Open-MRI measures of cam intrusion for hips in an anterior impingement position relate to acetabular contact force.

PubMed

Buchan, Lawrence L; Zhang, Honglin; Konan, Sujith; Heaslip, Ingrid; Ratzlaff, Charles R; Wilson, David R

2016-02-01

Open MRI in functional positions has potential to directly and non-invasively assess cam femoroacetabular impingement (FAI). Our objective was to investigate whether open MRI can depict intrusion of the cam deformity into the intra-articular joint space, and whether intrusion is associated with elevated acetabular contact force. Cadaver hips (9 cam; 3 controls) were positioned in an anterior impingement posture and imaged using open MRI with multi-planar reformatting. The β-angle (describing clearance between the femoral neck and acetabulum) was measured around the entire circumference of the femoral neck. We defined a binary "MRI cam-intrusion sign" (positive if β < 0°). We then instrumented each hip with a piezoresistive sensor and conducted six repeated positioning trials, measuring acetabular contact force (F). We defined a binary "contact-force sign" (positive if F > 20N). Cam hips were more likely than controls to have both a positive MRI cam-intrusion sign (p = 0.0182, Fisher's exact test) and positive contact-force sign (p = 0.0083), which represents direct experimental evidence for cam intrusion. There was also a relationship between the MRI cam-intrusion sign and contact-force sign (p = 0.033), representing a link between imaging and mechanics. Our findings indicate that open MRI has significant potential for in vivo investigation of the cam FAI mechanism. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Anterior ankle impingement syndromes.

PubMed

Umans, Hilary R; Cerezal, Luiz

2008-06-01

Ankle impingement syndromes are painful conditions that may complicate ankle trauma and are characterized by chronic, progressive pain, swelling, and limitation of movement. These disorders are subclassified according to anatomical location about the tibiotalar joint. This article reviews the various forms of anterior ankle impingement, detailing the unique clinical features, anatomical considerations, pathoetiology, and imaging findings for each.

Subspine impingement: 2 case reports of a previously unreported cause of instability in total hip arthroplasty.

PubMed

Davidovitch, Roy I; DelSole, Edward M; Vigdorchik, Jonathan M

2016-03-23

Instability is a common cause of revision hip arthroplasty and is frequently due to improper component placement and subsequent component impingement. Impingement of the greater trochanter upon the anterior inferior iliac spine (AIIS) has been described as a cause of symptomatic femoroacetabular impingement (FAI), but has never been described as a cause of instability following total hip arthroplasty (THA). We present 2 cases of patients undergoing THA. Each patient was evaluated preoperatively and found to have a prominent AIIS, which was concerning due to it overhanging the anterolateral acetabular lip. Both patients had intraoperative posterior instability of their THA, the cause of which was determined to be impingement of the greater trochanter upon a prominent AIIS. Open resection of the AIIS was performed with subsequent resolution of impingement. AIIS impingement has been reported as a cause of symptomatic FAI. In these case reports, open or arthroscopic resection of the AIIS resulted in resolution of symptoms. Morphologically distinct subtypes of the AIIS have been previously described based upon computed tomography, and some subtypes are associated with a high risk of impingement in the native hip. No previous studies have described this phenomenon in the setting of THA. Instability is a common cause of revision THA. Impingement of the greater trochanter upon a prominent AIIS is a previously unreported cause of THA instability which can be addressed with intraoperative resection of the AIIS with good result.

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

Surgical hip dislocation for treatment of cam femoroacetabular impingement.

PubMed

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

2015-01-01

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. 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. 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°). 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.

Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement.

PubMed

Zhang, Kailai; de Sa, Darren; Yu, Hang; Choudur, Hema Nalini; Simunovic, Nicole; Ayeni, Olufemi Rolland

2018-03-24

Femoroacetabular impingement (FAI) is a clinical entity of the hip causing derangements in range of motion, pain, gait, and function. Computer-assisted modeling and clinical studies suggest that patients with FAI have increased capsular thickness compared to those without.A retrospective chart review was performed to assess relationships between capsular thickness, hip range of motion, and demographic factors in patients with FAI. Local Research Ethics Board approval was obtained to extract electronic medical records for 188 patients at a single institution who had undergone hip arthroscopy. Procedures were performed from 2009 to 2017 by a single, fellowship-trained, board-certified sports medicine orthopaedic surgeon. Inclusion criteria were preoperative hip range of motion testing, positive clinical impingement testing, and magnetic resonance imaging (MRI) of the affected hip. Patient demographics, hip range of motion, and time to surgery were recorded. MRIs were reviewed by a board-certified musculoskeletal radiologist blinded to clinical data. Maximum thickness of the anterior hip capsule was measured in axial, axial oblique, and sagittal oblique sequences. Anterior capsular thickness was also measured at the level of the femoral head-neck junction in axial sequences (axial midline). Axial midline capsular thickness was negatively correlated with hip flexion (r = - 0.196, p = 0.0042) and internal rotation (r = - 0.143, p = 0.0278). Significant differences were seen between genders in axial midline thickness (5.3 ± 1.4 mm males/4.8 ± 1.3 mm females, p = 0.0079), flexion (113° ± 18° males/120° ± 17° females, p = 0.0029), and internal rotation (23° ± 13° males/29° ± 12° females, p = 0.0155). Significant differences also existed between side affected in flexion (116° ± 17° right/119° ± 17° left, p = 0.0396) and internal rotation (26° ± 12° right/29° ± 13° left

Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement.

PubMed

Bedi, Asheesh; Zaltz, Ira; De La Torre, Katrina; Kelly, Bryan T

2011-07-01

Whether open or arthroscopic techniques are employed, the goal of femoroacetabular impingement (FAI) surgery is to achieve impingement-free range of motion. While arthroscopic approaches have improved and gained popularity, an objective evaluation of the surgical correction achieved with this approach compared with open surgery remains to be defined in the literature. This study was undertaken to compare the efficacy of arthroscopic osteoplasty and open surgical dislocation in treating FAI dysmorphology in a consecutive series of patients. Cohort study; Level of evidence, 3. Surgical treatment was performed in 60 male patients under 40 years of age for symptomatic FAI refractory to nonoperative management. Patients were matched (not randomized) to treatment groups: 30 patients (15 left and 15 right hips) underwent arthroscopic cam and/or rim osteoplasty with labral debridement and/or refixation by an arthroscopic surgeon; and 30 (14 left and 16 right hips) underwent open surgical dislocation, cam and/or rim osteoplasty, and labral debridement or refixation by a hip preservation surgeon. Anteroposterior (AP) pelvis and extended-neck (Dunn) lateral radiographs were obtained and the depth of resection and arc of resection were measured by assessment of anterior femoral head-neck offset, AP and lateral α angle, and β angle on preoperative and postoperative radiographs. In the arthroscopic group, the extended-neck lateral α angle was reduced by a mean of 17.2° (28.3%, P < .05), AP α angle was reduced by a mean of 12.6° (16.8%), anterior head-neck offset improved 5.0 mm (111%, P < .05), and β angle increased by a mean of 23.1°. In the open dislocation group, the extended-neck lateral α angle was reduced by a mean of 21.2° (30.7%, P < .05), AP α angle was reduced by a mean of 20.1° (25.7%), anterior head-neck offset improved 6.56 mm (108%, P < .05), and β angle increased by a mean of 18.35°. Arthroscopic osteoplasty can restore head-neck offset and achieve

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

Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept.

PubMed

Larson, Christopher M; Kelly, Bryan T; Stone, Rebecca M

2011-12-01

Femoroacetabular impingement is typically described as occurring due to a conflict between the femoral head-neck junction and acetabular rim. A prior case report described an open decompression of the anterior inferior iliac spine (AIIS) due to impingement against the proximal femur. AIIS impingement may be developmental or the result of a prior AIIS avulsion or pelvic osteotomy. We describe 3 representative cases with minimum 1-year follow-up treated with an arthroscopic AIIS decompression. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy-a systematic review.

PubMed

Haldane, Chloe E; Ekhtiari, Seper; de Sa, Darren; Simunovic, Nicole; Ayeni, Olufemi R

2017-08-01

The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior-posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence : Level IV, Systematic Review of Level I-IV Studies.

ACL Roof Impingement Revisited: Does the Independent Femoral Drilling Technique Avoid Roof Impingement With Anteriorly Placed Tibial Tunnels?

PubMed

Tanksley, John A; Werner, Brian C; Conte, Evan J; Lustenberger, David P; Burrus, M Tyrrell; Brockmeier, Stephen F; Gwathmey, F Winston; Miller, Mark D

2017-05-01

Anatomic femoral tunnel placement for single-bundle anterior cruciate ligament (ACL) reconstruction is now well accepted. The ideal location for the tibial tunnel has not been studied extensively, although some biomechanical and clinical studies suggest that placement of the tibial tunnel in the anterior part of the ACL tibial attachment site may be desirable. However, the concern for intercondylar roof impingement has tempered enthusiasm for anterior tibial tunnel placement. To compare the potential for intercondylar roof impingement of ACL grafts with anteriorly positioned tibial tunnels after either transtibial (TT) or independent femoral (IF) tunnel drilling. Controlled laboratory study. Twelve fresh-frozen cadaver knees were randomized to either a TT or IF drilling technique. Tibial guide pins were drilled in the anterior third of the native ACL tibial attachment site after debridement. All efforts were made to drill the femoral tunnel anatomically in the center of the attachment site, and the surrogate ACL graft was visualized using 3-dimensional computed tomography. Reformatting was used to evaluate for roof impingement. Tunnel dimensions, knee flexion angles, and intra-articular sagittal graft angles were also measured. The Impingement Review Index (IRI) was used to evaluate for graft impingement. Two grafts (2/6, 33.3%) in the TT group impinged upon the intercondylar roof and demonstrated angular deformity (IRI type 1). No grafts in the IF group impinged, although 2 of 6 (66.7%) IF grafts touched the roof without deformation (IRI type 2). The presence or absence of impingement was not statistically significant. The mean sagittal tibial tunnel guide pin position prior to drilling was 27.6% of the sagittal diameter of the tibia (range, 22%-33.9%). However, computed tomography performed postdrilling detected substantial posterior enlargement in 2 TT specimens. A significant difference in the sagittal graft angle was noted between the 2 groups. TT grafts were

Arthroscopic Decompression of a Type III Subspine Impingement.

PubMed

Ilizaliturri, Víctor M; Arriaga Sánchez, Rubén; Suarez-Ahedo, Carlos

2016-12-01

Extra-articular hip impingement refers to a variety of hip disorders causing pain and limited function in young, non-arthritic patients. Recently, there has been an increased focus on analyzing the degree of anterior inferior iliac spine (AIIS) dysmorphism and its correlation with subspine impingement (SSI), defined as abutment between a prominent distal aspect of the AIIS and the anterior aspect of the femoral head-neck junction. Arthroscopic decompression of the AIIS is recognized as an effective treatment for SSI. However, there may be some inherent risks of performing this procedure arthroscopically that require further investigation.

Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement.

PubMed

Shibahara, Motoi; Ohnishi, Yasuo; Honda, Eisaburo; Matsuda, Dean K; Uchida, Soshi

2017-07-01

This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.]. Copyright 2017, SLACK Incorporated.

What is the impingement-free range of motion of the asymptomatic hip in young adult males?

PubMed

Larkin, Brian; van Holsbeeck, Marnix; Koueiter, Denise; Zaltz, Ira

2015-04-01

Femoroacetabular impingement is a recognized cause of chondrolabral injury. Although surgical treatment for impingement seeks to improve range of motion, there are very little normative data on dynamic impingement-free hip range of motion (ROM) in asymptomatic people. Hip ultrasound demonstrates labral anatomy and femoral morphology and, when used dynamically, can assist in measuring range of motion. The purposes of this study were (1) to measure impingement-free hip ROM until labral deflection is observed; and (2) to measure the maximum degree of sagittal plane hip flexion when further flexion is limited by structural femoroacetabular abutment. Forty asymptomatic adult male volunteers (80 hips) between the ages of 21 and 35 years underwent bilateral static and dynamic hip ultrasound examination. Femoral morphology was characterized and midsagittal flexion passive ROM was measured at two points: (1) at the initiation of labral deformation; and (2) at maximum flexion when the femur impinged on the acetabular rim. The mean age of the subjects was 28 ± 3 years and the mean body mass index was 25 ± 4 kg/m(2). Mean impingement-free hip passive flexion measured from full extension to initial labral deflection was 68° ± 17° (95% confidence interval [CI], 65-72). Mean maximum midsagittal passive flexion, measured at the time of bony impingement, was 96° ± 6° (95% CI, 95-98). Using dynamic ultrasound, we found that passive ROM in the asymptomatic hip was much less than the motion reported in previous studies. Measuring ROM using ultrasound is more accurate because it allows anatomic confirmation of terminal hip motion. Surgical procedures used to treat femoroacetabular impingement are designed to restore or increase hip ROM and their results should be evaluated in light of precise normative data. This study suggests that normal passive impingement-free femoroacetabular flexion in the young adult male is approximately 95°.

Endoscopic or arthroscopic iliopsoas tenotomy for iliopsoas impingement following total hip replacement. A prospective multicenter 64-case series.

PubMed

Guicherd, W; Bonin, N; Gicquel, T; Gedouin, J E; Flecher, X; Wettstein, M; Thaunat, M; Prevost, N; Ollier, E; May, O

2017-12-01

Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications. A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation. At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength. Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment. Copyright © 2017. Published by Elsevier Masson SAS.

Experimentally induced cam impingement in the sheep hip.

PubMed

Siebenrock, Klaus A; Fiechter, Ruth; Tannast, Moritz; Mamisch, Tallal C; von Rechenberg, Brigitte

2013-04-01

Sheep hips have a natural non-spherical femoral head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoro-acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam-type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non-operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38-weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam-type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273-280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012-1018), can be reproduced. This experimental sheep model can be used to study cam-type FAI. Copyright © 2012 Orthopaedic Research Society.

Two or more impingement and/or instability deformities are often present in patients with hip pain.

PubMed

Tibor, Lisa M; Liebert, Gunnar; Sutter, Reto; Impellizzeri, Franco M; Leunig, Michael

2013-12-01

Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery. We determined (1) the influence of sex on the expression of impingement-related or instability-related factors, (2) the associations among these factors, and (3) how often both impingement and/or instability factors occur in the same hip. We retrospectively reviewed a cohort of 170 hips (145 patients) undergoing MR arthrography of the hip for any reason. We excluded 58 hips with high-grade dysplasia, Perthes' sequelae, previous surgery, or incomplete radiographic information, leaving 112 hips (96 patients). We measured femoral version and alpha angles on MR arthrograms. Acetabular anteversion, lateral CEA, and neck-shaft angle were measured on pelvic radiographs. We observed a correlation between sex and alpha angle. Weak or no correlations were observed between the other five parameters. In 66% of hips, two or more (of five) impingement parameters, and in 51% of hips, two or more (of five) instability parameters were found. Patients with hip pain frequently have several anatomic factors potentially contributing to chondrolabral damage. To address pathologic hip loading due to impingement and/or instability, all of the anatomic influences should be known. As we found no associations between anatomic factors, we recommend an individualized assessment of each painful hip.

Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement.

PubMed

de Sa, Darren; Alradwan, Hussain; Cargnelli, Stephanie; Thawer, Zoyah; Simunovic, Nicole; Cadet, Edwin; Bonin, Nicolas; Larson, Christopher; Ayeni, Olufemi R

2014-08-01

Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management. We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented. Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score (P = .008), Hip Outcome Score-Activities of Daily Living (P = .02), and Hip Outcome Score-Sport (P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported. This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes. Systematic review of

Anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in residual poliomyelitis.

PubMed

Sung, Ki Hyuk; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Park, Moon Seok

2013-09-01

This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. Level IV, retrospective case series.

Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.

PubMed

Charbonnier, Caecilia; Kolo, Frank C; Duthon, Victoria B; Magnenat-Thalmann, Nadia; Becker, Christoph D; Hoffmeyer, Pierre; Menetrey, Jacques

2011-03-01

Early hip osteoarthritis in dancers could be explained by femoroacetabular impingements. However, there is a lack of validated noninvasive methods and dynamic studies to ascertain impingement during motion. Moreover, it is unknown whether the femoral head and acetabulum are congruent in typical dancing positions. The practice of some dancing movements could cause a loss of hip joint congruence and recurrent impingements, which could lead to early osteoarthritis. Descriptive laboratory study. Eleven pairs of female dancer's hips were motion captured with an optical tracking system while performing 6 different dancing movements. The resulting computed motions were applied to patient-specific hip joint 3-dimensional models based on magnetic resonance images. While visualizing the dancer's hip in motion, the authors detected impingements using computer-assisted techniques. The range of motion and congruence of the hip joint were also quantified in those 6 recorded dancing movements. The frequency of impingement and subluxation varied with the type of movement. Four dancing movements (développé à la seconde, grand écart facial, grand écart latéral, and grand plié) seem to induce significant stress in the hip joint, according to the observed high frequency of impingement and amount of subluxation. The femoroacetabular translations were high (range, 0.93 to 6.35 mm). For almost all movements, the computed zones of impingement were mainly located in the superior or posterosuperior quadrant of the acetabulum, which was relevant with respect to radiologically diagnosed damaged zones in the labrum. All dancers' hips were morphologically normal. Impingements and subluxations are frequently observed in typical ballet movements, causing cartilage hypercompression. These movements should be limited in frequency. The present study indicates that some dancing movements could damage the hip joint, which could lead to early osteoarthritis.

