Glynn, Aaron A.; Barattiero, Fabio Y.; Albers, Christoph E.; Hanke, Markus S.; Steppacher, Simon D.; Tannast, Moritz

    2014-01-01

    Surgical hip dislocation is the gold standard for treatment of femoroacetabular impingement (FAI). It utilizes an intermuscular and internervous approach to the hip. Concerns have been expressed that this approach causes soft tissue trauma resulting in post-operative muscle weakness of patients undergoing this procedure. We therefore asked whether surgical hip dislocation leads to (i) atrophy (decreased muscle diameter or cross-sectional area [CSA]) and (ii) degeneration (fatty infiltration) of 18 evaluated periarticular hip muscles. We retrospectively evaluated 32 patients (34 hips) following surgical hip dislocation for the treatment of FAI using pre and post-operative magnetic resonance (MR) arthrography of the hip. We evaluated muscle diameter, CSA and degree of fatty infiltration according to Goutallier for 18 periarticular hip muscles on axial and sagittal views. The mean interval between pre and post-operative MR was 1.9 ± 1.5 years (range, 0.4–6.1 years). Pre and post-operative muscle diameter and CSA of all 18 evaluated hip muscles did not differ. There was no post-operative change in the Goutallier classification for any of the evaluated 18 muscles. No muscle had post-operative degeneration higher than Grade 1 according to Goutallier. No atrophy or degeneration of periarticular hip muscles could be found following surgical hip dislocation for treatment of FAI. Any raised concerns about the invasiveness and potential muscle trauma for this type of surgery are unfounded. Level III, retrospective comparative study. See guidelines for authors for a complete description of levels of evidence. PMID:27011807

  18. 'Hip' pain.

    PubMed

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  19. Diagnosing Femoroacetabular Impingement From Plain Radiographs

    PubMed Central

    Ayeni, Olufemi R.; Chan, Kevin; Whelan, Daniel B.; Gandhi, Rajiv; Williams, Dale; Harish, Srinivasan; Choudur, Hema; Chiavaras, Mary M.; Karlsson, Jon; Bhandari, Mohit

    2014-01-01

    Background: A diagnosis of femoroacetabular impingement (FAI) requires careful history and physical examination, as well as an accurate and reliable radiologic evaluation using plain radiographs as a screening modality. Radiographic markers in the diagnosis of FAI are numerous and not fully validated. In particular, reliability in their assessment across health care providers is unclear. Purpose: To determine inter- and intraobserver reliability between orthopaedic surgeons and musculoskeletal radiologists. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Six physicians (3 orthopaedic surgeons, 3 musculoskeletal radiologists) independently evaluated a broad spectrum of FAI pathologies across 51 hip radiographs on 2 occasions separated by at least 4 weeks. Reviewers used 8 common criteria to diagnose FAI, including (1) pistol-grip deformity, (2) size of alpha angle, (3) femoral head-neck offset, (4) posterior wall sign abnormality, (5) ischial spine sign abnormality, (6) coxa profunda abnormality, (7) crossover sign abnormality, and (8) acetabular protrusion. Agreement was calculated using the intraclass correlation coefficient (ICC). Results: When establishing an FAI diagnosis, there was poor interobserver reliability between the surgeons and radiologists (ICC batch 1 = 0.33; ICC batch 2 = 0.15). In contrast, there was higher interobserver reliability within each specialty, ranging from fair to good (surgeons: ICC batch 1 = 0.72; ICC batch 2 = 0.70 vs radiologists: ICC batch 1 = 0.59; ICC batch 2 = 0.74). Orthopaedic surgeons had the highest interobserver reliability when identifying pistol-grip deformities (ICC = 0.81) or abnormal alpha angles (ICC = 0.81). Similarly, radiologists had the highest agreement for detecting pistol-grip deformities (ICC = 0.75). Conclusion: These results suggest that surgeons and radiologists agree among themselves, but there is a need to improve the reliability of radiographic interpretations for FAI between the

  20. Differential diagnosis of pain around the hip joint.

    PubMed

    Tibor, Lisa M; Sekiya, Jon K

    2008-12-01

    The differential diagnosis of hip pain is broad and includes intra-articular pathology, extra-articular pathology, and mimickers, including the joints of the pelvic ring. With the current advancements in hip arthroscopy, more patients are being evaluated for hip pain. In recent years, our understanding of the functional anatomy around the hip has improved. In addition, because of advancements in magnetic resonance imaging, the diagnosis of soft tissue causes of hip pain has improved. All of these advances have broadened the differential diagnosis of pain around the hip joint and improved the treatment of these problems. In this review, we discuss the causes of intra-articular hip pain that can be addressed arthroscopically: labral tears, loose bodies, femoroacetabular impingement, capsular laxity, tears of the ligamentum teres, and chondral damage. Extra-articular diagnoses that can be managed arthroscopically are also discussed, including: iliopsoas tendonitis, "internal" snapping hip, "external" snapping hip, iliotibial band and greater trochanteric bursitis, and gluteal tendon injury. Finally, we discuss extra-articular causes of hip pain that are often managed nonoperatively or in an open fashion: femoral neck stress fracture, adductor strain, piriformis syndrome, sacroiliac joint pain, athletic pubalgia, "sports hernia," "Gilmore's groin," and osteitis pubis. PMID:19038713

  1. SURGICAL TREATMENT FOR FEMOROACETABULAR IMPINGEMENT IN A GROUP THAT PERFORMS SQUATS

    PubMed Central

    Polesello, Giancarlo Cavalli; Cinagawa, Eduardo Hitoshi Tsuge; Cruz, Paulo Daniel Sousa Santa; de Queiroz, Marcelo Cavalheiro; Borges, Cristian Jandrey; Junior, Walter Ricioli; Daniachi, Daniel; Guimarães, Rodrigo Pereira; Honda, Emerson Kiyoshi; Ono, Nelson Keiske

    2015-01-01

    Objective: Describe the results from arthroscopic surgical treatment on a group of patients who developed symptoms after repetitive physical activity of moving their hips in a position of hyperflexion, as in leg presses and squats. Methods: The study group comprised 47 individuals (48 hips) who developed the onset of painful symptoms associated with hip hyperflexion exercises (leg presses or squats) and underwent arthroscopic treatment. The patients were evaluated radiographically and clinically according to the “Harris Hip Score", as modified by Byrd (MHHS), pre and postoperatively, and were asked about their return to sports activities and the surgical findings. Results: The mean preoperative and postoperative MHHS, respectively, were 60 points (SD 11.0, range 38.5 to 92.4) and 95.9 points (SD 7.7, range 63.8 to 100), with an increase of 35.9 points (P < 0.001). Regarding physical activity, 30 individuals (71.5%) resumed sports activities after surgery, and 25 of them (83.4%) at the previous level. Six patients (12.8%) did not resume activities because of persistent pain. During arthroscopy, 48 hips (100%) presented lesions of the acetabular labrum, and 41 hips (85.4%) had acetabular chondral lesions. Conclusion: The patients with painful symptoms after hip hyperflexion exercises associated with femoroacetabular impingement presented improvements after arthroscopic treatment. PMID:27047856

  2. Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance.

    PubMed

    Howse, Elizabeth A; Botros, Daniel B; Mannava, Sandeep; Stone, Austin V; Stubbs, Allston J

    2016-04-01

    Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance. A through understanding of the hip anatomy allows for these portals to be made both safely and reliably for hip arthroscopies in the modified supine positioned patient. The reduced use of fluoroscopy with this technique lowers the risk of ionizing radiation exposure to the patient and surgeon. PMID:27489756

  3. Evaluation and management of ischiofemoral impingement: a pathophysiologic, radiologic, and therapeutic approach to a complex diagnosis.

    PubMed

    Hernando, Moisés Fernández; Cerezal, Luis; Pérez-Carro, Luis; Canga, Ana; González, Raquel Prada

    2016-06-01

    Ischiofemoral impingement syndrome (IFI) is an underrecognized form of atypical, extra-articular hip impingement defined by hip pain related to narrowing of the space between the ischial tuberosity and the femur. The etiology of IFI is multifactorial and potential sources of ischiofemoral engagement include anatomic variants of the proximal femur or pelvis, functional disorders as hip instability, pelvic/spinal instability, or abductor/adductor imbalance, ischial tuberosity enthesopathies, trauma/overuse or extreme hip motion, iatrogenic conditions, tumors and other pathologies. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice for assessing IFI and may substantially influence patient management. The injection test of the ischiofemoral space (IFS) has both a diagnostic and therapeutic function. Endoscopic decompression of the IFS appears useful in improving function and diminishing hip pain in patients with IFI but conservative treatment is always the first step in the treatment algorithm. Because of the ever-increasing use of advanced MRI techniques, the frequent response to conservative treatment, and the excellent outcomes of new endoscopic treatment, radiologists must be aware of factors that predispose or cause IFI. In addition, focused treatment in these conditions is often more important than in secondary impingement. In this article, we briefly describe the anatomy of the IFS, review the clinical examination and symptoms, assess the diagnostic imaging criteria and pathophysiological mechanisms, and develop an understandable classification of IFI, with particular focus on its etiology, predisposing factors, and associated musculoskeletal abnormalities. We also assess the role of the radiologist in the diagnosis, treatment, and preoperative evaluation of both primary and secondary IFI. PMID:26940209

  4. Impingement of Water Droplets on a Sphere

    NASA Technical Reports Server (NTRS)

    Dorsch, Robert G.; Saper, Paul G.; Kadow, Charles F.

    1955-01-01

    Droplet trajectories about a sphere in ideal fluid flow were calculated. From the calculated droplet trajectories the droplet impingement characteristics of the sphere were determined. Impingement data and equations for determining the collection efficiency, the area, and the distribution of impingement are presented in terms of dimensionless parameters. The range of flight and atmospheric conditions covered in the calculations was extended considerably beyond the range covered by previously reported calculations for the sphere.

  5. Externally blown flap impingement noise.

    NASA Technical Reports Server (NTRS)

    Putnam, T. W.; Lasagna, P. L.

    1972-01-01

    An investigation of externally blown flap impingement noise was conducted using a full-scale turbofan engine and aircraft wing. The noise produced with a daisy nozzle installed on the engine exhaust system was greater than that produced by a conical nozzle at the same thrust. The daisy nozzle caused the jet velocity to decay about 35 percent at the flap. The presence of the wing next to the conical nozzle increased the noise, as did increasing the flap deflection. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested.

  6. Prevalence of Cam Morphology in Females with Femoroacetabular Impingement

    PubMed Central

    Levy, David M.; Hellman, Michael D.; Harris, Joshua D.; Haughom, Bryan; Frank, Rachel M.; Nho, Shane J.

    2015-01-01

    Cam and pincer are two common morphologies responsible for femoroacetabular impingement (FAI). Previous literature has reported that cam deformity is predominantly a male morphology, while being significantly less common in females. Cam morphology is commonly assessed with the alpha angle, measured on radiographs. The purpose of this study is to determine the prevalence of cam morphology utilizing the alpha angle in female subjects diagnosed with symptomatic FAI. All females presenting to the senior author’s clinic diagnosed with symptomatic FAI between December 2006 and January 2013 were retrospectively reviewed. Alpha (α) angles were measured on anteroposterior and lateral (Dunn 90°, cross-table lateral, and/or frog-leg lateral) plain radiographs by two blinded physicians, and the largest measured angle was used. Using Gosvig et al.’s classification, alpha angle was characterized as (pathologic > 57°), borderline (51–56°), subtle (46–50°), very subtle (43–45°), or normal (≤42°). Three hundred and ninety-one patients (438 hips) were analyzed (age 36.2 ± 12.3 years). Among the hips included, 35.6% were normal, 14.6% pathologic, 15.1% borderline, 14.6% subtle, and 20.1% very subtle. There was no correlation between alpha angle and patient age (R = 0.17) or body mass index (R = 0.05). The intraclass correlation coefficient for α-angle measurements was 0.84. Sixty-four percent of females in this cohort had an alpha angle >42°. Subtle cam deformity plays a significant role in the pathoanatomy of female patients with symptomatic FAI. As the majority of revision hip arthroscopies are performed due to incomplete cam correction, hip arthroscopists need to be cognizant of and potentially surgically address these subtle lesions. PMID:26649291

  7. Radiographic Evidence of Femoroacetabular Impingement in Athletes With Athletic Pubalgia

    PubMed Central

    Economopoulos, Kostas J.; Milewski, Matthew D.; Hanks, John B.; Hart, Joseph M.; Diduch, David R.

    2014-01-01

    Background: Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. An association between the 2 is apparent, but the prevalence of radiographic signs of FAI in patients undergoing athletic pubalgia surgery remains unknown. The purpose of this study was to determine the prevalence of radiologic signs of FAI in patients with athletic pubalgia. Hypothesis: We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI. Study Design: Case series. Level of Evidence: Level 4. Methods: A retrospective review of all patients evaluated at our institution with athletic pubalgia who underwent surgical treatment (ie, for sports hernia) from 1999 to 2011 was performed. The radiographs of patients with athletic pubalgia were reviewed for radiographic signs of FAI. Alpha angles were measured using frog-leg lateral radiographs. Pincer lesions were identified by measuring the lateral center-edge angle and identifying the presence of a “crossover” sign on anteroposterior radiographs. Phone follow-up was performed 2 years or more after the initial sports hernia surgery to evaluate recurrent symptoms. Results: Forty-three patients underwent 56 athletic pubalgia surgeries. Radiographic evidence of FAI was identified in at least 1 hip in 37 of 43 patients (86%). Cam lesions were identified in 83.7% of the population; the alpha angle averaged 66.7° ± 17.9° for all hips. Pincer lesions were present in 28% of the hips. Eight patients had recurrent groin pain, 3 patients had revision athletic pubalgia surgery, and 1 had hip arthroscopy. Conclusion: The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia. Clinical Relevance: Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI. PMID:24587869

  8. Nanofluid impingement jet heat transfer.

    PubMed

    Zeitoun, Obida; Ali, Mohamed

    2012-01-01

    Experimental investigation to study the heat transfer between a vertical round alumina-water nanofluid jet and a horizontal circular round surface is carried out. Different jet flow rates, jet nozzle diameters, various circular disk diameters and three nanoparticles concentrations (0, 6.6 and 10%, respectively) are used. The experimental results indicate that using nanofluid as a heat transfer carrier can enhance the heat transfer process. For the same Reynolds number, the experimental data show an increase in the Nusselt numbers as the nanoparticle concentration increases. Size of heating disk diameters shows reverse effect on heat transfer. It is also found that presenting the data in terms of Reynolds number at impingement jet diameter can take into account on both effects of jet heights and nozzle diameter. Presenting the data in terms of Peclet numbers, at fixed impingement nozzle diameter, makes the data less sensitive to the percentage change of the nanoparticle concentrations. Finally, general heat transfer correlation is obtained verses Peclet numbers using nanoparticle concentrations and the nozzle diameter ratio as parameters. PMID:22340669