Hip arthroscopy for femoroacetabular impingement

PubMed Central

Nasser, Rima; Domb, Benjamin

2018-01-01

The purpose of this article is to give a general overview of femoroacetabular impingement (FAI) and how it could be treated arthroscopically, with some details about indications, the procedure itself and some of the complications associated with the surgery. FAI is a dynamic condition of the hip that can be a source of pain and disability and could potentially lead to arthritis. When symptomatic, and if conservative treatment fails, FAI can be addressed surgically. The goal of surgical treatment for FAI is to recreate the spherical contour of the femoral head, improve femoral offset, normalize coverage of the acetabulum, repair/reconstruct chondral damage and repair/reconstruct the labrum to restore normal mechanics and joint sealing. Advances in equipment and technique have contributed to an increase in the number of hip arthroscopy procedures performed worldwide and have made it one of the more common treatment options for symptomatic FAI. Hip arthroscopy is a procedure with an extremely steep and long learning curve. Cite this article: EFORT Open Rev 2018;3:121-129. DOI: 10.1302/2058-5241.3.170041 PMID:29780619

Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: Retrospective study of 46 patients.

PubMed

Batailler, C; Bonin, N; M Wettstein; Nogier, A; Martres, S; Ollier, E; May, O; Lustig, S

2017-12-01

Impingement of the ilio-psoas tendon on the acetabular component is a cause of pain after total hip arthroplasty (THA). Studies of cup revision for ilio-psoas impingement (IPI) are scarce and limited in size. We therefore conducted a large multicentre retrospective study with the following objectives: to assess the effectiveness of cup replacement in resolving the impingement syndrome, to determine the frequency and nature of complications after cup revision for IPI, and to identify pre-operative factors associated with good outcomes of cup revision for IPI. Cup revision is effective in resolving the pain due to IPI in selected patients. This retrospective multicentre study included 46 patients who underwent cup revision because of IPI. Before the revision, 38 (83%) patients had prominence of the anterior cup rim (mean, 9.9±4.5mm (range, 2-22mm) by radiography and 35 (76%) had cup malposition (anteversion<10° and/or inclination>50°). Mean follow-up was 21months (range, 6months to 6 years) and no patient was lost to follow-up. Outcomes at last follow-up were assessed based on the Oxford Hip Score (OHS), patient satisfaction index, complications, and revisions. At last follow-up, 39 (85%) patients were satisfied with the revision procedure, a significant improvement versus baseline was noted in the OHS (mean, 43±6; range, 25-48; P<0.001), and 41 patients were free of pain during hip flexion (P<0.001 versus baseline). Complications occurred in 3 (6.5%) patients, but only one complication was severe (deep infection). Recurrent groin pain was reported by 4 (8.7%) patients at last follow-up. None of the factors studied predicted the outcome of revision surgery. Cup revision for IPI after THA is effective in relieving the groin pain in 80% of patients with anterior cup rim prominence and/or cup malposition. However, complications can occur. Tenotomy may be preferable when the diagnosis is in doubt and/or cup position is acceptable. IV, retrospective observational

Normal anatomy and imaging of the hip: emphasis on impingement assessment.

PubMed

Jesse, Mary Kristen; Petersen, Brian; Strickland, Colin; Mei-Dan, Omer

2013-07-01

A comprehensive knowledge of normal hip anatomy and imaging techniques is essential in the evaluation and assessment of the patient with hip pain. This article reviews the osseous, soft tissue, and vascular components of the hip and the normal anatomical variants encountered in routine hip imaging. Basic and advanced hip imaging is discussed with particular emphasis on radiographic and computed tomography measurements and their utility in evaluating patients with developmental hip dysplasia and femoroacetabular impingement syndrome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Inferior Iliac Spine Morphology and Outcomes of Hip Arthroscopy in Soccer Athletes: A Comparison to Nonkicking Athletes.

PubMed

Nawabi, Danyal H; Degen, Ryan M; Fields, Kara G; Wentzel, Catherine S; Adeoye, Olusanjo; Kelly, Bryan T

2017-04-01

To describe the anterior inferior iliac spine (AIIS) morphology and clinical outcomes following arthroscopic surgical decompression in a group of high-level soccer athletes presenting with symptomatic hip impingement when compared with a control group of nonkicking athletes. From 2009 to 2012, we retrospectively reviewed our prospective hip registry for soccer athletes who underwent arthroscopic treatment for femoroacetabular impingement (FAI) with 2-year follow-up, comparing with a control group of nonkicking athletes. Demographics were collected and radiographic studies (plain radiograph and computed tomographic scan) reviewed for several parameters, including AIIS morphology. Patient-reported outcome scores, including modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-33 (iHOT-33), were administered preoperatively, at 6 months, and at 1, 2, and 3 years postoperatively. Twenty-six soccer players (34 hips) and 87 nonkicking athletes (115) hips were identified. Demographics, including age (19.2 ± 4.1 vs 20.1 ± 3.8 years) and gender distribution (53.8% vs 51.7% male), were similar between the soccer and nonkicking athletes (P = .288, .849). Eighty-four percent of soccer players demonstrated some abnormality of the AIIS extending to (type II, 52%) or below the anterior acetabular rim (type III, 32%), compared with 52% nonkicking athletes (P < .001). At a mean follow-up of 35 months (range, 24-57 months) there was significant improvement in all outcome scores in both groups from pre- to postoperation (P < .001). There was no evidence of differences in outcome scores between groups (mHSS: 89 ± 14.6 vs 88.2 ± 14.4, P = .804; HOS-ADL: 94.1 ± 9.1 vs 92.2 ± 11.1, P = .431; HOS-SSS: 86 ± 17.1 vs 81.3 ± 24.3, P = .362) with the exception of iHOT-33 (81.7 ± 19 vs 70.3 ± 23.6, P = .027). High-level soccer players have a significantly higher rate

Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model.

PubMed

Iriuchishima, Takanori; Tajima, Goro; Ingham, Sheila J M; Shen, Wei; Horaguchi, Takashi; Saito, Akiyoshi; Smolinski, Patrick; Fu, Freddie H

2009-06-01

Anterior cruciate ligament (ACL) graft impingement against the intercondylar roof has been postulated, but not thoroughly investigated. The roof impingement pressure changes with different tibial and femoral tunnel positions in ACL reconstruction. Anterior tibial translation is also affected by the tunnel positions of ACL reconstruction. The study design included a controlled laboratory study. In 15 pig knees, the impingement pressure between ACL and intercondylar roof was measured using pressure sensitive film before and after ACL single bundle reconstruction. ACL reconstructions were performed in each knee with two different tibial and femoral tunnel position combinations: (1) tibial antero-medial (AM) tunnel to femoral AM tunnel (AM to AM) and (2) tibial postero-lateral (PL) tunnel to femoral High-AM tunnel (PL to High-AM). Anterior tibial translation (ATT) was evaluated after each ACL reconstruction using robotic/universal force-moment sensor testing system. Neither the AM to AM nor the PL to High-AM ACL reconstruction groups showed significant difference when compared with intact ACL in roof impingement pressure. The AM to AM group had a significantly higher failure load than PL to High-AM group. This study showed how different tunnel placements affect the ACL-roof impingement pressure and anterior-posterior laxity in ACL reconstruction. Anatomical ACL reconstruction does not cause roof impingement and it has a biomechanical advantage in ATT when compared with non-anatomical ACL reconstructions in the pig knee. There is no intercondylar roof impingement after anatomical single bundle ACL reconstruction.

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

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.

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

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

The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain.

PubMed

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

2014-03-01

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. A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level 4. 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. 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-arthritic, mechanical hip pain. B.

Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

PubMed Central

Zhang, Dagang; Chen, Long; Wang, Guanglin

2016-01-01

Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement.

PubMed

Devgan, Ashish; Rohilla, Rajesh; Tanwar, Milind; Jain, Aditya; Siwach, Karan; Devgan, Radika

2016-01-01

Arthroscopic debridement has been a gold standard procedure for anterior ankle impingement, both in cases of osseous and soft tissue impingement. There is sparse literature on comparative outcome with respect to functional results between the two types of impingement post-arthroscopic debridement. Our study included 14 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination. They were segregated into two groups (on the basis of cause of impingement (osseous versus soft tissue)). Both groups were treated by arthroscopic debridement. Primary outcome was patient satisfaction, which was assessed by Likert scale and clinical outcomes were measured using AOFAS ankle-hind foot scale, VAS score, range of motion and time to return to pre-injury activity level in both groups. Mean follow-up was of 15 months where eleven patients reported an excellent recovery, two patients had good recovery while one patient reported poor outcome. Mean AOFAS ankle hind foot scale improved from 50.5 preoperatively to 85.71 postoperatively (statistically significant; p value - 0.0001). Mean Likert scale value post-operative was 4.21. VAS score showed significant improvement in patients of both the groups. Range of motion was slightly better in soft tissue impingement type with a relatively shorter time to return to sports or preinjury activity level as compared to osseous impingement group. The patients in both the groups had comparable outcomes with no statistically significant difference with regard to patient satisfaction and clinical outcome.

Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain.

PubMed

Lewis, Cara L; Loverro, Kari L; Khuu, Anne

2018-04-01

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

Clinical application of arthroscopy in the diagnosis and treatment of anterior impingement syndrome of the ankle joint in physical workers.

PubMed

Wu, Wen-Te; Chen, Zhi-Wei; Zhou, Yu-Cheng

2012-10-01

To evaluate the clinical application of arthroscopy in the diagnosis and treatment of anterior impingement syndrome of the ankle joint in physical workers. A retrospective study was carried out at the Department of Orthopedics, the First Hospital affiliated to Nanhua University, Hengyang, China from March 2005 to December 2011. Seventeen cases of anterior impingement syndrome of the ankle joint were confirmed, and treated through arthroscopy. All these patients conformed to regular follow-up postoperatively, and clinical details, as well as postoperative prognosis were retrieved and analyzed retrospectively. The efficacy was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system, and pain relief was assessed by visual analogue scoring (VAS). Anterolateral impingement syndrome was found in 11 patients, anteromedial impingement syndrome in 4, while anterior impingement syndrome in 2 via arthroscopic examination. The VAS was reduced from 5.2-1.1, and the AOFAS score was elevated from 76.4-95.8 postoperatively; both of which demonstrated statistical differences when compared to preoperative scores. It was also found that concomitant cartilage damage was an indicator of poor prognosis in arthroscopic treatment of impingement syndrome of the ankle joint. Satisfactory results could be achieved for physical workers with anterior impingement syndrome treated by arthroscopy. As the cartilage damage is an indicator of poor prognosis, an early operation is advocated when the prognosis of anterior impingement syndrome is confirmed.

Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty.

PubMed

Weber, Markus; Woerner, Michael; Craiovan, Benjamin; Voellner, Florian; Worlicek, Michael; Springorum, Hans-Robert; Grifka, Joachim; Renkawitz, Tobias

2016-12-01

In this prospective study of 135 patients undergoing cementless total hip arthroplasty (THA) we asked whether six current definitions of combined anteversion prevent impingement and increase postoperative patient individual impingement-free range-of-motion (ROM). Implant position was measured by an independent, external institute on 3D-CT performed six weeks post-operatively. Post-operative ROM was calculated using a CT-based algorithm detecting osseous and/or prosthetic impingement by virtual hip movement. Additionally, clinical ROM was evaluated pre-operatively and one-year post-operatively by a blinded observer. Combined component position of cup and stem according to the definitions of Ranawat, Widmer, Dorr, Hisatome and Yoshimine inhibited prosthetic impingement in over 90 %, while combined osseous and prosthetic impingement still occurred in over 40 % of the cases. The recommendations by Jolles, Widmer, Dorr, Yoshimine and Hisatome enabled higher flexion (p ≤ 0.001) and internal rotation (p ≤ 0.006). Clinically, anteversion rules of Widmer and Yoshimine provided one-year post-operatively statistically but not clinically relevant higher internal rotation (p ≤0.034). Standard rules of combined anteversion detect prosthetic but fail to prevent combined osseous and prosthetic impingement in THA. Future models will have to account for the patient-individual anatomic situation to ensure impingement-free ROM.

Femoroacetabular Impingement in Elite Ice Hockey Goaltenders: Etiological Implications of On-Ice Hip Mechanics.

PubMed

Whiteside, David; Deneweth, Jessica M; Bedi, Asheesh; Zernicke, Ronald F; Goulet, Grant C

2015-07-01

Femoroacetabular impingement (FAI) is particularly prevalent in ice hockey. The butterfly goalie technique is thought to involve extreme ranges of hip motion that may predispose goaltenders to FAI. To quantify hip mechanics during 3 common goaltender movements and interpret their relevance to the development of FAI. Descriptive laboratory study. Fourteen collegiate and professional goaltenders performed skating, butterfly save, and recovery movements on the ice. Hip mechanics were compared across the 3 movements. The butterfly did not exhibit the greatest range of hip motion in any of the 3 planes. Internal rotation was the only hip motion that appeared close to terminal in this study. When subjects decelerated during skating—shaving the blade of their skate across the surface of the ice—the magnitude of peak hip internal rotation was 54% greater than in the butterfly and 265% greater than in the recovery. No movement involved levels of concomitant flexion, adduction, and internal rotation that resembled the traditional impingement (FADIR) test. The magnitude of internal rotation was the most extreme planar hip motion (relative to end-range) recorded in this study (namely during decelerating) and appeared to differentiate this cohort from other athletic populations. Consequently, repetitive end-range hip internal rotation may be the primary precursor to symptomatic FAI in hockey goaltenders and provides the most plausible account for the high incidence of FAI in these athletes. Resection techniques should, therefore, focus on enhancing internal rotation in goaltenders, compared with flexion and adduction. While the butterfly posture can require significant levels of hip motion, recovering from a save and, in particular, decelerating during skating are also demanding on goaltenders' hip joints. Therefore, it appears critical to consider and accommodate a variety of sport-specific hip postures to comprehensively diagnose, treat, and rehabilitate FAI. © 2015 The

Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement.

PubMed

Diamond, Laura E; Van den Hoorn, Wolbert; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; O'Donnell, John; Hodges, Paul W

2017-07-01

Diagnosis of femoroacetabular impingement (FAI) is increasing, yet the associated physical impairments remain poorly defined. This morphological hip condition can cause joint pain, stiffness, impaired function, and eventually hip osteoarthritis. This exploratory study compared coordination of deep hip muscles between people with and without symptomatic FAI using analysis of muscle synergies (i.e., patterns of activity of groups of muscles activated in synchrony) during gait. Fifteen individuals (11 males) with symptomatic FAI (clinical examination and imaging) and 14 age- and sex-comparable controls without morphological FAI underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles. A non-negative matrix factorization algorithm extracted three synergies which were compared between groups. Information regarding which muscles were activated together in the FAI group (FAI group synergy vector) was used to reconstruct individual electromyography patterns and compare groups. Variance accounted for (VAF) by three synergies was less for the control (94.8 [1.4]%) than FAI (96.0 [1.0]%) group (p = 0.03). VAF of obturator internus was significantly higher in the FAI group (p = 0.02). VAF of the reconstructed individual electromyography patterns with the FAI or control group vector were significantly higher for the FAI group (p < 0.01). Following reconstruction, VAF of quadratus femoris was significantly more reduced in controls (p = 0.04), indicating greater between-subject variability. Coordination of deep hip muscles in the synergy related to hip joint control during early swing differed between groups. This phase involves movement towards the impingement position, which has relevance for the interpretation of synergy differences and potential clinical importance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1494-1504, 2017

A Rare Case of Neglected Traumatic Anterior Dislocation of Hip in a Child.

PubMed

Mootha, Aditya Krishna; Mogali, Kasi Viswanadam

2016-01-01

Post traumatic hip dislocations are very rare in children. Neglected anterior hip dislocations in children are not described in literature so far. Here, we present a case of 6 weeks old anterior hip dislocation successfully managed by open reduction. A 9-year-old male child presented with neglected anterior hip dislocation on left side. Open reduction carried out through direct anterior approach to hip. Congruent reduction is achieved. At final follow up of 1 year, the child had unrestricted activities of daily living and no radiological signs of osteonecrosis or any joint space reduction. There is paucity of literature over neglected post traumatic anterior hip dislocations in children. The treatment options vary from closed reduction after heavy traction to sub trochanteric osteotomy. However, we feel that open reduction through direct anterior approach is the preferred mode of management whenever considered possible.

Impaired hip muscle strength in patients with femoroacetabular impingement syndrome.

PubMed

Kierkegaard, Signe; Mechlenburg, Inger; Lund, Bent; Søballe, Kjeld; Dalgas, Ulrik

2017-12-01

Patients with femoroacetabular impingement (FAI) experience hip pain as well as decreased function and lowered quality of life. The aim was to compare maximal isometric and isokinetic muscle strength (MVC) during hip flexion and extension and rate of force development (RFD) during extension between patients with FAI and a matched reference group. Secondary, the aim was to compare patient hips and subgroups defined by gender and age as well as to investigate associations between hip muscle strength and self-reported outcomes. Design Cross-sectional, comparative study Methods Sixty patients (36±9 years, 63% females) and 30 age and gender matched reference persons underwent MVC tests in an isokinetic dynamometer. During hip flexion and extension, patients' affected hip showed a strength deficit of 15-21% (p<0.001) and 10-25% (p<0.03) compared with reference MVC, respectively. The affected hip of the patients was significantly weaker than their contralateral hip. RFD was significantly decreased for both patient hips compared to the reference group (p<0.05). While age had less effect on MVC, female patients were more affected than male patients. Self-reported measures were associated with isometric hip muscle strength. Patients with FAI demonstrate decreased hip flexion and extension strength when compared to (1) reference persons and (2) their contralateral hip. There seems to be a gender specific affection which should be investigated further and addressed when planning training protocols. Furthermore, self-reported measures were associated with isometric muscle strength, which underlines the clinical importance of the reduced muscle strength. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy—a systematic review

PubMed Central

Haldane, Chloe E.; Ekhtiari, Seper; de SA, Darren; Simunovic, Nicole

2017-01-01

Abstract The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior–posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence: Level IV, Systematic Review of Level I–IV Studies. PMID:28948032

Arthroscopic Hip Revision Surgery for Residual Femoroacetabular Impingement (FAI): Surgical Outcomes Compared With a Matched Cohort After Primary Arthroscopic FAI Correction.

PubMed

Larson, Christopher M; Giveans, M Russell; Samuelson, Kathryn M; Stone, Rebecca M; Bedi, Asheesh

2014-08-01

There are limited data reporting outcomes after revision arthroscopic surgery for residual femoroacetabular impingement (FAI). (1) Revision arthroscopic FAI correction results in improved outcomes, but they are inferior to those of primary arthroscopic FAI correction. (2) Improved postrevision radiographic parameters are predictive of better outcomes. Cohort study; Level of evidence, 3. Patients who underwent arthroscopic hip revision for residual FAI were reviewed. Pathomorphological findings, intraoperative findings, and preoperative and postoperative modified Harris Hip Score (MHHS), Short Form-12 (SF-12), and pain on a visual analog scale (VAS) values were evaluated. Outcomes after revision arthroscopic FAI correction were compared with outcomes of a matched cohort who underwent primary arthroscopic FAI correction. A total of 79 patients (85 hips) with a mean age of 29.5 years underwent arthroscopic revision FAI correction (mean follow-up, 26 months). The labrum was debrided (27 hips), repaired (49 hips), or reconstructed (7 hips). Two labrums were stable and required no treatment. The results of revision arthroscopic FAI correction were compared with those of 220 age- and sex-matched patients (237 hips) who underwent primary arthroscopic FAI correction (mean follow-up, 23 months). The mean improvement in outcome scores after revision FAI correction was 17.8 (MHHS), 12.5 (SF-12), and 1.4 (VAS) points compared with 23.4 (MHHS), 19.7 (SF-12), and 4.6 (VAS) points after primary arthroscopic FAI correction. The mean improvement was significantly better in the primary cohort compared with the revision cohort (P < .01 for MHHS, SF-12, and VAS values). Good/excellent results were achieved in 81.7% of the primary cohort and 62.7% of the revision cohort (P < .01). Greater postoperative head-neck offset (P = .024), subspine/anterior inferior iliac spine (AIIS) decompression (P = .014), labral repair/reconstruction (P = .009), and capsular plication (P = .032) were

Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes.

PubMed

Sansone, Mikael; Ahldén, Mattias; Jonasson, Pall; Thomeé, Roland; Falk, Anders; Swärd, Leif; Karlsson, Jón

2014-04-01

There are several reports on the association between pubalgia and intra-articular hip disorders. The purpose of this study was to evaluate the long-term outcome in athletes who underwent tenotomy due to long-standing groin pain. A secondary purpose was evaluating the frequency of femoro-acetabular impingement (FAI) and its impact on the long-term outcome. Thirty-two high-level male athletes treated with adductor tenotomy, rectus abdominis tenotomy or both were included. At a median follow-up time of 6 years after the tenotomy, the subjects underwent standardised clinical examination, plain radiographs, completed web-based health-related patient-reported outcomes, including iHOT12, HAGOS (six subscales), EQ-5D (two subscales), HSAS for physical activity level and a VAS for overall hip function. Furthermore, patient satisfaction and return to sports were documented. Twenty-four of the 32 (75 %) athletes were satisfied with the outcome of the tenotomy, and 22 of the athletes (69 %) were able to return to their pre-injury sport. Before the long-term follow-up, two of these satisfied athletes had undergone repeat surgery (one hip arthroscopy due to FAI and one repeat tenotomy). Of the 24 satisfied athletes, eight (33 %) had a positive hip impingement test at the follow-up. Of the remaining eight athletes not satisfied with the outcome, only one returned to their pre-injury sport and three had undergone hip arthroscopy prior to follow-up. Five had positive hip impingement tests which was significantly more frequently than in the satisfied group (p = 0.008). The group with a positive hip impingement test reported significantly more pain and symptoms, more hip problems during sports and physical activity, as well as lower hip-related quality of life according to the HAGOS scores (p < 0.05), at follow-up. Tenotomy for pubalgia yielded a satisfactory long-term outcome, with three of four athletes being able to return to their pre-injury sport. The athletes that did not

Combined Anterolateral, Anterior, and Anteromedial Ankle Impingement in an Adolescent Soccer Player-A Case Report and Review of the Literature.

PubMed

Cosma, Dan I; Vasilescu, Dana E; Corbu, Andrei; Todor, Adrian; Valeanu, Madalina; Ulici, Alexandru

2018-01-24

A unique case of combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player is presented in this article. To the best of our knowledge, this is the only report of circumferential, massive, anterior ankle impingement in children described in the literature. The importance of proper diagnosis and treatment of such a lesion is illustrated in this case report. We also emphasize that clinical examination combined with 3D computed tomography scan reconstruction is an excellent and cost-effective imaging modality that can help with the diagnosis of anterior ankle impingement. Finally, open surgical treatment showed excellent results in an elite athlete.

Ultrasound in Total Hip Replacement: Value of Anterior Acetabular Cup Visibility and Contact With the Iliopsoas Tendon.

PubMed

Guillin, Raphaël; Bertaud, Valérie; Garetier, Marc; Fantino, Olivier; Polard, Jean-Louis; Lambotte, Jean-Christophe

2018-06-01

To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. Anterior cup visibility (P = .03), contact with the psoas tendon (P < .001), psoas tendinopathy (P = .02), and iliopsoas bursitis (P < .001) were significantly associated with iliopsoas impingement syndrome, the latter reported with specificity of 100%. In the sagittal plane at the level of the psoas tendon, a maximum sagittal length of greater than 5 mm and a posteroanterior cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs. © 2017 by the American Institute of Ultrasound in Medicine.

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.

PubMed

Griffin, Damian R; Dickenson, Edward J; Wall, Peter D H; Achana, Felix; Donovan, Jenny L; Griffin, James; Hobson, Rachel; Hutchinson, Charles E; Jepson, Marcus; Parsons, Nick R; Petrou, Stavros; Realpe, Alba; Smith, Joanna; Foster, Nadine E

2018-06-02

Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery, including reshaping the hip, or with physiotherapist-led conservative care. We aimed to compare the clinical effectiveness of hip arthroscopy with best conservative care. UK FASHIoN is a pragmatic, multicentre, assessor-blinded randomised controlled trial, done at 23 National Health Service hospitals in the UK. We enrolled patients with femoroacetabular impingement syndrome who presented at these hospitals. Eligible patients were at least 16 years old, had hip pain with radiographic features of cam or pincer morphology but no osteoarthritis, and were believed to be likely to benefit from hip arthroscopy. Patients with bilateral femoroacetabular impingement syndrome were eligible; only the most symptomatic hip was randomly assigned to treatment and followed-up. Participants were randomly allocated (1:1) to receive hip arthroscopy or personalised hip therapy (an individualised, supervised, and progressive physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre and was done by research staff at each hospital, using a central telephone randomisation service. Patients and treating clinicians were not masked to treatment allocation, but researchers who collected the outcome assessments and analysed the results were masked. The primary outcome was hip-related quality of life, as measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed in all eligible participants who were allocated to treatment (the intention-to-treat population). This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN64081839, and is closed to recruitment. Between July 20, 2012, and July 15, 2016, we identified 648 eligible patients and recruited 348 participants: 171 participants were allocated to

Conservative management of femoroacetabular impingement (FAI) in the long distance runner.

PubMed

Loudon, Janice K; Reiman, Michael P

2014-05-01

Femoroacetabular impingement (FAI) is one cause of anterior hip pain that may occur in a long distance runner. By definition FAI is due to bony abutment of the femoral neck and the acetabulum. This occurs primarily with end-ranges of hip flexion and adduction. An understanding of running mechanics and performing a thorough examination will help the clinician provide an appropriate intervention for these athletes. A course of conservative treatment that includes patient education, manual therapy and strengthening should be tried prior to surgical management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Femoroacetabular Impingement Is Associated With Sports-Related Posterior Hip Instability in Adolescents: A Matched-Cohort Study.

PubMed

Mayer, Stephanie W; Abdo, João Caetano Munhoz; Hill, Mary K; Kestel, Lauryn A; Pan, Zhaoxing; Novais, Eduardo N

2016-09-01

Femoroacetabular impingement (FAI) deformity has been associated with posterior hip instability in adult athletes. To determine if FAI deformity is associated with posterior hip instability in adolescents, the femoral head-neck junction or acetabular structure in a cohort of adolescent patients who sustained a low-energy, sports-related posterior hip dislocation was compared with that in a group of healthy age- and sex-matched controls with no history of hip injury or pain. Cross-sectional study; Level of evidence, 3. We identified 12 male patients (mean age, 13.9 years; range, 12-16 years) who sustained a sports-related posterior hip dislocation and underwent a computed tomography (CT) scan after closed reduction. For each patient, 3 age- and sex-matched healthy controls were identified. Femoral head-neck type was assessed by measurement of the alpha angle on the radially oriented CT images at the 12-, 1-, 2-, and 3-o'clock positions. Age, body mass index (BMI), alpha angle at each position, acetabular version, Tönnis angle, and lateral center-edge angle (LCEA) on the involved hip in the dislocation group were compared with those of the matched controls using a mixed-effects model. A logistic regression analysis using a generalized estimating equation was used to compare the percentage of subjects with cam-type FAI deformity (alpha angle >55°) in each group. The dislocation and control groups were similar in age distribution and BMI (P > .05). The mean alpha angles were statistically significantly higher in the dislocation group compared with the control group at the superior (46.3° ± 1.1° vs 42.7° ± 0.6°; P = .0213), superior-anterior (55.5° ± 1.9° vs 46.0° ± 1.3°; P = .0005), and anterior-superior (54.9° ± 1.5° vs 48.9° ± 1.0°; P = .0045) regions. Cam deformity was present in a larger proportion of patients in the dislocation group than in the control group (P < .0035). An alpha angle greater than 55° was present in 16.7% of the dislocation

Anterior center-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips.

PubMed

Monazzam, Shafagh; Williams, Karly Ann; Shelton, Trevor J; Calafi, Arash; Haus, Brian M

2018-05-01

The anterior center-edge angle (ACEA) describes anterior acetabular coverage on false profile radiographs. Variability associated with pelvic tilt, radiographic projection, and identifying the true anterior edge, causes discrepancies in measuring an accurate ACEA. Computed tomography (CT) has the potential of improving the accuracy of ACEA. However, because the ACEA on sagittal CT has been shown to not be equivalent to ACEA on false profile radiographs, the normal range of ACEA on CT currently remains unknown and cannot reliably be used to determine over/under coverage. We therefore asked: what is the normal variation of ACEA corrected for pelvic tilt on sagittal CT and how does this compare to dysplastic hips? A retrospective review was conducted on patients 10-35 who underwent CT for non-orthopedic related issues and patients with known hip dysplasia. The ACEA was measured on a sagittal slice corresponding to the center of the femoral head on the axial slice and adjusted for pelvic tilt. A statistical comparison was then performed. A total of 320 normal patients and 22 patients with hip dysplasia were reviewed. The mean ACEA for all ages was 50° ± 8°, (range: 23-81º), with a larger mean ACEA for males (51°) than females (49°). The ACEA mean for dysplastic hips was 30° ± 11° with a statistically significant difference in mean from the normal hip group ( p < 0.0001). The ACEA can be reliably measured on sagittal CT and significantly differs from dysplastic hips. ACEA measurements above 66° or below 34° may represent anterior over and under coverage.

Unusual case of mixed form of femoroacetabular impingement combined with nonspecific synovitis of the hip joint in a young adult-- A case report.

PubMed

Mladenović, Marko; Micić, Ivan; Andjelković, Zoran; Mladenović, Desimir; Stojiljković, Predrag

2015-12-01

Minimal bone changes in the acetabulum and/or proximal femur, through mechanism known as femoroacetabular impingement, during flexion, adduction and internal rotation lead to early contact between femoral head-neck junction and acetabular brim, in anterosuperior region. Each additional pathological substrate which further decreases specified clearance provokes earlier onset of femoroacetabular impingement symptoms. We presented a 20-year-old male patient with groin pain, limping, positive impingement test, radiological signs of mixed form of femoroacetabular impingement and unrecognized chronic hypertrophic synovitis with earlier development of clinical hip symptoms than it has been expected. Open surgery of the left hip was done. Two years after the surgery, patient was asymptomatic, painless, and free of motion, with stable x-rays. Hypertrophic synovial tissue further reduces the distance between the femoral head-neck junction and the acetabulum, leading to the earlier onset of femoroacetabular impingement symptoms. Surgical treatment is the method of choice.

The HAPI 'Hip Arthroscopy Pre-habilitation Intervention' study: does pre-habilitation affect outcomes in patients undergoing hip arthroscopy for femoro-acetabular impingement?

PubMed

Grant, Louise F; Cooper, Derek J; Conroy, Jon L

2017-01-01

The purpose of this randomized prospective comparative controlled pilot study was to determine whether specific patient exercises done pre-hip arthroscopy surgery for femoro-acetabular impingement affected post-operative recovery. Between October 2013 and June 2014, 6 males and twelve females over the age of eighteen, who were listed for hip arthroscopy for femoro-acetabular impingement, were randomized into two groups. A hip-specific, 8-week home exercise programme was given to the experimental group before their surgery. The control group was given no instruction on exercise before surgery. All participants followed the same rehabilitation programme after surgery. Outcome measures were assessed at set time intervals. Hand held dynamometry was used to assess muscle strength, and the EQ-5D-5 L Score and the Non-Arthritic Hip Score were utilized. Sixteen participants completed the study (eight controls: mean age 41.75 years and eight intervention: mean age 37.5 years). A mixed ANCOVA analysis compared the treatment groups taking baseline values into account. A statistically significant difference was found between the treatment groups for knee extension strength on both operative ( P  = 0.05) and non-operative sides ( P  = 0.002), hip flexor strength operative side ( P  = 0.02) and for EQ-5D-5 L health ( P  = 0.03), in favour of the intervention group. There was no significant difference between the treatment groups for the other measures, although some tended towards significance. This small pilot study has been designed to aid the further research and the differences between the groups found in these results may inform future larger scale studies.

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

PubMed

Azevedo, Daniel Camara; Paiva, Edson Barreto; Lopes, Alexia Moura Abuhid; Santos, Henrique de Oliveira; Carneiro, Ricardo Luiz; Rodrigues, André Soares; de Andrade, Marco Antonio Percope; Novais, Eduardo N; Van Dillen, Linda R

2016-11-01

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Hip arthroscopy for femoroacetabular impingement: the changing nature and severity of associated complications over time.

PubMed

Park, Myung-Sik; Yoon, Sun-Jung; Kim, Yong-Jin; Chung, Woo-Chul

2014-08-01

The aim of this study was to assess complications related to arthroscopy for femoroacetabular impingement (FAI) and how these complications have changed as we have gained more experience with this procedure. The authors reviewed 200 hips (197 patients). The average patient age was 44.64 years and the mean follow-up time was 28.2 months. All patients underwent hip arthroscopy in the supine position. Clinically, Modified Harris Hip Scores (MHHS) and patient satisfaction with outcome were used. We divided complications into 3 groups: Group 1 related to traction, group 2 related to surgical technique or implant failure, and group 3 related to outcomes. Clinically, the MHHS improved from 69.96 (±6.10) to 80.45 (±7.00), and patient satisfaction with the achieved outcome increased to 8.87 (±0.76). The overall complication rate was 15% (30 of 200 hips). Group 1 consisted of 4 patients with pudendal neuropraxia and 2 patients with ankle joint pain (P = .013). Group 2 consisted of 2 patients with lateral femoral cutaneous neuropraxia, 2 patients with iatrogenic labral perforations, one patient with a labral tear, and 4 patients with femoral head scuffs. There were 4 incidents of instrument breakage. Furthermore, 3 suture anchors failed, a second-degree burn occurred in one patient, and there was incomplete reshaping in 5 hips (P = .045). Group 3 included one patient with a snapping sound and heterotopic ossification. Second-look arthroscopy was performed for 5 hips. All the complications outlined in groups 1 and 2 are related to the learning curve and have statistical significance (P < .05). Complications relating to hip arthroscopy took different forms during the early learning period, but overall complication rates decreased along the learning curve. Surgical technique-related complications such as problems with suture anchors and the reshaping of cam impingements were also considered during the later stage. Level IV, therapeutic case series. Copyright © 2014

Mixed-type femoroacetabular impingement associated with subspine impingement: recognizing the trifocal femoropelvic impingement.

PubMed

Souza, Bruno Gonçalves Schröder E; Cardoso, Ranieri Monteiro; Loque, Rodrigo Silva; Monte, Luiz Fernando Ribeiro; Sabino, José Paulo; Oliveira, Valdeci Manoel de

2018-01-01

To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.

The HAPI ‘Hip Arthroscopy Pre-habilitation Intervention’ study: does pre-habilitation affect outcomes in patients undergoing hip arthroscopy for femoro-acetabular impingement?

PubMed Central

Cooper, Derek J.; Conroy, Jon L.