  9. Nanofluid impingement jet heat transfer

    PubMed Central

    2012-01-01

    Experimental investigation to study the heat transfer between a vertical round alumina-water nanofluid jet and a horizontal circular round surface is carried out. Different jet flow rates, jet nozzle diameters, various circular disk diameters and three nanoparticles concentrations (0, 6.6 and 10%, respectively) are used. The experimental results indicate that using nanofluid as a heat transfer carrier can enhance the heat transfer process. For the same Reynolds number, the experimental data show an increase in the Nusselt numbers as the nanoparticle concentration increases. Size of heating disk diameters shows reverse effect on heat transfer. It is also found that presenting the data in terms of Reynolds number at impingement jet diameter can take into account on both effects of jet heights and nozzle diameter. Presenting the data in terms of Peclet numbers, at fixed impingement nozzle diameter, makes the data less sensitive to the percentage change of the nanoparticle concentrations. Finally, general heat transfer correlation is obtained verses Peclet numbers using nanoparticle concentrations and the nozzle diameter ratio as parameters. PMID:22340669

  10. Safe arthroscopic access to the central compartment of the hip.

    PubMed

    Dienst, Michael; Seil, Romain; Kohn, Dieter M

    2005-12-01

    This technical note describes a new method that allows access to the central compartment of the hip under arthroscopic control via the peripheral compartment with less risk of labral perforation and/or cartilage scuffing. After placement of the anterolateral portal in the peripheral compartment without traction, the anterior head area with the anterior acetabular labrum and the anterior surface of the femoral head are inspected. Under arthroscopic control, a guidewire is introduced through the anterior portal in between the anterior labrum and anterior femoral head cartilage and into the central compartment. The arthroscope is then removed from the anterolateral portal, the hip distracted, and the arthroscope introduced via cannulated instruments over the guidewire into the central compartment. Further portal placement can be controlled arthroscopically. PMID:16376244

  11. Bistability and hysteresis of annular impinging jets

    NASA Astrophysics Data System (ADS)

    Tisovsky, Tomas

    2016-06-01

    In present study, the bistability and hysteresis of annular impinging jets is investigated. Annular impinging jets are simulated using open source CFD code - OpenFOAM. Both flow field patterns of interest are obtained and hysteresis is found by means of dynamic mesh simulation. Effect of nozzle exit velocity on resulting hysteresis loop is also illustrated.

  12. Fluorescence Imaging Study of Impinging Underexpanded Jets

    NASA Technical Reports Server (NTRS)

    Inman, Jennifer A.; Danehy, Paul M.; Nowak, Robert J.; Alderfer, David W.

    2008-01-01

    An experiment was designed to create a simplified simulation of the flow through a hole in the surface of a hypersonic aerospace vehicle and the subsequent impingement of the flow on internal structures. In addition to planar laser-induced fluorescence (PLIF) flow visualization, pressure measurements were recorded on the surface of an impingement target. The PLIF images themselves provide quantitative spatial information about structure of the impinging jets. The images also help in the interpretation of impingement surface pressure profiles by highlighting the flow structures corresponding to distinctive features of these pressure profiles. The shape of the pressure distribution along the impingement surface was found to be double-peaked in cases with a sufficiently high jet-exit-to-ambient pressure ratio so as to have a Mach disk, as well as in cases where a flow feature called a recirculation bubble formed at the impingement surface. The formation of a recirculation bubble was in turn found to depend very sensitively upon the jet-exit-to-ambient pressure ratio. The pressure measured at the surface was typically less than half the nozzle plenum pressure at low jet pressure ratios and decreased with increasing jet pressure ratios. Angled impingement cases showed that impingement at a 60deg angle resulted in up to a factor of three increase in maximum pressure at the plate compared to normal incidence.

  13. New perspectives on femoroacetabular impingement syndrome.

    PubMed

    Khan, Moin; Bedi, Asheesh; Fu, Freddie; Karlsson, Jon; Ayeni, Olufemi R; Bhandari, Mohit

    2016-05-01

    Femoroacetabular impingement (FAI) is characterized by an abnormality in the shape of the femoral head-neck or acetabulum that results in impingement between these two structures. Arthroscopic treatment has become the preferred method of management of FAI owing to its minimally invasive approach. Surgical correction involves resection of impinging osseous structures as well as concurrent management of the associated chondral and labral pathology. Research from the past 5 years has shown that repair of the labrum results in a better anatomic correction and improved outcomes compared with labral debridement. Research is underway to improve cartilage assessment by using innovative imaging techniques and biochemical tests to inform predictions of prognosis. Several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), will provide critical information regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI. PMID:26963727

  14. Externally blown flap impingement noise

    NASA Technical Reports Server (NTRS)

    Lasagna, P. L.; Putnam, T. W.

    1972-01-01

    Tests of the noise produced by the impingement of the jet exhaust on the wing and flap for an externally blown flap system were conducted with a CF700 turbofan engine and an F-111B wing panel. The noise produced with a daisy nozzle installed on the engine was greater than that produced by a conical nozzle at the same thrust. The presence of the wing next to the test nozzles increased the noise, as did increasing the flap deflection angle. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested. Tests showed that the single-slotted flap deflected 60 deg, produced less noise than the double-slotted flaps. Also, maintaining the maximum distance between the exit nozzle and flap system resulted in a minor reduction in noise.

  15. Hip Arthroscopy in the Presence of Acetabular Dysplasia

    PubMed Central

    Jayasekera, Narlaka; Aprato, Alessandro; Villar, Richard N

    2015-01-01

    Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality. PMID:26069512

  16. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Hesper, Tobias; Tiderius, Carl Johan; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined. PMID:26258129

  17. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects

    PubMed Central

    Bittersohl, Bernd; Hosalkar, Harish S.; Hesper, Tobias; Tiderius, Carl Johan; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined. PMID:26258129

  18. [Impingement syndrome following direct injuries of the shoulder joint].

    PubMed

    Volpin, G; Stahl, S; Stein, H

    1996-02-15

    Impingement is the most common cause of pain and limitation of movement in the shoulder, with painful arc syndrome its major clinical sign. It usually becomes manifest at between 70 degrees-120 degrees of abduction, but in severe cases, this may be reduced to only 50 degrees-70 degrees. We studied 22 patients who had developed shoulder impingement following direct injuries and who had been treated by anterior acromioplasty and decompression, with an average follow-up of 32 months. 5 had sustained fractures of the greater tuberosity of the humerus at the time of injury, 14 had tears of the rotator cuff of various sizes (1 in both shoulders) and 3 had developed fibrotic scars of the subacromial bursa. Excellent or good results were achieved in 86.6%. Healing time was shorter, and there was return of full range of shoulder movement in those with subacromial scars, undisplaced fractures of the greater tuberosity, or those with a small tear of the rotator cuff. Recovery took longer in those with larger tears of the rotator cuff and in those with displaced fractures of the greater tuberosity. Recovery time was proportional to the size of the rotator cuff tear. It is concluded that direct trauma to the shoulder bears a direct relationship to the development of impingement syndrome, and that at surgery a concomitant tear in the rotator cuff is seen more than 2/3. Because of the high rate of success in surgical treatment of this syndrome, operation is indicated when a few months of physical therapy and analgesics fail to provide relief. In the presence of fractures, decompression surgery should be postponed until the fracture has united. PMID:8675117

  19. Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

    A 53-year-old man presented with pain in the right hip. Radiological examination showed idiopathic osteonecrosis of the femoral head (ONFH) combined with a cam lesion. Findings on physical examination were consistent for femoroacetabular impingement. At surgery, we performed isolated arthroscopic correction for the cam lesion but did not use other treatment options such as hip arthroplasty or osteotomies for the ONFH. At the latest follow-up evaluation 3 years after surgery, findings indicted a satisfactory outcome, with a Harris hip score of 93.2 (compared with 76.4 before surgery), no joint-space narrowing, and no collapse of the femoral head. It is important to accurately diagnose the status of idiopathic ONFH and to consider another possible pathogenesis when a patient with idiopathic ONFH has hip pain even without femoral-head collapse. PMID:26773875

  20. Imaging of Sports-Related Hip and Groin Injuries

    PubMed Central

    Lischuk, Andrew W.; Dorantes, Thomas M.; Wong, William; Haims, Andrew H.

    2010-01-01

    A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries. PMID:23015946

  1. Imaging of sports-related hip and groin injuries.

    PubMed

    Lischuk, Andrew W; Dorantes, Thomas M; Wong, William; Haims, Andrew H

    2010-05-01

    A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries. PMID:23015946

  2. Correlations between the Alpha Angle and Femoral Head Asphericity: Implications and Recommendations for the Diagnosis of Cam Femoroacetabular Impingement

    PubMed Central

    Harris, Michael D.; Kapron, Ashley L.; Peters, Christopher L.; Anderson, Andrew E.

    2014-01-01

    Objective To determine the strength of common radiographic and radial CT views for measuring true femoral head asphericity. Patients and Methods In 15 patients with cam femoroacetabular impingement (FAI) and 15 controls, alpha angles were measured by two observers using radial CT (0°, 30°, 60°, 90°) and digitally reconstructed radiographs (DRRs) for the: anterior-posterior (AP), standing frog-leg lateral, 45° Dunn with neutral rotation, 45° Dunn with 40°external rotation, and cross-table lateral views. A DRR validation study was performed. Alpha angles were compared between groups. Maximum deviation from a sphere of each subject was obtained from a previous study. Alpha angles from each view were correlated with maximum deviation. Results There were no significant differences between alpha angles measured on radiographs and the corresponding DRRs (p = 0.72). Alpha angles were significantly greater in patients for all views (p ≤0.002). Alpha angles from the 45° Dunn with 40° external rotation, cross-table lateral, and 60° radial views had the strongest correlations with maximum deviation (r = 0.831; r = 0.823; r=0.808, respectively). The AP view had the weakest correlation (r = 0.358). Conclusion DRRs were a validated means to simulate hip radiographs. The 45° Dunn with 40° external rotation, cross-table lateral, and 60° radial views best visualized femoral asphericity. Although commonly used, the AP view did not visualize cam deformities well. Overall, the magnitude of the alpha angle may not be indicative of the size of the deformity. Thus, 3D reconstructions and measurements of asphericity could improve the diagnosis of cam FAI. PMID:24613175

  3. The validity of a non-radiologist reader in identifying cam and pincer femoroacetabular impingement (FAI) using plain radiography.

    PubMed

    Ratzlaff, C; Zhang, C; Korzan, J; Josey, L; Wong, H; Cibere, J; Prlic, H M; Kopec, J A; Esdaile, J M; Li, L C; Barber, M; Forster, B B

    2016-03-01

    The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films. PMID:26433895

  4. Return to Play Following Hip Arthroscopy.

    PubMed

    Lee, Simon; Kuhn, Andrew; Draovitch, Pete; Bedi, Asheesh

    2016-10-01

    Femoroacetabular impingement may be particularly disabling to the high-demand athlete, especially those with significant cutting and pivoting requirements. If nonoperative treatment fails to adequately alleviate symptoms or sufficiently restore function in the athlete, hip arthroscopy can lead to improved pain, improved range of motion, and high rates of return to play with proper postoperative rehabilitation. The rate of return to previous level of competition is also high with accurate diagnosis and well-executed correction of deformity. A clear understanding of the etiology, diagnosis, management, and outcomes is essential for clinicians to optimally help patients to return to play. PMID:27543404

  5. Effect of increased pushoff during gait on hip joint forces.

    PubMed

    Lewis, Cara L; Garibay, Erin J

    2015-01-01

    Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditions. For the natural condition, subjects were instructed to walk as they normally would. For the increased pushoff condition, subjects were instructed to "push more with your foot when you walk". We collected motion data of markers placed on the subjects' trunk and lower extremities to capture trunk and leg kinematics and ground reaction force data to determine joint moments. Data were processed in Visual3D to produce the inverse kinematics and model scaling files. In OpenSim, the generic gait model (Gait2392) was scaled to the subject, and hip joint forces were calculated for the femur on the acetabulum after computing the muscle activations necessary to reproduce the experimental data. The instruction to "push more with your foot when you walk" reduced the maximum hip flexion and extension moment compared to the natural condition. The average reduction in the hip joint forces were 12.5%, 3.2% and 9.6% in the anterior, superior and medial directions respectively and 2.3% for the net resultant force. Increasing pushoff may be an effective gait modification for people with anterior hip pain. PMID:25468661

  6. Effect of increased pushoff during gait on hip joint forces

    PubMed Central

    Lewis, Cara L.; Garibay, Erin J.

    2014-01-01

    Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditions. For the natural condition, subjects were instructed to walk as they normally would. For the increased pushoff condition, subjects were instructed to “push more with your foot when you walk”. We collected motion data of markers placed on the subjects’ trunk and lower extremities to capture trunk and leg kinematics and ground reaction force data to determine joint moments. Data were processed in Visual 3D to produce the inverse kinematics and model scaling files. In OpenSim, the generic gait model (Gait2392) was scaled to the subject, and hip joint forces were calculated for the femur on the acetabulum after computing the muscle activations necessary to reproduce the experimental data. The instruction to “push more with your foot when you walk” reduced the maximum hip flexion and extension moment compared to the natural condition. The average reduction in the hip joint forces was 12.5%, 3.2% and 9.6% in the anterior, superior and medial directions respectively and 2.3% for the net resultant force. Increasing pushoff may be an effective gait modification for people with anterior hip pain. PMID:25468661

  7. Does Previous Hip Surgery Effect the Outcome of Tönnis Triple Periacetabular Osteotomy? Mid-Term Results.

    PubMed

    Konya, Mehmet Nuri; Aydn, Bahattin Kerem; Yldrm, Timur; Sofu, Hakan; Gürsu, Sarper

    2016-03-01

    Hip dysplasia (HD) is 1 of the major reasons of coxarthrosis. The goal of the treatment of HD by Tönnis triple pelvic osteotomy (TPAO) is to improve the function of hip joint while relieving pain, delaying and possibly preventing end-stage arthritis. The aim of this study is to compare the clinical and radiological results of TPAO to determine if previous surgery has a negative effect on TPAO.Patients operated with TPAO between 2005 and 2010, included in this study. Patients divided into 2 groups: primary acetabular dysplasia (PAD) and residual acetabular dysplasia (RAD). Prepostoperatively, hip range of motion, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip score, visual analog scores (VAS), impingement tests, and also the presence of Trendelenburg sign (TS) were investigated for clinical evaluation. For radiological analysis pre-postoperative, anterior-posterior (AP) pelvis and faux profile radiographs were used. Acetabular index, lateral center edge (LCE) angle, and Sharp angles were measured by AP pelvis; anterior center edge (ACE) angle were measured by faux profile radiography. All the clinical and radiological data of the groups were analyzed separately for the pre-postoperative scores also the amount of improvement in all parameters were analyzed.SPSS20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Wilcoxon test, McNemar test, paired t tests, and Mann-Whitney U tests were used to compare the groups. P < 0.05 were defined as statistically significant.Study included 27 patients: 17 patients were in PAD and 10 patients were in RAD. The mean follow-up period was 6.2 years (5.2-10.3 years). In all patients, the radiological and the clinical outcomes were better after TPAO except the flexion of the hip parameter. When the patient groups were evaluated as pre-postoperatively, more statistically significant parameters were found in the PAD group when compared with RAD group. Extension

  8. Cleaning verification by air/water impingement

    NASA Technical Reports Server (NTRS)

    Jones, Lisa L.; Littlefield, Maria D.; Melton, Gregory S.; Caimi, Raoul E. B.; Thaxton, Eric A.

    1995-01-01

    This paper will discuss how the Kennedy Space Center intends to perform precision cleaning verification by Air/Water Impingement in lieu of chlorofluorocarbon-113 gravimetric nonvolatile residue analysis (NVR). Test results will be given that demonstrate the effectiveness of the Air/Water system. A brief discussion of the Total Carbon method via the use of a high temperature combustion analyzer will also be given. The necessary equipment for impingement will be shown along with other possible applications of this technology.