2017-01-01

Abstract The purpose of this randomized prospective comparative controlled pilot study was to determine whether specific patient exercises done pre-hip arthroscopy surgery for femoro-acetabular impingement affected post-operative recovery. Between October 2013 and June 2014, 6 males and twelve females over the age of eighteen, who were listed for hip arthroscopy for femoro-acetabular impingement, were randomized into two groups. A hip-specific, 8-week home exercise programme was given to the experimental group before their surgery. The control group was given no instruction on exercise before surgery. All participants followed the same rehabilitation programme after surgery. Outcome measures were assessed at set time intervals. Hand held dynamometry was used to assess muscle strength, and the EQ-5D-5 L Score and the Non-Arthritic Hip Score were utilized. Sixteen participants completed the study (eight controls: mean age 41.75 years and eight intervention: mean age 37.5 years). A mixed ANCOVA analysis compared the treatment groups taking baseline values into account. A statistically significant difference was found between the treatment groups for knee extension strength on both operative (P = 0.05) and non-operative sides (P = 0.002), hip flexor strength operative side (P = 0.02) and for EQ-5D-5 L health (P = 0.03), in favour of the intervention group. There was no significant difference between the treatment groups for the other measures, although some tended towards significance. This small pilot study has been designed to aid the further research and the differences between the groups found in these results may inform future larger scale studies. PMID:28630726

Restricted Hip Rotation Is Correlated With an Increased Risk for Anterior Cruciate Ligament Injury.

PubMed

VandenBerg, Curtis; Crawford, Eileen A; Sibilsky Enselman, Elizabeth; Robbins, Christopher B; Wojtys, Edward M; Bedi, Asheesh

2017-02-01

The primary purpose was to compare ipsilateral hip internal rotation (IR) in male and female athletes with or without an anterior cruciate ligament (ACL) tear. A secondary purpose was to compare radiographic markers of femoroacetabular impingement (FAI) in patients with or without an ACL tear. In this prospective case-control study, based on a power analysis, a convenience sample of 25 ACL-injured and 25 control patients matched by age and gender were examined over 14 months. The ACL injury group included preoperative patients 12-40 years old with an ACL rupture within the previous 3 months with no prior lower extremity injuries, ligamentous laxity, or arthralgias. Controls included patients presenting with an upper extremity complaint with no history of knee injury. In the outpatient clinic, hip axial rotation range of motion was measured with a goniometer on physical examination and hip radiographs were evaluated for morphologic variations consistent with FAI. Univariate analysis of variance was used to examine differences between groups. Each group had 13 males and 12 females, average ages of 22.8 ± 7.2 years (ACL group) versus 24.5 ± 7.9 years (controls; P = .439). The average sum of hip rotation (internal plus external) in patients with an ACL tear was 60.3 ± 12.4° compared with 72.6 ± 17.2° in controls (P = .006). ACL-injured patients had decreased hip IR compared with controls, with respective mean measurements of 23.4 ± 7.6° versus 30.4 ± 10.4° (P = .009). For every 10° increase in hip IR, the odds of having an ACL tear decreased by a factor of 0.419 (P = .015). Risk of ACL injury is associated with restricted hip IR, and as hip IR increases, the odds of having an ACL tear decreases. In addition, ACL injury is associated with FAI in a generalized population of male and female athletes, although causality cannot be determined and most ACL-injured patients do not exhibit hip complaints. Level II, prognostic, prospective cohort study

Range of Hip Joint Motion Is Correlated With MRI-Verified Cam Deformity in Adolescent Elite Skiers

PubMed Central

Agnvall, Cecilia; Swärd Aminoff, Anna; Todd, Carl; Jonasson, Pall; Thoreson, Olof; Swärd, Leif; Karlsson, Jon; Baranto, Adad

2017-01-01

Background: Radiologically verified cam-type femoroacetabular impingement (FAI) has been shown to correlate with reduced internal rotation, reduced passive hip flexion, and a positive anterior impingement test. Purpose: To validate how a clinical examination of the hip joint correlates with magnetic resonance imaging (MRI)–verified cam deformity in adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The sample group consisted of 102 adolescents with the mean age 17.7 ± 1.4 years. The hip joints were examined using MRI for measurements of the presence of cam (α-angle ≥55°) and clinically for range of motion (ROM) in both supine and sitting positions. The participants were divided into a cam and a noncam group based on the results of the MRI examination. Passive hip flexion, internal rotation, anterior impingement, and the FABER (flexion, abduction, and external rotation) test were used to test both hips in the supine position. With the participant sitting, the internal/external rotation of the hip joint was measured in 3 different positions of the pelvis (neutral, maximum anteversion, and retroversion) and lumbar spine (neutral, maximum extension, and flexion). Results: Differences were found between the cam and noncam groups in terms of the anterior impingement test (right, P = .010; left, P = .006), passive supine hip flexion (right: mean, 5°; cam, 117°; noncam, 122° [P = .05]; and left: mean, 8.5°; cam, 116°; noncam, 124.5° [P = .001]), supine internal rotation (right: mean, 4.9°; cam, 24°; noncam, 29° [P = .022]; and left: mean, 4.8°; cam, 26°; noncam, 31° [P = .028]), sitting internal rotation with the pelvis and lumbar spine in neutral (right: mean, 7.95°; cam, 29°; noncam, 37° [P = .001]; and left: mean, 6.5°; cam, 31.5°; noncam, 38° [P = .006]), maximum anteversion of the pelvis and extension of the lumbar spine (right: mean, 5.2°; cam, 20°; noncam, 25° [P = .004]; and left: mean, 5.85°; cam, 20

The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis.

PubMed

Nawabi, Danyal H; Bedi, Asheesh; Tibor, Lisa M; Magennis, Erin; Kelly, Bryan T

2014-03-01

The purpose of this study was to determine differences in age, gender, and the need for bilateral surgery between high-level athletes grouped by sports with similar mechanical demands on the hip and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement (FAI). By use of a hip-preservation center registry, a retrospective review of patients undergoing hip arthroscopy for FAI between March 2010 and April 2012 was performed. Athletes were categorized as high level (high school, collegiate, or professional) or recreational. We performed a subgroup analysis for high-level athletes, looking at differences among contact, cutting, impingement, overhead/asymmetric, endurance, and flexibility sports. The study included 288 high-level athletes and 334 recreational athletes. Being a high-level athlete was associated with a younger age (mean age, 20.2 years v 33.0 years; odds ratio, 0.69; P < .001) and male gender (61.5% v 53.6%; odds ratio, 1.75; P = .03). The percentage of high-level athletes undergoing bilateral surgery was higher than that of recreational athletes (28.4% v 15.9%); however, this association was found to be confounded by age on multivariate analysis. The most common sports for high-level athletes were soccer, hockey, and football. Athletes participating in cutting sports were significantly younger than athletes participating flexibility, contact, or impingement sports. When compared with recreational athletes undergoing arthroscopic treatment for FAI, high-level athletes are more likely to be younger, to be male, and to undergo bilateral surgery. When high-level athletes are grouped by the mechanical demands placed on the hip by their sport, athletes participating in cutting sports are more likely to be younger than those in the other groups. Level IV, case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Impingement following anterior cruciate ligament reconstruction: comparing the direct versus indirect femoral tunnel position.

PubMed

van der List, J P; Zuiderbaan, H A; Nawabi, D H; Pearle, A D

2017-05-01

During anterior cruciate ligament (ACL) reconstruction, authors have suggested inserting the femoral tunnel at the biomechanically relevant direct fibres, but this higher position can cause more impingement. Therefore, we aimed to assess ACL graft impingement at the femoral notch for ACL reconstruction at both the direct and indirect tunnel positions. A virtual model was created for twelve cadaveric knees with computed tomography scanning in which a virtual graft was placed at direct and indirect tunnel positions of the anteromedial bundle (AM), posterolateral bundle (PL) or centre of the both bundles (C). In these six tunnel positions, the volume (mm 3 ) and mid-point location of impingement (°) were measured at different flexion angles. Generally, more impingement was seen with the indirect position compared with the direct position although this was only significant at 90° of flexion for the AM position (97 ± 28 vs. 76 ± 20 mm 3 , respectively; p = 0.046). The direct tunnel position impinged higher at the notch, whereas the indirect position impinged more towards the lateral wall, but this was only significant at 90° of flexion for the AM (24 ± 5° vs. 34 ± 4°, respectively; p < 0.001) and C position (34 ± 5° vs. 42 ± 5°, respectively; p = 0.003). In this cadaveric study, the direct tunnel position did not cause more impingement than the indirect tunnel position. Based on these results, graft impingement is not a limitation to reconstruct the femoral tunnel at the insertion of the biomechanically more relevant direct fibres.

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

Hip Arthroscopy for Femoral-Acetabular Impingement: Do Active Claims Affect Outcomes?

PubMed

Gigi, Roy; Rath, Ehud; Sharfman, Zachary T; Shimonovich, Shachar; Ronen, Itai; Amar, Eyal

2016-04-01

To compare outcomes of 3 patient groups undergoing hip arthroscopy. This study included 138 consecutive hip arthroscopies (106 analyzed) for femoral-acetabular impingement (FAI) with or without labral tear in patients with a minimum 1-year follow-up. Inclusion criteria included patients older than 18 with clinical or radiologic manifestation of FAI with or without labral tear. Exclusion criteria included previous hip surgery and various hip pathologies. Patients were classified into 3 study groups. Group 1 included work-related injuries with active claims ACs (n = 33); mean age, 32 (range, 19 to 63); group 2 included sports injuries with no ACs (n = 35); mean age, 32 (range, 18 to 69); and group 3 included non-sports-related injuries without pending ACs (NAS; n = 38); mean age, 45 (range, 20 to 68). Outcomes were assessed using modified Harris hip scores (mHHS) and hip outcome scores (HOS) preoperatively and during the final evaluation. Baseline score for all groups did not significantly differ (P = .210 for mHHS, P = .176 for HOS). All groups significantly improved from preoperative to final evaluation (group 1: mHHS P = .42, HOS P = .001; group 2: mHHS P < .001, HOS P < .001; group 3 NAS: mHHS P = .001, HOS P = .007). AC patients had the lowest final evaluation scores, while the sports group had the highest. The NAS group did not differ from either group at final evaluation. Preoperative and final evaluation scores inversely correlated with age (r range, -24 to -28; P < .05). This study has shown that patients may benefit from arthroscopic repair of FAI and labral tears regardless of ACs. The level of improvement, however, is not constant across patients with different characteristics. Moreover, it appears that age may impact perceived improvement after hip arthroscopy. Hip arthroscopy as an intervention in patients with ACs provided positive outcomes, corroborating that an AC is not a contraindication for this procedure. Level III, retrospective comparative

A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

PubMed

Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

2016-01-01

Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study.

PubMed

Wyles, Cody C; Norambuena, Germán A; Howe, Benjamin M; Larson, Dirk R; Levy, Bruce A; Yuan, Brandon J; Trousdale, Robert T; Sierra, Rafael J

2017-11-01

with 8 of 26 hips (31%) in the control group (RR, 2.0; 95% CI, 0.95-4.2; P = .067). The mean alpha angle measured from radial MRI sequences was 58° in the LROM group versus 44° in the control group ( P < .0001). In the LROM group, 13 of 26 hips (50%) had a positive anterior impingement sign, whereas 0 of 26 hips (0%) had a positive anterior impingement sign in the control group. At 5-year follow-up, 18 of 19 hips (95%) in the LROM group had abnormal MRI findings compared with 14 of 26 hips (54%) in the control group (RR, 1.7; 95% CI, 1.1-2.7; P = .014). New or progressive findings were documented on MRI in 15 of 20 hips in the LROM group compared with 8 of 26 hips in the control group (RR, 2.4; 95% CI, 1.2-4.8; P = .011). Six of 22 hips (27%) in the LROM group progressed from Tönnis grade 0 to Tönnis grade 1 in degenerative changes, whereas all 26 hips in the control group remained at Tönnis grade 0 on hip radiographs. In the LROM group, 11 of 22 hips (50%) had a positive anterior impingement sign, whereas 1 of 26 hips (4%) had a positive anterior impingement sign in the control group. A cam deformity (alpha angle >55° on lateral radiographs) was present in 20 of 22 hips (91%) in the LROM group and 12 of 26 hips (46%) in the control group ( P = .0165). The following variables at baseline were associated with an increased risk of degenerative changes at 5-year follow-up for the entire cohort: decreased hip internal rotation, positive anterior impingement sign, decreased hip flexion, increased alpha angle, and presence of a cam lesion. At 5 years, young athletes with LROM of the hip showed increased progressive degenerative changes on MRI and radiographs compared with matched controls. Although the majority of these participants remained asymptomatic, those with features of FAI had radiographic findings consistent with early osteoarthritis. These outcomes suggest that more aggressive screening and counseling of young active patients may be helpful to prevent hip

The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study.

PubMed

Birmingham, Patrick M; Kelly, Bryan T; Jacobs, Robert; McGrady, Linda; Wang, Mei

2012-05-01

A link between femoroacetabular impingement and athletic pubalgia has been reported clinically. One proposed origin of athletic pubalgia is secondary to repetitive loading of the pubic symphysis, leading to instability and parasymphyseal tendon and ligament injury. Hypothesis/ The purpose of this study was to investigate the effect of simulated femoral-based femoroacetabular impingement on rotational motion at the pubic symphysis. The authors hypothesize that the presence of a cam lesion leads to increased relative symphyseal motion. Controlled laboratory study. Twelve hips from 6 fresh-frozen human cadaveric pelvises were used to simulate cam-type femoroacetabular impingement. The hips were held in a custom jig and maximally internally rotated at 90° of flexion and neutral adduction. Three-dimensional motion of the pubic symphysis was measured by a motion-tracking system for 2 states: native and simulated cam. Load-displacement plots were generated between the internal rotational torque applied to the hip and the responding motion in 3 anatomic planes of the pubic symphysis. As the hip was internally rotated, the motion at the pubic symphysis increased proportionally with the degrees of the rotation as well as the applied torque measured at the distal femur for both states. The primary rotation of the symphysis was in the transverse plane and on average accounted for more than 60% of the total rotation. This primary motion caused the anterior aspect of the symphyseal joint to open or widen, whereas the posterior aspect narrowed. At the torque level of 18.0 N·m, the mean transverse rotation in degrees was 0.89° ± 0.35° for the native state and 1.20° ± 0.41° for cam state. The difference between cam and the native groups was statistically significant (P < .03). Dynamic femoroacetabular impingement as caused by the presence of a cam lesion causes increased rotational motion at the pubic symphysis. Repetitive loading of the symphysis by cam impingement is

Isometric and isokinetic hip strength and agonist/antagonist ratios in symptomatic femoroacetabular impingement.

PubMed

Diamond, Laura E; Wrigley, Tim V; Hinman, Rana S; Hodges, Paul W; O'Donnell, John; Takla, Amir; Bennell, Kim L

2016-09-01

This study investigated isometric and isokinetic hip strength in individuals with and without symptomatic femoroacetabular impingement (FAI). The specific aims were to: (i) determine whether differences exist in isometric and isokinetic hip strength measures between groups; (ii) compare hip strength agonist/antagonist ratios between groups; and (iii) examine relationships between hip strength and self-reported measures of either hip pain or function in those with FAI. Cross-sectional. Fifteen individuals (11 males; 25±5 years) with symptomatic FAI (clinical examination and imaging (alpha angle >55° (cam FAI), and lateral centre edge angle >39° and/or positive crossover sign (combined FAI))) and 14 age- and sex-matched disease-free controls (no morphological FAI on magnetic resonance imaging) underwent strength testing. Maximal voluntary isometric contraction strength of hip muscle groups and isokinetic hip internal (IR) and external rotation (ER) strength (20°/s) were measured. Groups were compared with independent t-tests and Mann-Whitney U tests. Participants with FAI had 20% lower isometric abduction strength than controls (p=0.04). There were no significant differences in isometric strength for other muscle groups or peak isokinetic ER or IR strength. The ratio of isometric, but not isokinetic, ER/IR strength was significantly higher in the FAI group (p=0.01). There were no differences in ratios for other muscle groups. Angle of peak IR torque was the only feature correlated with symptoms. Individuals with symptomatic FAI demonstrate isometric hip abductor muscle weakness and strength imbalance in the hip rotators. Strength measurement, including agonist/antagonist ratios, may be relevant for clinical management of FAI. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Investigation into three dimensional hip anatomy in anterior dislocation after THA. Influence of the position of the hip rotation centre.

PubMed

Sariali, Elhadi; Klouche, Shahnez; Mamoudy, Patrick

2012-07-01

The components position is a major factor under the surgeon's control in determining the risk of dislocation post total hip arthroplasty. The aim of this study was to investigate the proper three-dimensional components position including the centre of rotation in the case of anterior dislocation. Among 1764 consecutive patients who underwent total hip arthroplasty using a direct anterior approach, 27 experienced anterior dislocation. The three-dimensional hip anatomy was investigated in 12 patients who were paired with 12 patients from the same initial cohort who did not experience dislocation and also with 36 control patients with osteoarthritis. A pelvic Cartesian referential was defined to perform the acetabular analysis. The coordinates were expressed as percentages of the pelvic width, height and depth. The anteversion angles were measured. The hip centre of rotation was significantly shifted medially and posteriorly in the dislocation group when compared to the non-dislocation group and also to the control group. There was no significant difference in component angular position between the dislocation-group and the non-dislocation group. However, the stem anteversion in the dislocation group was increased in comparison to the mean natural femoral anteversion of the control group. A medial and posterior displacement of the hip rotation centre was found to correlate to anterior dislocation post total hip arthoplasty. These results suggest the importance of an accurate restoration of the centre of rotation, whilst avoiding an excessive acetabular reaming which may induce a medial and a posterior displacement. III comparative non randomised. Copyright © 2011 Elsevier Ltd. All rights reserved.

Arthroscopic Anterior and Posterior Labral Repair After Traumatic Hip Dislocation: Case Report and Review of the Literature

PubMed Central

Shindle, Michael K.; Kelly, Bryan T.

2010-01-01

With the improvements in flexible instrumentation, hip arthroscopy is being increasingly used to treat a variety of hip pathology, including labral tears. However, up to this point, there has not been a case report of an anterior and a posterior labral tear successfully repaired arthroscopically. We present a case report of a 27-year-old male firefighter who presented to our institution with an anterior and posterior labral tear, as well as a cam lesion and loose body, following a traumatic hip dislocation. The purpose of this case report is to illustrate that both anterior and posterior labral tears can be repaired using hip arthroscopy. Anterior and posterior labral tears can be caused by a traumatic hip dislocation, and both can be successfully repaired using arthroscopic techniques. PMID:21886540

Sex Determination by Biometry of Anterior Features of Human Hip Bones in South Indian Population.

PubMed

Rajasekhar, Sssn; Vasudha, T K; Aravindhan, K

2017-06-01

Sex determination is the first step in establishing the identity of skeletal remains. Many studies included biometry of posterior features of hip bone. Very few studies are reported involving the biometry of anterior features of the hip bone. Anterior features of hip bone are important especially, if there is damage to the posterior features of hip bone in cases involving deliberate disfigurement of the body to resist identification of the crime in medicolegal cases. The present study was done to evaluate the effectiveness of anterior border parameters of the hip bone for prediction of sex using discriminant function analysis in South Indian population. A total of 206 dry bones were used (121 male and 85 female) and parameters like the distance between pubic tubercle and anterior rim of acetabulum, vertical acetabular diameter, transverse acetabular diameter, and the distance between pubic tubercle to highest point on the iliopubic eminence were measured using Vernier calipers. Normally distributed variables were compared using Students t-test to analyse the significance. There was significant difference between the male and female hip bones of the observed variables with p-value less than 0.05. In parameters like the distance between pubic tubercle to anterior rim of acetabulum and distance between the highest points on iliopubic eminence to pubic tubercle; the values were more in female when compared to males. In parameters like vertical and transverse acetabular diameters; the values in males were more when compared to females. These parameters of hip bone can be utilised for sex determination in South Indian population.

Comparison of improved range of motion between cam-type femoroacetabular impingement and borderline developmental dysplasia of the hip -evaluation by virtual osteochondroplasty using computer simulation.

PubMed

Kubota, So; Inaba, Yutaka; Kobayashi, Naomi; Choe, Hyonmin; Tezuka, Taro; Saito, Tomoyuki

2017-10-16

While cam resection is essential to achieve a good clinical result with respect to femoroacetabular impingement (FAI), it is unclear whether it should also be performed in cases of borderline developmental dysplasia of the hip (DDH) with a cam deformity. The aim of this study was to evaluate improvements in range of motion (ROM) in cases of cam-type FAI and borderline DDH after virtual osteochondroplasty using a computer impingement simulation. Thirty-eight symptomatic hips in 31 patients (11male and 20 female) diagnosed with cam-type FAI or borderline DDH were analyzed. There were divided into a cam-type FAI group (cam-FAI group: 15 hips), borderline DDH without cam group (DDH W/O cam group: 12 hips), and borderline DDH with cam group (DDH W/ cam group: 11 hips). The bony impingement point on the femoral head-neck junction at 90° flexion and maximum internal rotation of the hip joint was identified using ZedHip® software. Virtual osteochondroplasty of the impingement point was then performed in all cases. The maximum flexion angle and maximum internal rotation angle at 90° flexion were measured before and after virtual osteochondroplasty at two resection ranges (i.e., slight and sufficient). The mean improvement in the internal rotation angle in the DDH W/ cam group after slight resection was significantly greater than that in the DDH W/O cam group (P = 0.046). Furthermore, the mean improvement in the internal rotation angle in the DDH W/ cam and cam-FAI groups after sufficient resection was significantly greater than that in the DDH W/O cam group (DDH W/ cam vs DDH W/O cam: P = 0.002, cam-FAI vs DDH W/O cam: P = 0.043). Virtual osteochondroplasty resulted in a significant improvement in internal rotation angle in DDH W/ cam group but not in DDH W/O cam group. Thus, borderline DDH cases with cam deformity may be better to consider performing osteochondroplasty.

Arthroscopy Up to Date: Hip Femoroacetabular Impingement.

PubMed

Khan, Moin; Habib, Anthony; de Sa, Darren; Larson, Christopher M; Kelly, Bryan T; Bhandari, Mohit; Ayeni, Olufemi R; Bedi, Asheesh

2016-01-01

To provide a comprehensive review and summary of the research published in Arthroscopy: The Journal of Arthroscopic and Related Surgery and The American Journal of Sports Medicine (AJSM) related to hip arthroscopy for femoroacetabular impingement (FAI). A comprehensive review was conducted in duplicate of Arthroscopy and AJSM from February 2012 to February 2015 for all articles related to FAI, and a quality assessment was completed for all included studies. Clinical outcomes were dichotomized into short-term (<6 months) and midterm (<24 months) outcomes, and values were pooled when possible. We identified 60 studies in Arthroscopy and 44 studies in AJSM, primarily from North America (78.8%), that predominantly assessed clinical outcomes after arthroscopic hip surgery (46.1%). Seventy-one percent of Arthroscopy studies and 20.5% of AJSM studies were Level IV evidence. The modified Harris Hip Score (mHHS) was used by 81.5% of included studies. Pooled weighted mean mHHS values after arthroscopic surgery for FAI showed improvements at the midterm from 60.5 points (range, 56.6 to 83.6 points) to 80.5 points (range, 72.1 to 98.0 points) out of a possible 100 points. Pooled weighted outcomes for labral repair showed mean mHHS improvements from 63.8 points (range, 62.5 to 69.0 points) preoperatively to 86.9 points (range, 85.5 to 89.9 points) up to 24 months postoperatively. This comprehensive review of research published in Arthroscopy and AJSM over the past 3 years identified a number of key findings. Arthroscopic intervention results in improvements in functional outcomes at both the short-term and midterm for patients with symptomatic FAI in the absence of significant existing degenerative changes. Labral repair may result in improvements over labral debridement. The most commonly used outcome score was the mHHS for objective assessment of surgical success. There is a need for continued focus on improvement of methodologic quality and reporting of research pertaining

Recognizing anterior metaphyseal femoral bone loss during uncemented total hip arthroplasty: the skylight sign.

PubMed

Harwin, Steven F

2007-03-01

During preparation for uncemented femoral arthroplasty, a phenomenon has been observed that indicates thinning of anterior metaphyseal bone to a critical level. Light can be seen from within the canal passing through the anterior cortex. This skylight sign alerts the surgeon that a cortical defect or fracture can occur on reaming, broaching, or component insertion. In 420 consecutive arthroplasties, a skylight sign was noted in 97 (23%) hips. In 5 of those hips an oval cortical defect was created and in 3 hips a fracture occurred during broaching or insertion. Loosening developed in 1 hip with fracture. No fractures or defects occurred in hips without a skylight sign. If a skylight sign is present, the femur is at risk and preventive measures should be taken.

Revision hip preservation surgery with hip arthroscopy: clinical outcomes.

PubMed

Domb, Benjamin G; Stake, Christine E; Lindner, Dror; El-Bitar, Youseff; Jackson, Timothy J

2014-05-01

To analyze and report the clinical outcomes of a cohort of patients who underwent revision hip preservation with arthroscopy and determine predictors of positive and negative outcomes. During the study period from April 2008 to December 2010, all patients who underwent revision hip preservation with arthroscopy were included. This included patients who had previous open surgery and underwent revision with arthroscopy. Patient-reported outcome (PRO) scores were obtained preoperatively and at 3-month, 1-year, 2-year, and 3-year follow-up time points. Any revision surgeries and conversions to total hip arthroplasty were noted. A multiple regression analysis was performed to look for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy. Forty-seven hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. The mean length of follow-up was 29 months (range, 24 to 47 months). Of the hips, 31 (66%) had either unaddressed or incompletely treated femoroacetabular impingement. There was a significant improvement in all PRO scores at a mean of 29 months after revision (P < .0001). The visual analog scale score improved from 7.3 ± 1.5 to 3.9 ± 2.5 (P < .0001). Improvements in the Non-Arthritic Hip Score of at least 10 points and 20 points were found in 28 hips (65%) and 19 hips (44%), respectively. Four hips in 3 patients required conversion to total hip arthroplasty. Positive predictive factors for PRO improvement were previous open surgery, pincer impingement, cam impingement, symptomatic heterotopic ossification, and segmental labral defects treated with labral reconstruction. On the basis of multiple PROs, revision hip preservation with hip arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

PubMed

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Total hip arthroplasty through anterior "minimal invasive" approach].

PubMed

Moerenhout, Kevin G; Cherix, Stéphane; Rüdiger, Hannes A

2012-12-19

Total hip replacement has seen a tremendous development and has become one of the most successful surgical interventions in orthopaedics. While during the first decades of development of total hip arthroplasty the fixation of the implant into the bone was the main concern, the focus has shifted towards surgical technique and soft tissue handling. In order to avoid permanent soft tissue damage, muscular dysfunction and concerns in regards to cosmetics, minimal invasive and anatomic approaches have been developed. We here provide a short overview on various methods of total hip replacements and we describe our technique through a minimal invasive direct anterior approach. While muscle and nerve damage is minimal, this technique allows for a rapid rehabilitation and is associated with an excellent functional outcome and a minimal risk for dislocation.

Simultaneous Versus Staged Bilateral Hip Arthroscopy in the Treatment of Femoroacetabular Impingement.

PubMed

Degen, Ryan M; Nawabi, Danyal H; Fields, Kara G; Wentzel, C Sally; Kelly, Bryan T; Coleman, Struan H

2016-07-01

To compare the clinical outcomes and complication rates of patients undergoing simultaneous versus staged bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement (FAI). Between 2010 and 2013, a total of 1,800 hip arthroscopy cases were retrospectively reviewed for cases of simultaneous bilateral hip arthroscopy. All patients with minimum 1-year follow-up were included. This group was matched 1:2 for age, sex, and alpha angle, to a control group of patients who underwent staged, bilateral procedures. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), and the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) were obtained preoperatively at 6 months and 1 and 2 years postoperatively. Eighty-one patients (162 hips) were identified who underwent bilateral hip arthroscopy for symptomatic FAI. Twelve patients (24 hips) who underwent simultaneous bilateral arthroscopy with minimum 1-year follow-up were compared with a matched cohort of 24 patients (48 hips) who underwent staged bilateral procedures. Mean preoperative alpha angle was 65.3° ± 9.6° in the simultaneous group and 65.9° ± 11.2° in the staged group (P = .6). At a mean follow-up of 17.8 months (range, 12 to 33 months), there were comparable improvements in simultaneous versus staged patient-reported outcome scores (mHHS 90.8 ± 11 v 88.9 ± 12.5, P = .662; HOS-ADL 97.3 ± 3.8 v 92.6 ± 10.3, P = .057; HOS-SSS 93.3 ± 10.2 v 86.5 ± 16.6, P = .203). The mean single anesthetic traction time was 90.8 ± 21.9 minutes (sum of both hips) in the simultaneous group, compared with a combined 2-anesthetic traction time of 85.7 ± 27.2 minutes in the staged group (P = .579). There were no traction-related complications in either group. No patients in the simultaneous group required revision surgery, whereas 1 patient in the staged group required lysis of adhesions at 24 months postoperatively

Regression models to predict hip joint centers in pathological hip population.

PubMed

Mantovani, Giulia; Ng, K C Geoffrey; Lamontagne, Mario

2016-02-01

The purpose was to investigate the validity of Harrington's and Davis's hip joint center (HJC) regression equations on a population affected by a hip deformity, (i.e., femoroacetabular impingement). Sixty-seven participants (21 healthy controls, 46 with a cam-type deformity) underwent pelvic CT imaging. Relevant bony landmarks and geometric HJCs were digitized from the images, and skin thickness was measured for the anterior and posterior superior iliac spines. Non-parametric statistical and Bland-Altman tests analyzed differences between the predicted HJC (from regression equations) and the actual HJC (from CT images). The error from Davis's model (25.0 ± 6.7 mm) was larger than Harrington's (12.3 ± 5.9 mm, p<0.001). There were no differences between groups, thus, studies on femoroacetabular impingement can implement conventional regression models. Measured skin thickness was 9.7 ± 7.0mm and 19.6 ± 10.9 mm for the anterior and posterior bony landmarks, respectively, and correlated with body mass index. Skin thickness estimates can be considered to reduce the systematic error introduced by surface markers. New adult-specific regression equations were developed from the CT dataset, with the hypothesis that they could provide better estimates when tuned to a larger adult-specific dataset. The linear models were validated on external datasets and using leave-one-out cross-validation techniques; Prediction errors were comparable to those of Harrington's model, despite the adult-specific population and the larger sample size, thus, prediction accuracy obtained from these parameters could not be improved. Copyright © 2015 Elsevier B.V. All rights reserved.

Unconstrained tripolar hip implants: effect on hip stability.

PubMed

Guyen, Olivier; Chen, Qing Shan; Bejui-Hugues, Jacques; Berry, Daniel J; An, Kai-Nan

2007-02-01

Tripolar implants were developed to treat unstable total hip arthroplasties. However, there is limited confirmation that they achieve this purpose despite their increasing use. Because they have a larger effective head size, these implants are expected to increase range of motion to impingement and improve stability in situations at risk for impingement compared with conventional implants. We assessed the range of motion to impingement using a tripolar implant mounted to an automated hip simulator using 22.2-mm and 28-mm femoral head sizes. The 22 and 28-mm tripolar implants provided increases of 30.5 degrees in flexion, 15.4 degrees in adduction, and 22.4 degrees in external rotation compared with the conventional 22.2-mm femoral head diameter implant. At the critical position of 90 degrees hip flexion, there was an increase of 45.2 degrees in internal rotation. At 0 degrees and 30 degrees external rotation, extension increases were 18.8 degrees and 7.8 degrees, respectively. Bony impingement was the limiting factor. Tripolar implants increased the arc of motion before impingement in positions at risk for dislocation and are expected to provide greater stability.

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

PubMed

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

2015-06-01

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement.

PubMed

Naal, Florian D; Miozzari, Hermes H; Kelly, Bryan T; Magennis, Erin M; Leunig, Michael; Noetzli, Hubert P

2013-01-01

To develop and validate a sports activity scale for patients with a diagnosis of femoroacetabular impingement (FAI).
 A nine level Hip Sports Activity Scale (HSAS) was constructed both in German and English languages. Fifty-nine consecutive patients undergoing surgical treatment for FAI at two centers in Switzerland and in the US completed a questionnaire set consisting of the HSAS, the University of California at Los Angeles (UCLA) activity scale and different hip joint-specific and generic outcome tools. For reliability assessment, the HSAS was completed twice about nine days apart. Evidence of reliability, validity and responsiveness was investigated by classical psychometric analyses.
 Reliability was excellent for both the German and the English versions with intraclass correlation coefficients of 0.94 and 0.96, respectively. Evidence of convergent validity was supported by moderate to high correlations with the UCLA activity scale and with the joint-specific measures used. Evidence of divergent validity was supported by low correlations with the SF-12 Mental Component Scale and the WOMAC stiffness subscale. The standardised response mean was 0.69.
 The HSAS is a reliable and valid tool to determine sports levels in patients suffering from FAI. Its use in future studies investigating outcomes in young patients with hip disease can be recommended.
 Level III, Diagnostic Studies - An independent, masked comparison with an appropriate population of patients, but reference standard not applied to all study patients.

Surgical dislocation of the hip and the management of femoroacetabular impingement: results of the Christchurch experience.

PubMed

Kempthorne, Joshua T; Armour, Paul C; Rietveld, John A; Hooper, Gary J

2011-06-01

Surgical dislocation of the hip has been developed to deal with the problems causing femoroacetabular impingement (FAI). This is a relatively recent procedure that was historically reserved for larger areas specializing in hip surgery. We hypothesized that surgical dislocation can be used for symptomatic FAI in a typical Australasian tertiary orthopaedic centre with acceptable results. This prospective study reviews the results of 53 surgical dislocations in this setting, looking particularly at functional outcomes and early complications. There were significant improvements in the Western Ontario and McMaster University Osteoarthritis Index score at 1, 2, 3 and 4 years post-operatively. Western Ontario and McMaster University Osteoarthritis Index scores increased by 23, 28, 34 and 35 points, respectively (P 0.0039). There was no significant improvement in hip range of motion. There were two (4%) early failures with conversion to total hip arthroplasty, and no cases of post-operative avascular necrosis of the femoral head. We believe that as the diagnosis of FAI and conservative nonarthroplasty surgery of the hip gains wider acceptance, it will become a procedure that should be offered to all appropriate patients in an attempt to delay or limit total hip arthroplasty in this young age group.