  9. Hip arthroscopy and osteoarthritis: Where are the limits and indications?

    PubMed Central

    Mella, Claudio; Villalón, Ignacio E.; Núñez, Álvaro; Paccot, Daniel; Díaz-Ledezma, Claudio

    2015-01-01

    The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage. PMID:27163082

  10. REHABILITATION AFTER HIP ARTHROSCOPY AND LABRAL REPAIR IN A HIGH SCHOOL FOOTBALL ATHLETE

    PubMed Central

    Kolber, Morey J.

    2012-01-01

    Study Design: Case Report Background: Femoral acetabular impingement (FAI) has been implicated in the etiology of acetabular labral tears. The rehabilitation of younger athletes following arthroscopic surgery for FAI and labral tears is often complex and multifactorial. A paucity of evidence exists to describe the rehabilitation of younger athletes who have undergone arthroscopic hip surgery. Case Presentation: This case report describes a four-phase rehabilitation program for a high school football player who underwent hip arthroscopy with a labral repair and chondroplasty. Outcomes: The player returned to training for football 16 weeks later and at the 4 month follow-up was pain free with no signs of FAI. Discussion: There is little evidence regarding the rehabilitation of younger athletes who undergo arthroscopic hip surgery. This case study described a four phase rehabilitation program for a high school football player who underwent hip arthroscopy and labral repair. The patient achieved positive outcomes with a full return to athletic activity and football. The overall success of these patients depends on the appropriate surgical procedure and rehabilitation program. Key Words: Femoral acetabular impingement (FAI), hip, hip impingement Level of evidence: 4-Case report PMID:22530192

  11. Evaluation and management of chronic total hip instability.

    PubMed

    Sheth, N P; Melnic, C M; Paprosky, W G

    2016-01-01

    Given the increasing number of total hip arthroplasty procedures being performed annually, it is imperative that orthopaedic surgeons understand factors responsible for instability. In order to treat this potentially complex problem, we recommend correctly classifying the type of instability present based on component position, abductor function, impingement, and polyethylene wear. Correct classification allows the treating surgeon to choose the appropriate revision option that ultimately will allow for the best potential outcome. PMID:26733640

  12. Characterization of the Neural Anatomy in the Hip Joint to Optimize Periarticular Regional Anesthesia in Total Hip Arthroplasty.

    PubMed

    Simons, Matthew J; Amin, Nirav H; Cushner, Fred D; Scuderi, Giles R

    2015-01-01

    The purpose of the current study was to identify and map the periarticular neural anatomy of the hip to optimize periarticular injection techniques in total hip arthroplasty. A literature review of common search engines was performed using terms associated with hip innervation and 17 met the inclusion criteria. The studies addressed both gross and microscopic neural anatomy of the human hip joint, and the findings summarize key areas of hip mechanoreceptors and free nerve endings to provide a framework for targeted periarticular hip infiltration. Grossly, the hip joint is supplied by the femoral, obturator, sciatic, and superior gluteal nerves, as well as the nerve to the quadratus femoris. The greatest concentration of sensory nerve endings and mechanoreceptors is found at the anterior hip capsule, especially superiorly. The labrum is most highly innervated from the 10 to 2 o'clock position. After the cup and liner are placed, periarticular injections should be infiltrated toward the remnant labrum from 10 to 2 o'clock. Before stem insertion, the visible periosteum may then be injected circumferentially about the femur. The anterior and superior capsular tissue, if retained, is routinely infiltrated at the time of capsular repair. Depending on surgical approach, the fascia and incised soft tissue are infiltrated before final closure. PMID:26731384

  13. Sports hernia and femoroacetabular impingement in athletes: A systematic review

    PubMed Central

    Munegato, Daniele; Bigoni, Marco; Gridavilla, Giulia; Olmi, Stefano; Cesana, Giovanni; Zatti, Giovanni

    2015-01-01

    AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy. PMID:26380829

  14. Femoroacetabular Impingement Surgery Is on the Rise-But What Is the Next Step?

    PubMed

    Reiman, Michael P; Thorborg, Kristian; Hölmich, Per

    2016-06-01

    Surgery for femoroacetabular impingement (FAI) has been advocated for correction of cam and pincer hip joint morphology. Surgery for FAI was first pioneered by Myers et al, who surgically treated FAI by open dislocation. Arthroscopy was then introduced in 2005 by Sampson. Arthroscopy has continued to develop since then, with the intent of providing pain relief and improving function in patients with FAI. This Viewpoint discusses the escalating popularity of FAI surgery, the widespread acceptance of this relatively new surgical procedure, and next steps for determination of who benefits from this treatment. J Orthop Sports Phys Ther 2016;46(6):406-408. doi:10.2519/jospt.2016.0605. PMID:27245488

  15. Treatments for Shoulder Impingement Syndrome

    PubMed Central

    Dong, Wei; Goost, Hans; Lin, Xiang-Bo; Burger, Christof; Paul, Christian; Wang, Zeng-Li; Zhang, Tian-Yi; Jiang, Zhi-Chao; Welle, Kristian; Kabir, Koroush

    2015-01-01

    Abstract Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant–Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping

  16. Spray formation processes of impinging jet injectors

    NASA Technical Reports Server (NTRS)

    Anderson, W. E.; Ryan, H. M.; Pal, S.; Santoro, R. J.

    1993-01-01

    A study examining impinging liquid jets has been underway to determine physical mechanisms responsible for combustion instabilities in liquid bi-propellant rocket engines. Primary atomization has been identified as an important process. Measurements of atomization length, wave structure, and drop size and velocity distribution were made under various ambient conditions. Test parameters included geometric effects and flow effects. It was observed that pre-impingement jet conditions, specifically whether they were laminar or turbulent, had the major effect on primary atomization. Comparison of the measurements with results from a two dimensional linear aerodynamic stability model of a thinning, viscous sheet were made. Measured turbulent impinging jet characteristics were contrary to model predictions; the structure of waves generated near the point of jet impingement were dependent primarily on jet diameter and independent of jet velocity. It has been postulated that these impact waves are related to pressure and momentum fluctuations near the impingement region and control the eventual disintegration of the liquid sheet into ligaments. Examination of the temporal characteristics of primary atomization (ligament shedding frequency) strongly suggests that the periodic nature of primary atomization is a key process in combustion instability.

  17. Developmental dysplasia of the hip

    MedlinePlus

    ... Developmental hip dysplasia; DDH; Congenital dysplasia of the hip; Congenital dislocation of the hip; CDH; Pavlik harness ... dislocation Shorter leg on the side with the hip dislocation Uneven skin folds of thigh or buttocks After ...

  18. Microtextured Surfaces for Turbine Blade Impingement Cooling

    NASA Technical Reports Server (NTRS)

    Fryer, Jack

    2014-01-01

    Gas turbine engine technology is constantly challenged to operate at higher combustor outlet temperatures. In a modern gas turbine engine, these temperatures can exceed the blade and disk material limits by 600 F or more, necessitating both internal and film cooling schemes in addition to the use of thermal barrier coatings. Internal convective cooling is inadequate in many blade locations, and both internal and film cooling approaches can lead to significant performance penalties in the engine. Micro Cooling Concepts, Inc., has developed a turbine blade cooling concept that provides enhanced internal impingement cooling effectiveness via the use of microstructured impingement surfaces. These surfaces significantly increase the cooling capability of the impinging flow, as compared to a conventional untextured surface. This approach can be combined with microchannel cooling and external film cooling to tailor the cooling capability per the external heating profile. The cooling system then can be optimized to minimize impact on engine performance.