High Rate of Return to Cycling After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

PubMed

Frank, Rachel M; Ukwuani, Gift; Clapp, Ian; Chahla, Jorge; Nho, Shane J

Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in athletes who sustain repetitive flexion and rotational loading to their hip. The purpose of this study was to evaluate a patient's ability to return to cycling after hip arthroscopy for FAIS. There is a high rate of return to cycling after hip arthroscopy. Retrospective analysis. Level 4. Consecutive patients who had identified themselves as cyclists and had undergone hip arthroscopy for the treatment of FAIS were reviewed. Pre- and postoperative physical examinations, imaging, and patient-reported outcomes (PROs) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale for pain, as well as a cycling-specific questionnaire, were assessed for all patients. A total of 58 patients (62% female; mean age, 30.0 ± 7.1 years; mean body mass index, 23.2 ± 2.7 kg/m 2 ) were included. Prior to surgery, patients averaged 30 ± 42 miles per week (range, 2-300 miles). Fifty-five patients (95%) were forced to discontinue cycling at an average of 7.5 ± 6.2 months prior to surgery due to hip pain. Fifty-six patients (97%) returned to cycling at an average of 4.5 ± 2.5 months after surgery, with 33 (59%) returning to a better level of cycling and 23 (41%) to the same cycling level. Postoperatively, there was no difference in the average number of miles patients completed per week compared with preoperative values ( P = 0.08). At a mean follow-up of 31.14 ± 0.71 months (range, 24-48 months), all patients experienced significant improvements in mHHS, HOS-ADL, and HOS-SS PROs (all P < 0.0001), with an overall satisfaction rate of 91% ± 13%. Recreational and competitive cyclists return to cycling 97% of the time after hip arthroscopy for FAIS, with most of these patients returning at an average of 4.5 months after surgery. This information is helpful in counseling patients on their

Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes.

PubMed

Mei-Dan, Omer; McConkey, Mark O; Knudsen, Joshua S; Brick, Matthew J

2014-01-01

The purpose of this study was to investigate whether, in patients with bilateral symptomatic femoroacetabular impingement, bilateral surgery under 1 anesthetic is safe and efficacious and allows a rapid return of function compared with staged procedures. Three groups were evaluated: in group 1 both hips were treated simultaneously, in group 2 both hips were treated in a staged fashion, and in group 3 a single hip was addressed. The outcome measures were anesthesia and surgical times; time in the hospital; visual analog scale score for pain on postoperative days 1, 3, 7, and 30; analgesic use; and time until the patient could bike, drive, perform office work, perform gym activities, run, and return to play. Midterm evaluation was performed with the Non-Arthritic Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at 6 and 12 months postoperatively. We enrolled 76 patients (122 hips) in this study. There were 42 male and 34 female patients. The mean age was 33 years (range, 14 to 50 years), and the mean body mass index was 24 (range, 18 to 35). Group 1 comprised 26 patients (52 hips, 16 male and 10 female patients). Group 2 comprised 20 patients (40 hips, 13 male and 7 female patients), with a mean time between surgeries of 14.56 weeks. Group 3 comprised 33 patients (30 hips, 13 male and 17 female patients). No preoperative differences were found between the groups. The surgical and anesthesia times in group 1 were significantly longer than those in groups 2 and 3. We found no significant differences in postoperative visual analog scale scores, analgesic use, or length of hospital stay. Group 1 required more time before patients were able to ride a stationary bicycle (14.7 days in group 1, 7.8 days in group 2, and 8.5 days in group 3; P < .05). We found no differences between the groups regarding when patients returned to driving, performing office work, or reporting a normal gait. Each group had significant improvements in the Western

Does Hip Arthroscopy Provide Meaningful Outcome Improvement for Adolescent Femoroacetabular Impingement

PubMed Central

Nwachukwu, Benedict Uchenna; Chang, Brenda; Kahlenberg, Cynthia A.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2017-01-01

Objectives: Arthroscopic treatment of femoroacetabular impingement (FAI) produces meaningful outcome improvement in adults. Hip arthroscopy for pediatric FAI is now established as a safe procedure however there is a paucity of evidence reporting on outcome improvement after arthroscopic treatment of FAI in this population. Methods: A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for pediatric FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) are routinely collected as part of the registry. Minimal clinically important difference (MCID) was calculated using a distribution based method and substantial clinical benefit (SCB) was calculated using the an anchor question. Receiver operating characteristic (ROC) analysis with area under the curve was used. AUC > 0.7 was considered significantly predictive. Results: Forty-seven children and adolescents were identified. The majority of patients were female (N=32, 68.1%) with a mean age of 16.5 (+ 1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%) and 10.7 (94%) respectively. MCID values on these outcome tools were comparable to adult patients within the registry however for each outcome measure pediatric patients were more likely to achieve MCID. In univariate analysis acetabular version was the only predictive variable for achieving MCID in pediatric FAI (p<0.05). The majority of children (91%) reported improved physical ability based on the anchor question and 53% (compared to 40% in adult registry patients) were classified as achieving SCB. The following one-year raw outcome scores were significantly predictive of SCB on the mHHS, HOS

Brake Reaction Time After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear.

PubMed

Vera, Angelina M; Beauchman, Naseem; McCulloch, Patrick C; Gerrie, Brayden J; Delgado, Domenica A; Harris, Joshua D

2017-05-01

To determine if a difference exists in brake reaction time (BRT) before and after hip arthroscopy for femoroacetabular impingement (FAI) and labral tear compared with age- and gender-matched controls. Consecutive adult subjects undergoing primary hip arthroscopy were eligible for this prospective investigation. Individuals with symptomatic FAI and labral tear that underwent hip arthroscopy with minimum 8 weeks follow-up were included. BRT was measured using the RT-2S reaction time tester a maximum of 6 weeks preoperatively and every 2 weeks postoperatively for 8 weeks. Sit-to-stand test (STST) was measured at each BRT testing session. An age- and gender-matched control group without hip or lower extremity symptoms were selected and completed both BRT and STST. Continuous pre- and postoperative BRT values were compared with Mann-Whitney and analyses of variance. Association of BRT and STST tests was performed with Spearman correlation. An a priori sample size calculation determined that minimally 18 subjects per group (surgery group vs control group) were necessary to detect, with 80% power (difference of 0.2 seconds in BRT). Nineteen subjects (age 37.1 ± 12.7 years, 10 women, 11 right hip) were analyzed. All subjects underwent arthroscopic labral repair and FAI correction. There was no difference between preoperative (604 ± 148 milliseconds [ms]) and postoperative (608 ms 2 weeks; 566 ms 4 weeks; 559 ms 6 weeks; 595 ms 8 weeks) BRT. There was no difference between controls and subjects at any time point. There was a strong negative correlation between BRT and STST preoperatively and at 4 and 6 weeks postoperatively and a moderate negative correlation at 2 weeks postoperatively. After hip arthroscopy for FAI and labral tear, BRT is not different from preoperative values or that of controls. In addition, BRT had a significant correlation with STST in the first 6 weeks after surgery. Level II, diagnostic, prospective. Copyright © 2016

Acute ischiofemoral impingement?

PubMed

García, X G; Turmo, A; Cos, M A; Puigdellívol, J; Til, Ll

2018-03-31

We report a case of rare clinical entity, which comes within the spectrum of hip impingements. The case deals with a 36 year old female, Olympic athlete, who developed ischiofemoral impingement 14 months after a surgical hamstring reattachment. She was treated conservatively and fully recovered. When looking into literature on this matter, we found that it is probably an under-diagnosed problem, particularly in patients with no history of prior surgery. To our knowledge, this is the first case reported after a hamstrings tendon reattachment. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

ACUTE EFFECTS OF DIFFERENT ANTERIOR THIGH SELF-MASSAGE ON HIP RANGE-OF-MOTION IN TRAINED MEN.

PubMed

Monteiro, Estêvão Rios; Vigotsky, Andrew D; Novaes, Jefferson da Silva; Škarabot, Jakob

2018-02-01

Self-massage is a ubiquitous intervention similar to massage, but performed by the recipient him- or herself rather than by a therapist, most often using a tool (e.g., foam roller, roller massager). Self-massage has been found to have a wide range of effects. It is particularly known for increasing flexibility acutely, although not always. The variability of the results in previous studies may potentially be a function of the tool used. Recent findings also suggest that self-massage exerts global effects. Therefore, increased flexibility should be expected in the areas adjacent to the ones treated. To investigate the acute effects of foam rolling and rolling massage of anterior thigh on hip range-of-motion (ROM) - i.e., hip extension and hip flexion - in trained men. Eighteen recreationally active, resistance trained males visited the lab on two occasions over a 4-day period separated by at least a day. Each session included two baseline ROM measures of passive hip flexion and extension taken in a randomized fashion. Recording of baseline measures was followed by the intervention of the day, which was either foam rolling or rolling massage of the anterior thigh as per randomization. Immediately post intervention, passive hip flexion and hip extension ROM were reassessed. In order to assess the time course of improvements in ROM, hip flexion and hip extension ROM were reevaluated at 10, 20, and 30 minutes post-intervention. Hip flexion and hip extension ROM increased immediately following both interventions (foam rolling or roller massager) and remained increased for 30 minutes post intervention. Foam rolling was statistically superior in improving hip flexion and hip extension ROM immediately post intervention. However, immediately post-intervention was the only time point that measurements exceeded the minimum detectable change for both interventions. Both foam rolling and rolling massage appear to be effective interventions for improving hip flexion and extension

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

[Secondary impingement syndrome in athletes].

PubMed

Jerosch, J; Castro, W H; Sons, H U

1990-12-01

Dysfunction of the shoulder joint is based not only on anatomic conditions. The consideration of the special kinesiology of the shoulder helps to understand the shoulder pathology. This mainly applies to young "overhead athletes" like swimmers, handball-, basketball-, volleyball-, and racketplayers. These disciplines cause stress on the anterior joint structures (capsule, ligaments, labrum, subscapularis tendon) and lead to anterior instability. This includes anterior subluxation or even dislocation. Finally, an impingement syndrome with the typical symptoms can frequently result from these conditions. The impingement-syndrome of the elderly must be considered as a primary disease, whereas the young overhead athlete suffers from the impingement syndrome as a secondary disease and does not take the first place in therapy. The first step in therapy should to be treat the muscular imbalance of the shoulder. To gain a regular pattern of motion the rotator cuff must be strengthened. This regimen is likely to be successful in 80-90% of the cases. If the conservative therapy fails the surgical treatment may come into consideration. Arthroscopic surgery has the advantage not to affect the proprioceptivity. To retain the previous level of performance an adequate rehabilitation programme is essential for the athlete.

Electromyographic study of hip muscles involved in total hip arthroplasty: Surprising results using the direct anterior minimally invasive approach.

PubMed

Bernard, Jules; Razanabola, Fredson; Beldame, Julien; Van Driessche, Stéphane; Brunel, Helena; Poirier, Thomas; Matsoukis, Jean; Billuart, Fabien

2018-05-16

The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S). The study addressed the following questions: (1) Is bipodal and unipodal GMed activity greater following anterior THA than in asymptomatic subjects? (2) Is a single manual test sufficient to assess maximal voluntary contraction (MVC) in hip abductors (GMax, GMed, TFL) and flexors (TFL, S)? Bipodal and unipodal GMed activity is greater following anterior THA than in asymptomatic subjects. Eleven patients with anterior THA and 11 asymptomatic subjects, matched for age, gender and body-mass index, were included. Subjects underwent 3 postural tests: bipodal, eyes closed (BEC), unipodal on the operated side (UOP), and unipodal on the non-operated side (UnOP), with unipodal results averaged between both sides in the asymptomatic subjects. Data were recorded from 4-channel EMG and a force plate. EMG test activity was normalized as a ratio of MVC activity. Postural parameters (mean center of pressure displacement speed) were poorer and sEMG activity higher in anterior THA than asymptomatic subjects (p<0.005). On the BEC test, GMax and GMed activity was higher on both operated and non-operated sides than in asymptomatic controls (respectively, 0.15±0.12 and 0.12±0.6 versus 0.07±0.06 for GMax, and 0.13±0.08 and 0.13±0.08 versus 0.08±0.05 for GMed; p<0.05). On unipodal tests, both UOP and UnOP GMed activities were higher than in controls (respectively

Prospective, Observational Study of Opioid Use After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

PubMed

Cunningham, Daniel; Lewis, Brian; Hutyra, Carolyn; Nho, Shane; Olson, Steven; Mather, Richard

2018-05-01

To provide estimates of postoperative opioid use after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify risk factors for increased postoperative opioid use. All patients aged at least 18 years who were undergoing hip arthroscopy for FAI syndrome performed by 1 of 2 hip-preservation surgeons between November 2015 and August 2016 were eligible for inclusion in this study. Target minimum enrollment was set at 30 patients per surgeon based on an a priori sample size calculation. Enrolled patients completed the International Hip Outcome Tool, visual analog pain scale, Pain Catastrophizing Scale, abbreviated Patient Health Questionnaire, and questions regarding demographic characteristics and opioid and anti-inflammatory use. Opioid consumption was assessed through pill counting at 2- and 6-week postoperative appointments. Of 80 patients enrolled, 67 had complete 2- and 6-week opioid use data. Patient and operative factors were correlated with outcomes in multivariate models. Opioid use in the 2 weeks before surgery was significantly associated with higher postoperative opioid use at 2 weeks postoperatively (253.8 additional oral morphine equivalents [OMEs]; 95% confidence interval [CI], 171.2-336.5 additional OMEs; P < .0001; n = 73) and 6 weeks postoperatively (385.3 additional OMEs; 95% CI, 241.6-529.0 additional OMEs; P < .0001; n = 67). By 6 weeks postoperatively, 41 of 52 patients (79%) without opioid use in the 2 weeks before surgery used 30 or fewer 5-mg oxycodone pills compared with only 2 of 15 patients (13%) with preoperative use (odds ratio, 24.9; 95% CI, 4.2-148.5; P < .0001). Among patients undergoing hip arthroscopy for FAI syndrome, any opioid use in the 2 weeks preceding surgery was the strongest predictor of opioid use after hip arthroscopy. The impact of preoperative opioid use far exceeded the impact of other baseline patient and operative factors. Assessment of preoperative opioid use could be an important

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging.

PubMed

Battaglia, Patrick J; D'Angelo, Kevin; Kettner, Norman W

2016-12-01

The purpose of this study was to present a narrative review of the literature of musculoskeletal causes of adult hip pain, with special attention to history, physical examination, and diagnostic imaging. A narrative review of the English medical literature was performed by using the search terms "hip pain" AND "anterior," "lateral," and "posterior." Additionally, specific entities of hip pain or pain referral sources to the hip were searched for. We used the PubMed search engine through January 15, 2016. Musculoskeletal sources of adult hip pain can be divided into posterior, lateral, and anterior categories. For posterior hip pain, select considerations include lumbar spine and femoroacetabular joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy. Gluteal tendinopathy and iliotibial band thickening are the most common causes of lateral hip pain. Anterior hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment. A limited number of historical features and physical examination tests for evaluation of adult hip pain are supported by the literature and are discussed in this article. Depending on the clinical differential, the gamut of diagnostic imaging modalities recommended for accurate diagnosis include plain film radiography, computed tomography, magnetic resonance imaging, skeletal scintigraphy, and ultrasonography. The evaluation of adult hip pain is challenging. Clinicians should consider posterior, lateral, and anterior sources of pain while keeping in mind that these may overlap.

Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent.

PubMed

Diamond, Laura E; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; Hall, Michelle; O'Donnell, John; Hodges, Paul W

2018-03-01

Femoroacetabular impingment (FAI) syndrome is common among young active adults and a proposed risk factor for the future development of hip osteoarthritis. Pain is dominant and drives clinical decision-making. Evidence for altered hip joint function in this patient population is inconsistent, making the identification of treatment targets challenging. A broader assessment, considering adjacent body segments (i.e. pelvis, trunk) and individual movement strategies, may better inform treatment programs. This exploratory study aimed to compare trunk, pelvis, and hip biomechanics during step ascent between individuals with and without FAI syndrome. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery, and 11 age-, and sex-comparable pain- and disease-free individuals, underwent three-dimensional motion analysis during a step ascent task. Trunk, pelvis and hip biomechanics were compared between groups. Participants with FAI syndrome exhibited altered ipsilateral trunk lean and pelvic rise towards the symptomatic side during single-leg support compared to controls. Alterations were not uniformly adopted across all individuals with FAI syndrome; those who exhibited more pronounced alterations to frontal plane pelvis control tended to report pain during the task. There were minimal between-group differences for hip biomechanics. Exploratory data suggest biomechanics at the trunk and pelvis during step ascent differ between individuals with and without FAI syndrome. Those with FAI syndrome implement a range of proximal strategies for task completion, some of which may have relevance for rehabilitation. Longitudinal investigations of larger cohorts are required to evaluate hypothesized clinical and structural consequences. Copyright © 2018 Elsevier B.V. All rights reserved.

Pelvic posture and kinematics in femoroacetabular impingement: a systematic review.

PubMed

Pierannunzii, Luca

2017-09-01

Pelvic posture and kinematics influence acetabular orientation and are therefore expected to be involved in the pathomechanics of femoroacetabular impingement (FAI). This systematic review aims to determine whether FAI patients show pelvic postures or patterns of motion contributing to impingement or, conversely, develop compensatory postures and patterns of motion preventing it. PubMed/MEDLINE, Embase, Google Scholar and the Cochrane Library were systematically searched to find all the studies that measured pelvic positional and/or kinematic data in humans (patients or cadaveric specimens) affected by FAI. Twelve items were selected and grouped according to the main field of investigation. No quantitative data synthesis was allowed due to methodological heterogeneity. Pelvic posture and kinematics seem to play a relevant role in FAI. The patients, especially if symptomatic, show a paradoxical lack of pelvic back tilt in standing hip flexions, i.e., in squatting, that enhances femoroacetabular engagement. Such an aberrant pattern might depend on a lower pelvic incidence. On the contrary, active hip flexion in decubitus elicits a compensatory, more pronounced back tilt to facilitate hip flexion without impingement. Stair climbing shows a compensatory pattern of augmented pelvic axial rotation and augmented peak forward tilt to reduce painful hip motions, namely internal rotation and extension. In FAI patients, pelvic posture and kinematics are sometimes an expression of compensatory mechanisms developed to reduce pain and discomfort, and sometimes an expression of paradoxical responses that further enhance the impingement pathomechanism. IV.