  19. Improved Stirling engine performance using jet impingement

    NASA Technical Reports Server (NTRS)

    Johnson, D. C.; Britt, E. J.; Thieme, L. G.

    1982-01-01

    Of the many factors influencing the performance of a Stirling engine, that of transferring the combustion gas heat into the working fluid is crucial. By utilizing the high heat transfer rates obtainable with a jet impingement heat transfer system, it is possible to reduce the flame temperature required for engine operation. Also, the required amount of heater tube surface area may be reduced, resulting in a decrease in the engine nonswept volume and a related increase in engine efficiency. A jet impingement heat transfer system was designed by Rasor Associates, Inc., and tested in the GPU-3 Stirling engine at the NASA Lewis Research Center. For a small penalty in pumping power (less than 0.5% of engine output) the jet impingement heat transfer system provided a higher combustion-gas-side heat transfer coefficient and a smoothing of heater temperature profiles resulting in lower combustion system temperatures and a 5 to 8% increase in engine power output and efficiency.

  20. Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques

    PubMed Central

    Ruiz Santiago, Fernando; Santiago Chinchilla, Alicia; Ansari, Afshin; Guzmán Álvarez, Luis; Castellano García, Maria del Mar; Martínez Martínez, Alberto; Tercedor Sánchez, Juan

    2016-01-01

    Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both. PMID:26885391

  1. Industrial stator vane with sequential impingement cooling inserts

    DOEpatents

    Jones, Russell B; Fedock, John A; Goebel, Gloria E; Krueger, Judson J; Rawlings, Christopher K; Memmen, Robert L

    2013-08-06

    A turbine stator vane for an industrial engine, the vane having two impingement cooling inserts that produce a series of impingement cooling from the pressure side to the suction side of the vane walls. Each insert includes a spar with a row of alternating impingement cooling channels and return air channels extending in a radial direction. Impingement cooling plates cover the two sides of the insert and having rows of impingement cooling holes aligned with the impingement cooling channels and return air openings aligned with the return air channel.

  2. Usefulness of the Medial Portal during Hip Arthroscopy

    PubMed Central

    Kang, Chan; Hwang, Jung-Mo; Park, Eugene J.

    2015-01-01

    The current conventional portals for hip arthroscopic surgery are the anterior, anterolateral, and posterolateral portals. For lesions in the medial anteroinferior or posteroinferior portion of the hip, these portals provide insufficient access to the lesion and consequently lead to incomplete treatment. Thus, in such a situation, a medial portal approach might be helpful. However, operators have avoided this procedure because of the risk of injury to the obturator, femoral neurovascular structures, and the medial femoral circumflex artery. Thus, to overcome the disadvantages of the conventional method for medial lesions of the hip, we performed a cadaveric study to evaluate the technique, usefulness, and risk of the medial portal technique. PMID:26330964

  3. Optimal management of shoulder impingement syndrome

    PubMed Central

    Escamilla, Rafael F; Hooks, Todd R; Wilk, Kevin E

    2014-01-01

    Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a complete and thorough evaluation. The clinician devises an effective rehabilitation program to regain full glenohumeral range of motion, reestablish dynamic rotator cuff stability, and implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers. The clinician can introduce stresses and forces via sport-specific drills and functional activities to allow a return to activity. PMID:24648778

  4. Acoustics measurements in normal jet impingement

    NASA Technical Reports Server (NTRS)

    Kleis, S. J.

    1977-01-01

    The dependence of far field acoustic measurements for a uniform jet on nozzle to plate spacing for small dimensionless spacings (h/d - 0.75 to 3.0) was investigated. Spectra from a real time analyzer were read and processed by an HP 2116 minicomputer in on-line mode. Similar data was generated for a fully developed pipe flow exit condition jet to compare with other investigations. The data base for normal jet impingement was extended to smaller values of nozzle to plate spacing. The effects of slight noise heating (30 deg rise) of the jet on the far field noise produced by the impinging jet are demonstrated.

  5. Bursitis of the Hip

    MedlinePlus

    ... following: Repeated overuse or stress of the hip Rheumatoid arthritis Gout Pseudogout Injury of the hip Infection with bacteria, such as Staphylococcus aureus (or a staph infection) Diabetes Spine problems, such as scoliosis Uneven leg lengths ...

  6. Hip joint replacement - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: the ...

  7. Hip joint injection

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007633.htm Hip joint injection To use the sharing features on this ... injection is a shot of medicine into the hip joint. The medicine helps relieve pain and inflammation. It ...

  8. Hip joint replacement

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/002975.htm Hip joint replacement To use the sharing features on this page, please enable JavaScript. Hip joint replacement is surgery to replace all or part ...

  9. Hip Injuries and Disorders

    MedlinePlus

    ... or falling can all sometimes lead to hip injuries. These include Strains Bursitis Dislocations Fractures Certain diseases also lead to hip injuries or problems. Osteoarthritis can cause pain and limited ...

  10. Hip fracture surgery

    MedlinePlus

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  11. Arthroscopic Technique for Treatment of Combined Pathology Associated With Femoroacetabular Impingement Syndrome Using Traction Sutures and a Minimal Capsulotomy

    PubMed Central

    Thakral, Rishi; Ochiai, Derek

    2014-01-01

    The use of hip arthroscopy is gaining popularity for diagnostic and therapeutic purposes. With our increasing understanding of hip biomechanics and pathophysiology, our techniques for treatment are evolving as well. The main aim is to preserve the joint and prolong the degenerative process associated with femoroacetabular impingement (FAI). In general, combined pathology is encountered when a diagnosis of FAI is established. In our experience, we have seen large number of patients with a combination of cam and pincer lesions with or without associated labral tears. It is optimal to address all symptomatic pathology with one surgical intervention. The described technique shows the feasibility of dealing with the hip FAI pathology by using traction sutures on the capsule through a 2-portal technique. PMID:25264515

  12. Greater Hip Extension but Not Hip Abduction Explosive Strength Is Associated With Lesser Hip Adduction and Knee Valgus Motion During a Single-Leg Jump-Cut

    PubMed Central

    Cronin, Baker; Johnson, Samuel T.; Chang, Eunwook; Pollard, Christine D.; Norcross, Marc F.

    2016-01-01

    Background: The relationships between hip abductor and extensor strength and frontal plane hip and knee motions that are associated with anterior cruciate ligament injury risk are equivocal. However, previous research on these relationships has evaluated relatively low-level movement tasks and peak torque rather than a time-critical strength measure such as the rate of torque development (RTD). Hypothesis: Females with greater hip abduction and extension RTD would exhibit lesser frontal plane hip and knee motion during a single-leg jump-cutting task. Study Design: Descriptive laboratory study. Methods: Forty recreationally active females performed maximal isometric contractions and single-leg jump-cuts. From recorded torque data, hip extension and abduction RTD was calculated from torque onset to 200 ms after onset. Three-dimensional motion analysis was used to quantify frontal plane hip and knee kinematics during the movement task. For each RTD measure, jump-cut biomechanics were compared between participants in the highest (high) and lowest (low) RTD tertiles. Results: No differences in frontal plane hip and knee kinematics were identified between high and low hip abduction RTD groups. However, those in the high hip extension RTD group exhibited lower hip adduction (high, 3.8° ± 3.0°; low, 6.5° ± 3.0°; P = .019) and knee valgus (high, –2.5° ± 2.3°; low, –4.4° ± 3.2°; P = .046) displacements during the jump-cut. Conclusion: In movements such as cutting that are performed with the hip in a relatively abducted and flexed position, the ability of the gluteus medius to control hip adduction may be compromised. However, the gluteus maximus, functioning as a hip abductor, may take on a pivotal role in controlling hip adduction and knee valgus motion during these types of tasks. Clinical Relevance: Training with a specific emphasis on increasing explosive strength of the hip extensors may be a means through which to improve frontal plane hip and knee