[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.

Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter?

PubMed

Naal, Florian D; Müller, Aileen; Varghese, Viju D; Wellauer, Vanessa; Impellizzeri, Franco M; Leunig, Michael

2017-05-01

Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females. To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure. Cohort study; Level of evidence, 3. We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn't help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score. All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol-5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = -0.16 to -0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and

Does the Hip Capsule Remain Closed After Hip Arthroscopy With Routine Capsular Closure for Femoroacetabular Impingement? A Magnetic Resonance Imaging Analysis in Symptomatic Postoperative Patients.

PubMed

Weber, Alexander E; Kuhns, Benjamin D; Cvetanovich, Gregory L; Lewis, Paul B; Mather, Richard C; Salata, Michael J; Nho, Shane J

2017-01-01

The purpose of this study was to examine the hip capsule in a subset of symptomatic patients who underwent capsular closure during hip arthroscopy. All patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) with routine capsular closure between January 1, 2012, and December 31, 2015, were eligible. Only patients with unilateral surgery and a postoperative magnetic resonance imaging (MRI; ordered for persistent symptoms) were included. Four independent reviewers evaluated each hip capsule for thickness and the absence or presence of defects. During the study, 1,463 patients had hip arthroscopy for FAI with routine capsular closure, and 53 (3.6%) underwent a postoperative MRI. Fourteen of the 53 were excluded owing to revision status or additional procedures. The final study population included 39 patients (23 female patients and 16 male patients), with an average patient age of 31.7 ± 11.4 years and an average body mass index of 23.3 ± 2.9. There were 3 (7.5%) capsular defects, and the intraclass correlation coefficient (ICC) was 0.82. The operative hip capsule was significantly thicker in the zone of capsulotomy, and subsequent repair as compared with the unaffected, contralateral hip capsule (5.0 ± 1.2 mm vs 4.6 ± 1.4 mm; P = .02), ICC 0.83. Additionally, males had thicker hip capsules as compared with their female counterparts, on the operative side (5.4 ± 1.1 mm vs 4.5 ± 1.2 mm; P = .02) and the nonoperative side (4.8 ± 1.6 mm vs 4.1 ± 0.9 mm; P = .08). In a subset of symptomatic patients after hip arthroscopy for FAI, the majority (92.5%) of the repaired hip capsules remained closed at greater than 1 year of follow-up. The hip capsule adjacent to the capsulotomy and subsequent repair is thickened compared with the same location on the contralateral, nonoperative hip. Aside from gender, patient-related and FAI-related factors do not correlate with capsular thickness nor do they seem to correlate with the propensity

Physical Therapy Protocol After Hip Arthroscopy

PubMed Central

Domb, Benjamin G.; Sgroi, Terrance A.; VanDevender, Jeremy C.

2016-01-01

Context: Femoroacetabular impingement (FAI) was first described by Ganz in 2003 and is a significant cause of decreased function and mobility. Femoroacetabular impingement must be treated in an individualized, goal-oriented, stepwise fashion. This protocol was developed with biomechanical considerations of soft tissue and bony structures surrounding the hip joint. Evidence Acquisition: The PubMed database was searched for scientific and review articles from the years 2000 to 2015 utilizing the search terms: hip rehabilitation, femoroacetabular impingement, and arthroscopy. Study Design: Clinical review. Level of Evidence: Level 5. Results: Five hundred ninety-five of 738 patients were available for follow-up showing improvement from preoperative to 2-year follow-up of 61.29 to 82.02 for modified Harris Hip Score (mHHS), 62.79 to 83.04 for Hip Outcome Score–Activities of Daily Living (HOS-ADL), 40.96 to 70.07 for Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and 57.97 to 80.41 for Non-Arthritic Hip Score (NAHS); visual analog scale (VAS) scores decreased from 5.86 preoperatively to 2.94 postoperatively. Conclusion: Following a structured, criteria-based program, appropriate patients undergoing hip arthroscopy may achieve excellent outcomes and return to full independent activities of daily living as well as sport. PMID:27173983

Labral Reattachment in Femoroacetabular Impingement Surgery Results in Increased 10-year Survivorship Compared With Resection.

PubMed

Anwander, Helen; Siebenrock, Klaus A; Tannast, Moritz; Steppacher, Simon D

2017-04-01

Since the importance of an intact labrum for normal hip function has been shown, labral reattachment has become the standard method for open or arthroscopic treatment of hips with femoroacetabular impingement (FAI). However, no long-term clinical results exist evaluating the effect of labral reattachment. A 2-year followup comparing open surgical treatment of FAI with labral resection versus reattachment was previously performed at our clinic. The goal of this study was to report a concise followup of these patients at a minimum of 10 years. We asked if patients undergoing surgical hip dislocation for the treatment of mixed-type FAI with labral reattachment compared with labral resection had (1) improved hip pain and function based on the Merle d'Aubigné-Postel score; and (2) improved survival at 10-year followup. Between June 1999 and July 2002, we performed surgical hip dislocation with femoral neck osteoplasty and acetabular rim trimming in 52 patients (60 hips) with mixed-type FAI. In the first 20 patients (25 hips) until June 2001, a torn labrum or a detached labrum in the area of acetabular rim resection was resected. In the next 32 patients (35 hips), reattachment of the labrum was performed. The same indications were used to perform both procedures during the periods in question. Of the 20 patients (25 hips) in the first group, 19 patients (95%) (24 hips [96%]) were available for clinical and/or radiographic followup at a minimum of 10 years (mean, 13 years; range, 12-14 years). Of the 32 patients (35 hips) in the second group, 29 patients (91%) (32 hips [91%]) were available for clinical and/or radiographic followup at a minimum of 10 years (mean, 12 years; range, 10-13 years). We used the anterior impingement test to assess pain. Function was assessed using the Merle d'Aubigné- Postel score and ROM. Survivorship calculation was performed using the method of Kaplan-Meier with failure defined as conversion to THA, progression of osteoarthritis (of one

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.

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

Characterization of ossification of the posterior rim of acetabulum in the developing hip and its impact on the assessment of femoroacetabular impingement.

PubMed

Morris, William Z; Chen, Jason Y; Cooperman, Daniel R; Liu, Raymond W

2015-02-04

Many radiographic indices that are used to assess adolescents for femoroacetabular impingement rely on an ossified posterior acetabular wall. A recent study identified a secondary ossification center in the posterior rim of the acetabulum, the ossification of which may affect perceived acetabular coverage. The purpose of this study was to characterize ossification of the posterior rim of the acetabulum with use of a longitudinal radiographic study and quantify its impact on the radiographic assessment of femoroacetabular impingement. In this study, we utilized a historical collection of annual radiographs made in a population of healthy adolescents. Six hundred and twelve anteroposterior radiographs of the left hip of ninety-eight patients were reviewed to identify the appearance, duration, and fusion of the secondary ossification center in the posterior rim of the acetabulum. The center-edge angle was then measured before appearance and after fusion of the secondary ossification center in a subset of ten patients who had <5° of rotation on all radiographs. The secondary ossification center in the posterior rim was identified in seventy-three of the ninety-eight subjects, with no significant difference between the sexes. The mean patient age at the time of radiographic appearance of this secondary ossification center was fourteen years for males and twelve years for females. The mean duration of radiographic appearance was ten months for both sexes. Serial center-edge angles were measured in a subset of ten patients, and they increased during posterior rim ossification by a mean of 4.1°. The secondary ossification center in the posterior rim of the acetabulum (the posterior rim sign) is a common radiographic finding that reliably appears for ten months around the time of triradiate closure. Posterior rim ossification led to a mean increase of 4° of perceived acetabular coverage through the center-edge angle. Given the narrow margin between normal coverage (33�

Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression.

PubMed

Hapa, Onur; Bedi, Asheesh; Gursan, Onur; Akar, Mehmet Sait; Güvencer, Mustafa; Havitçioğlu, Hasan; Larson, Christopher M

2013-12-01

The purposes of this study were to define the anatomy of the anterior inferior iliac spine (AIIS) and its relation to the footprint of the rectus femoris tendon and to evaluate on the clinical outcomes after AIIS/subspine decompression. The rectus origin was dissected and detached in 11 male cadaveric hips with a mean age of 54.3 ± 14.3 years (range, 33 to 74 years). The proximal-distal and medial-lateral extent of the footprint and its relation to the AIIS and acetabular rim were evaluated, with the 12-o'clock position defined as directly lateral at the insertion of the indirect head of the rectus tendon and the 1- to 6-o'clock positions defined as anterior acetabular positions. To assess the safety and efficacy of subspine decompression for AIIS deformity, clinical correlation of a series of 163 AIIS decompressions (mean age, 27.8 years; age range, 14 to 52 years) performed from January 2011 to January 2012 was completed, and outcome scores, strength deficits, and ruptures were assessed by manual muscle testing and postoperative radiographs. All patients presented with symptomatic FAI with proximal femoral and/or acetabular deformity and type 2 (131 hips) or type 3 (32 hips) AIIS morphology as defined by Hetsroni et al. The mean proximal-distal and medial-lateral distances for the rectus origin footprint were 2.2 ± 0.1 cm (range, 2.1 to 2.4 cm) and 1.6 ± 0.3 cm (range, 1.2 to 2.3 cm), respectively. There was a characteristic bare area at the anteromedial AIIS. On the clock face, the lateral margin (1-o'clock to 1:30 position) and medial margin (2-o'clock to 2:30 position) of the AIIS and the indirect head of the rectus (12 o'clock) were consistent for all specimens. In the clinical series, 163 AIIS decompressions were performed for symptomatic subspine impingement. The mean modified Harris Hip Score was 63.1 points (range, 21 to 90 points) preoperatively compared with 85.3 points (range, 37 to 100 points) at a mean follow-up of 11.1 ± 4.1 months (range, 6 to

Dynamic Clinical Assessment of Femoral Acetabular Impingement

PubMed Central

Maak, Travis; Kraszewski, Andrew; Ranawat, Anil S.; Backus, Sherry I.; Magennis, Erin; Hillstrom, Howard; Kelly, Bryan T.

2013-01-01

Objectives: There has been a recent interest in the non-arthritic hip and its associated complex pathologies. Passive range of motion and static specialty tests are the corner stone of diagnosis and assessment of treatment. Little information exists on the use of dynamic functional measurements to assess non-arthritic hip function. The aims of this study were: (1) to measure and identify objective and reliable functional parameters to assess dynamic hip function, and (2) to compare functional kinematic and kinetic parameters among healthy controls and subjects with symptomatic diagnosed femoral acetabular impingement (FAI). Methods: An ongoing cross-sectional study was conducted on male healthy non-arthritic control and symptomatic, diagnosed FAI subjects. Functional kinematic and kinetic data were acquired with dynamic 3D motion analysis during stair ascent, stair descent, and a sit-to-stand maneuver. Joint kinematics were measured in degrees and joint kinetic moments were normalized by body mass (N-m/kg). Surface electromyographic (EMG) activity was measured for hip and trunk musculature. Measurement reliability was quantified with the adjusted coefficient of multiple correlation (CMC), and was calculated for angle, moment and EMG per subject, and averaged across subjects. Control and FAI subjects were compared with differences in kinematic and kinetic waveforms. Results: Data from ten healthy subjects (Age=25±4 years; BMI=24.3±3.6); and six FAI subjects (Age=32±10 years; BMI=25±4) have been recorded. Control and FAI subject CMC values are listed in Table 1. Kinematic and kinetic behavior differed (>1 SD) between control and FAI for multiple joints and planes of motion. Increased internal hip rotation moments were recorded in FAI subjects during both stair ascent and descent tasks, as compared to healthy controls. Increased external rotation moments were recorded in FAI subjects during the sit-to-stand task. Electromyographic data demonstrated notable

Radiographic findings of femoroacetabular impingement in National Football League Combine athletes undergoing radiographs for previous hip or groin pain.

PubMed

Nepple, Jeffrey J; Brophy, Robert H; Matava, Matthew J; Wright, Rick W; Clohisy, John C

2012-10-01

The purpose of this study was to investigate the prevalence of radiographic findings of femoroacetabular impingement (FAI) in elite football players with a history of hip pain or groin injury who underwent radiographs. We performed a retrospective review of athletes undergoing hip radiography at the National Football League Combine from 2007 to 2009. Radiographs were obtained in athletes with a history of hip pain or injury. Anteroposterior pelvis and frog-lateral radiographs were obtained in 123 hips (107 players) that met our inclusion criteria. Radiographic indicators of cam-type FAI (alpha angle, head-neck offset ratio) and pincer-type FAI (acetabular retroversion, center-edge angle, acetabular inclination) were recorded. Findings were correlated with clinical factors (previous groin/hip pain, position, race, and body mass index). The most common previous injuries included groin strain (n = 57) and sports hernia/abdominal strain (n = 21). Markers of cam- and/or pincer-type FAI were present in 94.3% of hips (116 of 123). Radiographic evidence of combined cam- and pincer-type FAI was the most common (61.8%, 76 hips), whereas isolated cam-type FAI (9.8%, 12 hips) and pincer-type FAI (22.8%, 28 hips) were less common. The most common deformities included acetabular retroversion (71.5%) and an abnormal alpha angle (61.8%). A body mass index greater than 35 was associated with the presence of global overcoverage (46.2% v 17.3%, P = .025). Radiographic indicators of FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease. Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI, because pain from FAI may be falsely attributed to or may be present in addition to other disorders. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America

A FOUR-PHASE PHYSICAL THERAPY REGIMEN FOR RETURNING ATHLETES TO SPORT FOLLOWING HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT WITH ROUTINE CAPSULAR CLOSURE

PubMed Central

Weber, Alexander E.; Batko, Brian; Nho, Shane J.; Stegemann, Catherine

2017-01-01

Hip preservation surgery has become more common over the past decade and is now a preferred treatment modality for an increasingly diverse array of pathology in the young, active patient with hip pain. In particular, hip arthroscopy has become an increasingly popular treatment choice for active patients diagnosed with femoroacetabular impingement (FAI). Appropriate postoperative rehabilitation is critical for overall patient success and optimal long-term outcome. As surgical techniques continue to evolve, rehabilitation protocols must adapt to accommodate changes in the surgical procedure and ultimately provide the safest and fastest recovery of function for the patient. One such surgical modification has been the incorporation of routine capsular closure as part of the treatment of FAI in the young, active patient. The purpose of this clinical commentary is to present a four-phase rehabilitation protocol for returning to sport following arthroscopic correction of FAI with routine capsular closure. Level of Evidence 5 PMID:28900574

High Rate of Return to Yoga for Athletes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

PubMed

Frank, Rachel M; Ukwuani, Gift; Allison, Bradley; Clapp, Ian; Nho, Shane J

2018-02-01

Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in patients who perform activities that require repetitive hip flexion and rotational loading. Yoga is an activity growing in popularity that involves these motions. The purpose of this study was to evaluate patients' ability to return to yoga after hip arthroscopy for FAIS. There would be a high rate of return to yoga after hip arthroscopy. Retrospective analysis. Level 4. Consecutive patients with FAIS who had identified themselves as participating in yoga and had undergone hip arthroscopy for the treatment of FAIS between 2012 and 2015 were reviewed. Demographic data were collected and assessed for all patients, as well as preoperative physical examination, imaging, and patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale (VAS) for pain. Postoperatively, examination and PRO data were collected at a minimum 1 year after surgery, including a yoga-specific questionnaire. A total of 42 patients (90% female; mean age, 35 ± 9 years; mean body mass index, 23.1 ± 3.2 kg/m 2 ) were included. Thirty patients (71%) had to discontinue their yoga routine preoperatively because of hip-related symptoms at a mean 9.5 ± 8.2 months before surgery. After surgery, 39 patients (93%) were able to return to yoga at a mean 5.3 ± 2.2 months after surgery. Two of the 3 patients who did not return to yoga noted loss of interest as their reason for stopping, while 1 patient was unable to return because of persistent hip pain. Nineteen patients (45%) returned to a higher level of yoga practice, 17 patients (40%) returned to the same level, and 3 patients (7%) returned to a lower level. There was no difference in the number of hours spent practicing yoga per week pre- and postoperatively (2.7 ± 1.9 vs 2.5 ± 1.3 hours; P = 0.44). All patients demonstrated

Surgical Correction of Cam Deformity in Association with Femoroacetabular Impingement and Its Impact on the Degenerative Process within the Hip Joint.

PubMed

Beaulé, Paul E; Speirs, Andrew D; Anwander, Helen; Melkus, Gerd; Rakhra, Kawan; Frei, Hanspeter; Lamontagne, Mario

2017-08-16

Cam morphology in association with femoroacetabular impingement (FAI) is a recognized cause of hip pain and cartilage damage and proposed as a leading cause of arthritis. The purpose of this study was to analyze the functional and biomechanical effects of the surgical correction of the cam deformity on the degenerative process associated with FAI. Ten male patients with a mean age of 34.3 years (range, 23.1 to 46.5 years) and a mean body mass index (and standard deviation) of 26.66 ± 4.79 kg/m underwent corrective surgery for cam deformity in association with FAI. Each patient underwent a computed tomography (CT) scan to assess acetabular bone mineral density (BMD), high-resolution T1ρ magnetic resonance imaging (MRI) of the hips to assess proteoglycan content, and squatting motion analysis as well as completed self-administered functional questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS]) both preoperatively and 2 years postoperatively. At a mean follow-up of 24.5 months, improvements in functional scores and squat performance were seen. Regarding the zone of impingement in the anterosuperior quadrant of the acetabular rim, the mean change in BMD at the time of follow-up was -31.8 mg/cc (95% confidence interval [CI], -11 to -53 mg/cc) (p = 0.008), representing a 5% decrease in BMD. The anterosuperior quadrant also demonstrated a significant decrease in T1ρ values, reflecting a stabilization of the cartilage degeneration. Significant correlations were noted between changes in clinical functional scores and changes in T1ρ values (r = -0.86; p = 0.003) as well as between the BMD and maximum vertical force (r = 0.878; p = 0.021). Surgical correction of a cam deformity in patients with symptomatic FAI not only improved clinical function but was also associated with decreases in T1ρ values and BMD. These findings are the first, to our knowledge, to show that alteration of the hip biomechanics through surgical intervention improves the overall

Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement.