  13. Does Previous Hip Surgery Effect the Outcome of Tönnis Triple Periacetabular Osteotomy? Mid-Term Results

    PubMed Central

    Konya, Mehmet Nuri; Aydın, Bahattin Kerem; Yıldırım, Timur; Sofu, Hakan; Gürsu, Sarper

    2016-01-01

    Abstract Hip dysplasia (HD) is 1 of the major reasons of coxarthrosis. The goal of the treatment of HD by Tönnis triple pelvic osteotomy (TPAO) is to improve the function of hip joint while relieving pain, delaying and possibly preventing end-stage arthritis. The aim of this study is to compare the clinical and radiological results of TPAO to determine if previous surgery has a negative effect on TPAO. Patients operated with TPAO between 2005 and 2010, included in this study. Patients divided into 2 groups: primary acetabular dysplasia (PAD) and residual acetabular dysplasia (RAD). Prepostoperatively, hip range of motion, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip score, visual analog scores (VAS), impingement tests, and also the presence of Trendelenburg sign (TS) were investigated for clinical evaluation. For radiological analysis pre–postoperative, anterior–posterior (AP) pelvis and faux profile radiographs were used. Acetabular index, lateral center edge (LCE) angle, and Sharp angles were measured by AP pelvis; anterior center edge (ACE) angle were measured by faux profile radiography. All the clinical and radiological data of the groups were analyzed separately for the pre–postoperative scores also the amount of improvement in all parameters were analyzed. SPSS20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Wilcoxon test, McNemar test, paired t tests, and Mann–Whitney U tests were used to compare the groups. P < 0.05 were defined as statistically significant. Study included 27 patients: 17 patients were in PAD and 10 patients were in RAD. The mean follow-up period was 6.2 years (5.2–10.3 years). In all patients, the radiological and the clinical outcomes were better after TPAO except the flexion of the hip parameter. When the patient groups were evaluated as pre–postoperatively, more statistically significant parameters were found in the PAD group when compared with RAD

  14. Particle-Molecule Collection by Sonic Flow Impingers

    ERIC Educational Resources Information Center

    Jackson, Melbourne L.

    1974-01-01

    The theoretical basis of the sonic-flow impinger is discussed. Details are given for the design, prediction of performance, preliminary evaluation for particle collection, and field use of a sonic-flow impinger train. (DT)

  15. Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement

    PubMed Central

    Phadke, V; Camargo, PR; Ludewig, PM

    2009-01-01

    Objective The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. Results The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. Conclusion These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients. PMID:20411160

  16. Shoulder Impingement/Rotator Cuff Tendinitis

    MedlinePlus

    .org Shoulder Impingement/Rotator Cuff Tendinitis Page ( 1 ) One of the most common physical complaints is shoulder pain. Your shoulder is made up of several ... is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the ...

  17. Shoulder Impingement Syndrome (Beyond the Basics)

    MedlinePlus

    ... activities: ● Swim ● Throw ● Play tennis ● Lift weights ● Play golf ● Play volleyball ● Do gymnastics ● Paint ● Stock shelves SHOULDER ... impingement, your healthcare provider will examine you to learn what movements elicit symptoms. As part of the ...

  18. Subacromial impingement syndrome secondary to scapulothoracic dyskinesia.

    PubMed

    Han, Kyeong-Jin; Cho, Jae-Ho; Han, Seung-Hwan; Hyun, Hwan-Sub; Lee, Doo-Hyung

    2012-10-01

    The authors describe two cases of subacromial impingement syndrome of the shoulder secondary to scapular dyskinesia caused by a tumor in young adults. The two tumors, an osteochondroma and a ganglion, were located in the scapulothoracic joint and inhibited normal kinesis of the scapula during arm motion. PMID:22127513

  19. Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty.

    PubMed

    Sculco, Peter K; Austin, Matthew S; Lavernia, Carlos J; Rosenberg, Aaron G; Sierra, Rafael J

    2016-01-01

    Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education. The use of larger femoral heads, high-offset stem options, and enhanced soft-tissue repairs have improved impingement-free range of motion as well as dynamic hip stability and have contributed to an overall reduction in dislocation. Methods for accurate leg length restoration and component positioning include anatomic landmarks, intraoperative radiographs, intraoperative calipers, stability testing, and computer-assisted surgery. If recurrent instability occurs after total hip arthroplasty, the underlying cause for dislocation should be identified and treated; this may include the use of semiconstrained dual-mobility or fully constrained liners, depending on abductor function. Surgeons should be aware of the clinical and surgical techniques for achieving leg length equalization and dynamic hip stability in total hip arthroplasty. PMID:27049193

  20. Injuries about the hip in the adolescent athlete.

    PubMed

    Kovacevic, David; Mariscalco, Michael; Goodwin, Ryan C

    2011-03-01

    Athletic injuries in or around the hip in the adolescent athlete encompass possible causes such as a single, traumatic event to those of repetitive microtrauma. The injuries may involve the bone or the soft tissues, with former involving the epiphysis, apophysis, metaphysis, or diaphysis, whereas the latter includes muscles and tendons. With the improvements in surgical technique and instrumentation for hip arthroscopy and the development of magnetic resonance arthrography, clinicians have been able to diagnose and treat labral tears, hip instability, snapping hip, loose bodies, chondral injuries, and femoroacetabular impingement. The clinician needs to consider acquired conditions that may have coincidentally become apparent as a result of the adolescent's participation in an organized sports program. These include slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, and pathologic lesions and fractures. This study reviews the more common acute and chronic overuse injuries in or around the hip in the adolescent athlete and discusses hip injury prevention in this active patient population. PMID:21293240

  1. Femur-mounted navigation system for the arthroscopic treatment of femoroacetabular impingement

    NASA Astrophysics Data System (ADS)

    Park, S. H.; Hwang, D. S.; Yoon, Y. S.

    2013-07-01

    Femoroacetabular impingement stems from an abnormal shape of the acetabulum and proximal femur. It is treated by resection of damaged soft tissue and by the shaping of bone to resemble normal features. The arthroscopic treatment of femoroacetabular impingement has many advantages, including minimal incisions, rapid recovery, and less pain. However, in some cases, revision is needed owing to the insufficient resection of damaged bone from a misreading of the surgical site. The limited view of arthroscopy is the major reason for the complications. In this research, a navigation method for the arthroscopic treatment of femoroacetabular impingement is developed. The proposed navigation system consists of femur attachable measurement device and user interface. The bone mounted measurement devices measure points on head-neck junction for registration and position of surgical instrument. User interface shows the three-dimensional model of patient's femur and surgical instrument position that is tracked by measurement device. Surgeon can know the three-dimensional anatomical structure of hip joint and surgical instrument position on surgical site using navigation system. Surface registration was used to obtain relation between patient's coordinate at the surgical site and coordinate of three-dimensional model of femur. In this research, we evaluated the proposed navigation system using plastic model bone. It is expected that the surgical tool tracking position accuracy will be less than 1 mm.

  2. The evolution and concepts of joint-preserving surgery of the hip.

    PubMed

    Leunig, M; Ganz, R

    2014-01-01

    The use of joint-preserving surgery of the hip has been largely abandoned since the introduction of total hip replacement. However, with the modification of such techniques as pelvic osteotomy, and the introduction of intracapsular procedures such as surgical hip dislocation and arthroscopy, previously unexpected options for the surgical treatment of sequelae of childhood conditions, including developmental dysplasia of the hip, slipped upper femoral epiphysis and Perthes' disease, have become available. Moreover, femoroacetabular impingement has been identified as a significant aetiological factor in the development of osteoarthritis in many hips previously considered to suffer from primary osteoarthritis. As mechanical causes of degenerative joint disease are now recognised earlier in the disease process, these techniques may be used to decelerate or even prevent progression to osteoarthritis. We review the recent development of these concepts and the associated surgical techniques. PMID:24395304

  3. Do normal hips dislocate?

    PubMed

    Alshameeri, Zeiad; Rehm, Andreas

    2014-11-01

    There have been a small number of case reports describing late normal-hip dislocations in children who were later diagnosed with developmental dysplasia of the hip. Here, we contest the assumption that normal hips can dislocate. We argue that (as in our case) the ultrasound scans in all published case reports on late dislocated normal hips did not show results that were entirely normal and therefore, so far, there has been no convincing evidence of a dislocation of a normal hip. We also want to highlight the importance of meticulous ultrasound and clinical assessments of high-risk children by an experienced orthopaedic surgeon. PMID:25144883

  4. Experimental Droplet Impingement on Four Bodies of Revolution

    NASA Technical Reports Server (NTRS)

    Lewis, James P.; Ruggeri, Robert S.

    1957-01-01

    The rate and. area of cloud droplet impingement on four bodies of revolution were obtained experimentally in the NACA Lewis icing tunnel with a dye-tracer technique. The study included spheres, ellipsoidal forebodies of fineness ratios of 2.5 and 3.0, and a conical forebody of 300 included angle and covered a range of angles of attack from 0? to 60 and rotational speeds up to 1200 rpm. The data were obtained at an airspeed of 157 knots and are correlated by dimensionless impingement parameters. In general, the experimental data show that the local and total impingement rates and impingement limits of bodies of revolution are primarily functions of the modified inertia parameters, the body shape, and fineness ratio. Both the local impingement rate and impingement limits depend upon the angle of attack. Rotation of the bodies had a negligible effect on the impingement characteristics except for an averaging effect at angle of attack. For comparable diameters the bluffer bodies had the largest total impingement efficiency, but the finer and sharper bodies had the largest values of maximum local impingement efficiency and, in most cases, the largest limits of impingement. In most cases, the impingement characteristics were less than those calculated from theoretical trajectories; in general, however, fairly good agreement was obtained between the experimental and theoretical impingement characteristics.

  5. Phacoemulsification in anterior megalophthalmos.

    PubMed

    Lee, Graham A; Hann, Joshua V; Braga-Mele, Rosa

    2006-07-01

    This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes. PMID:16857490

  6. Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study.

    PubMed

    Hughes, A W; Clark, D; Carlino, W; Gosling, O; Spencer, R F

    2015-01-01

    Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the 'capsule repaired' (mean 22.96 Nm, standard deviation (sd) 4.61) and the 'capsule not repaired' group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA. PMID:25568428

  7. Improved Squat and Gait Biomechanics 6-Months Post-Arthroscopic Surgery for Femoroacetabular Impingement

    PubMed Central

    Cvetanovich, Gregory; Farkas, Gary Jordan; Rajan, Kumar; Espinoza, Alejandro; Nho, Shane Jay

    2016-01-01

    Objectives: This study aimed to assess gait and squat biomechanics 6-months following arthroscopic surgery for femoroacetabular impingement. Methods: Symptomatic patients with clinical and radiographic diagnosis of FAI who had failed non-operative treatment underwent gait and squat analysis preoperatively and at 6-months postoperatively following arthroscopic surgery for FAI. Age- and BMI-matched controls without radiographic FAI or other lumbar or lower extremity pathology underwent a single analysis for comparison. Comparisons between preoperative and 6-month postoperative gait and squat parameters as well as comparison to the control group were performed using paired and independent sample t-tests. Statistical significance was set at p<0.05. Results: Fifteen FAI patients and 9 controls were analyzed. Age for the patients vs. controls was 28.7±9.6 y vs. 27.8±6.5 y (p>0.05), respectively; while BMI was 23.5±5.1 kg/m2 vs. 22.8±3.5 kg/m2 (p>0.05). All gait parameters were unchanged between preoperative and 6-month postoperative testing (p>0.05), with a trend toward significance for hip external rotation moment (p=0.056) (Table 1). Squat testing revealed that FAI arthroscopic surgery increased maximum hip extension (p=0.011), with a trend toward significance for hip adduction moment (p=0.059). All other squat parameters did not differ from preoperative to 6-month follow-up (p>0.05). Compared to the control group, preoperative FAI patients had reduced hip external rotation moment during gait (p=0.024), with a trend toward significance for hip abduction moment (p=0.082). No other gait or squat differences were detected between FAI patients preoperatively or 6-months postoperatively compared to controls (p>0.05). Conclusion: Biomechanical gait and squat analysis at 6-month follow-up from arthroscopic FAI surgery revealed a tendency to improve external hip rotation during gait and maximum hip extension and hip adduction during squat. Arthroscopic surgery for FAI may

  8. Vortex rings impinging on permeable boundaries

    NASA Astrophysics Data System (ADS)

    Mujal-Colilles, Anna; Dalziel, Stuart B.; Bateman, Allen

    2015-01-01

    Experiments with vortex rings impinging permeable and solid boundaries are presented in order to investigate the influence of permeability. Utilizing Particle Image Velocimetry, we compared the behaviour of a vortex ring impinging four different reticulated foams (with permeability k ˜ 26 - 85 × 10-8 m2) and a solid boundary. Results show how permeability affects the stretching phenomena of the vortex ring and the formation and evolution of the secondary vortex ring with opposite sign. Moreover, permeability also affects the macroscopic no-slip boundary condition found on the solid boundary, turning it into an apparent slip boundary condition for the most permeable boundary. The apparent slip-boundary condition and the flux exchange between the ambient fluid and the foam are jointly responsible for both the modified formation of the secondary vortex and changes on the vortex ring diameter increase.

  9. Minimally invasive medial hip approach.

    PubMed

    Chiron, P; Murgier, J; Cavaignac, E; Pailhé, R; Reina, N

    2014-10-01

    The medial approach to the hip via the adductors, as described by Ludloff or Ferguson, provides restricted visualization and incurs a risk of neurovascular lesion. We describe a minimally invasive medial hip approach providing broader exposure of extra- and intra-articular elements in a space free of neurovascular structures. With the lower limb in a "frog-leg" position, the skin incision follows the adductor longus for 6cm and then the aponeurosis is incised. A slide plane between all the adductors and the aponeurosis is easily released by blunt dissection, with no interposed neurovascular elements. This gives access to the lesser trochanter, psoas tendon and inferior sides of the femoral neck and head, anterior wall of the acetabulum and labrum. We report a series of 56 cases, with no major complications: this approach allows treatment of iliopsoas muscle lesions and resection or filling of benign tumors of the cervical region and enables intra-articular surgery (arthrolysis, resection of osteophytes or foreign bodies, labral suture). PMID:25164350

  10. The Use of Double-Loaded Suture Anchors for Labral Repair and Capsular Repair During Hip Arthroscopy

    PubMed Central

    Slikker, William; Van Thiel, Geoffrey S.; Chahal, Jaskarndip; Nho, Shane J.

    2012-01-01

    With the development of hip joint preservation procedures, the use of hip arthroscopy has grown dramatically over the past decade. However, recent articles have reported cases of hip instability after hip arthroscopy. Little is known about the role of static and dynamic stabilizers on hip joint stability, but there are concerns that an extensile capsulotomy or capsulectomy, osteoplasty of the acetabulum and proximal femur, and labral detachment or debridement during hip arthroscopy could potentially compromise hip stability. The safety parameters for arthroscopic hip surgery have not yet been fully established, and techniques are being developed for labral refixation and capsular repair after arthroscopic treatment of femoroacetabular impingement in an attempt to decrease the chance of iatrogenic hip instability or microinstability. The surgical technique presented in this article may provide anatomic repair of both the labrum and capsule using a double-loaded suture anchor technique. We believe that this technique increases both operative efficiency and the strength of the overall repair, which may minimize the risk of iatrogenic hip instability after hip arthroscopy. PMID:23766998