PubMed

Hammond, Connor A; Hatfield, Gillian L; Gilbart, Michael K; Garland, S Jayne; Hunt, Michael A

2017-02-01

Femoroacetabular impingement is a pathomechanical hip condition leading to pain and impaired physical function. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric muscle contractions. However, no studies to-date have looked at trunk kinematics or muscle activation during dynamic movements such as stair climbing in this patient population. The purpose of this study was to compare biomechanical outcomes (trunk and lower limb kinematics as well as lower limb kinetics and muscle activation) during stair climbing in those with and without symptomatic femoroacetabular impingement. Trunk, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and muscle activity of nine lower limb muscles were collected during stair climbing for 20 people with clinical and radiographic femoroacetabular impingement and compared to 20 age- and sex-matched pain-free individuals. Those with femoroacetabular impingement ascended the stairs slower (effect size=0.82), had significantly increased peak trunk forward flexion angles (effect size=0.99) and external hip flexion moments (effect size=0.94) and had decreased peak external knee flexion moments (effect size=0.90) compared to the control group. Findings from this study indicate that while those with and without femoroacetabular impingement exhibit many biomechanical similarities when ascending stairs, differences in trunk forward flexion and joint kinetics indicate some important differences. Further longitudinal research is required to elucidate the cause of these differences as well as the clinical relevance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Similar Superior Patient-Reported Outcome Measures for Anterior and Posterolateral Approaches After Total Hip Arthroplasty: Postoperative Patient-Reported Outcome Measure Improvement After 3 months in 12,774 Primary Total Hip Arthroplasties Using the Anterior, Anterolateral, Straight Lateral, or Posterolateral Approach.

PubMed

Peters, Rinne M; van Beers, Loes W A H; van Steenbergen, Liza N; Wolkenfelt, Julius; Ettema, Harmen B; Ten Have, Bas L E F; Rijk, Paul C; Stevens, Martin; Bulstra, Sjoerd K; Poolman, Rudolf W; Zijlstra, Wierd P

2018-06-01

Patient-reported outcome measures (PROMs) are used to evaluate the outcome of total hip arthroplasty (THA). We determined the effect of surgical approach on PROMs after primary THA. All primary THAs, with registered preoperative and 3 months postoperative PROMs were selected from the Dutch Arthroplasty Register. Based on surgical approach, 4 groups were discerned: (direct) anterior, anterolateral, direct lateral, and posterolateral approaches. The following PROMs were recorded: Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS); Oxford Hip Score; EQ-5D index score; EQ-5D thermometer; and Numeric Rating Scale measuring pain, both active and in rest. The difference between preoperative and postoperative scores was calculated (delta-PROM) and used as primary outcome measure. Multivariable linear regression analysis was performed for comparisons. Cohen's d was calculated as measure of effect size. All examined 4 approaches resulted in a significant increase of PROMs after primary THA in the Netherlands (n = 12,274). The anterior and posterolateral approaches were associated with significantly more improvement in HOOS-PS scores compared with the anterolateral and direct lateral approaches. Furthermore, the posterolateral and anterior approaches showed greater improvement on Numeric Rating Scale pain scores compared with the anterolateral approach. No relevant differences in delta-PROM were seen between the anterior and posterolateral surgical approaches. Anterior and posterolateral surgical approaches showed more improvement in self-reported physical functioning (HOOS-PS) compared with anterolateral and direct lateral approaches in patients receiving a primary THA. However, clinical differences were only small. Copyright © 2018 Elsevier Inc. All rights reserved.

The anterior approach for a non-image-guided intra-articular hip injection.

PubMed

Mei-Dan, Omer; McConkey, Mark O; Petersen, Brian; McCarty, Eric; Moreira, Brett; Young, David A

2013-06-01

The purpose of this study was to investigate and validate the accuracy and safety of a technique using an anterior approach for non-image-guided intra-articular injection of the hip by use of anatomic landmarks. We enrolled 55 patients. Injections were performed before supine hip arthroscopy after landmarking and before application of traction. After the needle insertion, success was confirmed with an air arthrogram and by direct visualization after arthroscope insertion. Accuracy and difficulty achieving correct needle placement were correlated with age, weight, height, body mass index, body type, gender, and surgical indication, as well as femoral and pelvic morphology. Forty-five patients who underwent injection in the office were followed up separately to document injection side effects. Needle placement accuracy was correlated to patients' demographics. All statistical tests with P values were 2 sided, with the level of significance set at P < .05. There were 51 correct needle placements and 4 misses, yielding a 93% success rate. The most common location for needle placement was the upper medial head-neck junction. Female gender was correlated with a more difficult needle placement and misses in relation to group size (P = .06). The reasons for misplacements of the needle were a high-riding trochanter, increased femoral version, thick adipose tissue over the landmarks, and variant of ilium morphology. Of 45 patients in the side effect study arm, 3 reported sensory changes of the lateral femoral cutaneous nerve that resolved within 24 hours. Hip injections by use of the direct anterior approach, from the intersection of the lines drawn from the anterior superior iliac spine and 1 cm distal to the tip of the greater trochanter, are safe and reproducible. Patient characteristics, such as increased subcutaneous adipose tissue or osseous anatomic variants, can lead to difficulty in placing the needle successfully. These characteristics can be predicted with the aid

Validity of real-time ultrasound imaging to measure anterior hip muscle size: a comparison with magnetic resonance imaging.

PubMed

Mendis, M Dilani; Wilson, Stephen J; Stanton, Warren; Hides, Julie A

2010-09-01

Clinical measurement, criterion standard. To investigate the validity of real-time ultrasound imaging (USI) to measure individual anterior hip muscle cross-sectional area. The hip flexor muscles are important for hip joint function and could be affected by joint pathology or injury. Objectively documenting individual anterior hip muscle size can be useful in identifying muscle size asymmetry and monitoring treatment efficacy for patients with hip problems. USI offers a novel method of measuring individual muscle size in the clinic, but its validity in measuring the anterior hip muscles has not been investigated. Nine healthy participants (5 males, 4 females) underwent imaging of their iliopsoas, sartorius, and rectus femoris muscles with USI and magnetic resonance imaging. Bilateral muscle cross-sectional areas were measured on images from both modalities. There was no significant difference (P>.05) in mean cross-sectional area measurements from USI and magnetic resonance imaging for each muscle. Agreement between measurements was high for the iliopsoas (left: intraclass correlation coefficient [ICC3,1] = 0.86; 95% confidence interval [CI]: 0.51, 0.97; right: ICC3,1 = 0.88; 95% CI: 0.57, 0.97), sartorius (left: ICC3,1 = 0.82; 95% CI: 0.41, 0.96; right: ICC3,1 = 0.81; 95% CI: 0.39, 0.95), and rectus femoris (left: ICC3,1 = 0.85; 95% CI: 0.49, 0.96; right: ICC3,1 = 0.89; 95% CI: 0.61, 0.97). Reliability of measuring each muscle with USI was high between 2 trials (ICCs3,1 = 0.84 to 0.94). USI is a valid measure of iliopsoas, sartorius, and rectus femoris muscle size in healthy people, as long as a strict measurement protocol is followed.

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

MRI of lower extremity impingement and friction syndromes in children

PubMed Central

Aydıngöz, Üstün; Özdemir, Zeynep Maraş; Güneş, Altan; Ergen, Fatma Bilge

2016-01-01

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon–lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data. PMID:27538047

Femoroacetabular Impingement in Professional Football Players: Return to Play and Predictors of Career Length After Hip Arthroscopy.

PubMed

Menge, Travis J; Bhatia, Sanjeev; McNamara, Shannen C; Briggs, Karen K; Philippon, Marc J

2017-07-01

Previous studies have shown hip arthroscopy to be a highly effective treatment for symptomatic femoroacetabular impingement (FAI) in a wide range of athletes; however, the rate of return to play and length of career after hip arthroscopy in professional football players are unknown. To determine how many athletes returned to professional football and the number of seasons they played after surgery. Case series; Level of evidence, 4. Fifty-one professional football players (60 hips) underwent hip arthroscopy for FAI between 2000 and 2014 by a single surgeon. Return to play was defined as competing in a preseason or regular season professional football game after surgery. Data were retrospectively obtained for each player from NFL.com , ESPN.com , individual team websites, and/or CFL.ca . We found that 87% (52/60) of the arthroscopic procedures allowed professional football players to return to play in a preseason or regular season game. Athletes who returned played an average of 38 games during 3.2 seasons after arthroscopy, with an average total career length of 7.4 seasons. Ninety-two percent (48/52) of players who returned had a minimum total career length of 3 years. When participants were analyzed by position, linemen were less likely to return after hip arthroscopy compared with other players (odds ratio 5.6; 95% CI, 1.1-35; P = .04). All quarterbacks and tight ends returned to play after surgery. No significant difference in return to play rate was found between athletes who underwent microfracture and those who did not (25% vs 38%, P = .698). Hip arthroscopy for treatment of FAI and associated pathologic abnormalities in professional football players resulted in a high rate of return to play. The study's findings demonstrate that 87% of the arthroscopic procedures allowed professional football players to return to play, linemen were less likely to return compared with other positions, and the presence of microfracture did not significantly affect the return

The sagittal stem alignment and the stem version clearly influence the impingement-free range of motion in total hip arthroplasty: a computer model-based analysis.

PubMed

Müller, Michael; Duda, Georg; Perka, Carsten; Tohtz, Stephan

2016-03-01

The component alignment in total hip arthroplasty influences the impingement-free range of motion (ROM). While substantiated data is available for the cup positioning, little is known about the stem alignment. Especially stem rotation and the sagittal alignment influence the position of the cone in relation to the edge of the socket and thus the impingement-free functioning. Hence, the question arises as to what influence do these parameters have on the impingement-free ROM? With the help of a computer model the influence of the sagittal stem alignment and rotation on the impingement-free ROM were investigated. The computer model was based on the CT dataset of a patient with a non-cemented THA. In the model the stem version was set at 10°/0°/-10° and the sagittal alignment at 5°/0°/-5°, which resulted in nine alternative stem positions. For each position, the maximum impingement-free ROM was investigated. Both stem version and sagittal stem alignment have a relevant influence on the impingement-free ROM. In particular, flexion and extension as well as internal and external rotation capability present evident differences. In the position intervals of 10° sagittal stem alignment and 20° stem version a difference was found of about 80° in the flexion and 50° in the extension capability. Likewise, differences were evidenced of up to 72° in the internal and up to 36° in the external rotation. The sagittal stem alignment and the stem torsion have a relevant influence on the impingement-free ROM. To clarify the causes of an impingement or accompanying problems, both parameters should be examined and, if possible, a combined assessment of these factors should be made.

Design of a hip prosthetic tribometer based on salat gait cycle

NASA Astrophysics Data System (ADS)

Towijaya, T.; Ismail, R.; Jamari, J.

2017-01-01

Indonesia is the country with the largest muslim population in the world, most of the inhabitants do salat every day. THR (Total Hip Replacement) patients are prohibited from doing salat in normal gait. It leads to the damage of the hip joint prostheses due to impingement and dislocation.This paper reports the design of a pin-on-ring tribometer which is used to measure and analyze the wear volume and the impingement of hip joint prostheses during salat. The modifications of the femoral head and acetabular cup holder are performed to design the reciprocating motion for the movement of the hip prostheses. The interesting finding of the present research is a new mechanism of linked-bar which leads to the feasibility of the measurement of the wear volume and the impingement for THR patients during salat.

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

PubMed

Kivlan, Benjamin R; Carcia, Christopher R; Christoforetti, John J; Martin, RobRoy L

2016-08-01

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. 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. Quasi-experimental, cohort comparison. 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. 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 group (2.5 ± 0.75 seconds) on the crossover hop

The cam impinging femur has multiple morphologic abnormalities.

PubMed

Ellis, Andrew R; Noble, Philip C; Schroder, Steven J; Thompson, Matthew T; Stocks, Gregory W

2011-09-01

This study was performed to establish whether the "cam" impinging femur has a single deformity of the head-neck junction or multiple abnormalities. Average dimensions (anteversion angle, α angle of Notzli, β angle of Beaulé, normalized anterior head offset) were compared between normal and impinging femora. The results demonstrated that impinging femora had wider necks, larger heads, and decreased head-neck ratios. There was no difference in neck-shaft angle or anteversion angle. Forty-six percent of impinging femora had significant posterior head displacement (>2mm), which averaged 1.93 mm for the cam impinging group, and 0.78 mm for the normal group. In conclusion, surgical treatment limited to localized recontouring of the head-neck profile may fail to address significant components of the underlying abnormality. Copyright © 2011 Elsevier Inc. All rights reserved.

Eliminating impingement optimizes patellar biomechanics in high knee flexion.

PubMed

Tang, Qi-heng; Zhou, Yi-xin; Tang, Jing; Shao, Hong-yi; Wang, Guang-zhi

2010-08-01

We investigated the impact of eliminating the impingement between extensor mechanism and tibial insert on patellar tracking and patellar ligament tension in high knee flexion. Six cadaveric specimens were tested on an Oxford-type testing rig. The Genesis II knee system was implanted into each specimen knee with the traditional tibial insert and high-flex insert successively. Compared to traditional insert, the high-flex insert was characterized with a chambered anterior post and a chambered anterior lip which eliminates patella-post and patellar ligament-anterior lip impingements. The patella was tracked with an NDI Optotrak Certus system. The patellar ligament tension was measured using a NKB S-type tension transducer. There was a decrease of resultant patellar translation relative to the femur with statistically significant (P<0.05) at 90 degrees to 150 degrees of knee flexion and a decrease of patellar ligament tension with statistical significance (P<0.05) at 100 degrees, 120 degrees, 130 degrees, and 140 degrees of flexion using high-flex insert compared to traditional insert. Eliminating the impingement between extensor mechanism and implant in high knee flexion altered patellar tracking and reduced patellar ligament tension, which would facilitate high knee flexion.

The distal fascicle of the anterior inferior tibio-fibular ligament as a cause of anterolateral ankle impingement: results of arthroscopic resection.

PubMed

Akseki, D; Pinar, H; Bozkurt, M; Yaldiz, K; Araç, S

1999-10-01

We arthroscopically resected the impinged distal fascicle of the anterior inferior tibiofibular ligament (AIT-FL) in 21 patients (mean age 31 (11-68) years, 14 women) with chronic ankle pain after an ankle sprain. Clinical tests revealed moderate laxity in 2 and severe laxity in another 2, the remaining 17 ankles showing only mild laxity. During arthroscopy, an impinging distal fascicle of the AITFL was found in all cases. Following anterolateral synovectomy, the fascicle was excised. At the follow-up after mean 3 (2-4) years, good-to-excellent results were obtained in 17 patients. 19 patients were satisfied with the procedure and 17 patients returned to their previous level of activity. 2 patients who had mild laxity were graded as poor because of neuromas of the terminal branches of the superficial peroneal nerve. These patients became asymptomatic after an injection of steroids.

Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.

PubMed

Paterno, Mark V; Kiefer, Adam W; Bonnette, Scott; Riley, Michael A; Schmitt, Laura C; Ford, Kevin R; Myer, Gregory D; Shockley, Kevin; Hewett, Timothy E

2015-12-01

Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Sixty-one female athletes who were cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify differences. A main effect of group (P = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (P = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], P = 0.03. Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at risk. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prospectively Identified Deficits in Sagittal Plane Hip-Ankle Coordination in Female Athletes who Sustain a Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Kiefer, Adam W.; Bonnette, Scott; Riley, Michael A.; Schmitt, Laura C.; Ford, Kevin R.; Myer, Gregory D.; Shockley, Kevin; Hewett, Timothy E.

2015-01-01

Background Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Methods Sixty-one female athletes who were medically cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify coordination differences. Findings A main effect of group (p = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (p = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], p = 0.03. Interpretation Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at high-risk. PMID:26416200

Distal Extension of the Direct Anterior Approach to the Hip: A Cadaveric Feasibility Study.

PubMed

Ghijselings, Stijn G M; Driesen, Ronald; Simon, Jean-Pierre; Corten, Kristoff

2017-01-01

The direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, femoral complications of up to 2.8% have been reported. Therefore, it is important for surgeons to understand the periarticular neurovascular anatomy in order to safely deal with intraoperative complications. Anatomic dissections were performed on 20 cadaveric hips. The neurovascular structures anterior to the femur and distal to the intertrochanteric line were dissected and its position was described in relation to anatomic landmarks easily identified through the DAA: anterior superior iliac spine (ASIS), the insertion of the gluteus minimus (GM), and the lesser trochanter (LT). Two clearly distinguishable neurovascular bundles running to the vastus lateralis were seen in 17 of 20 specimens. The average distances to the landmarks were as follows: ASIS-1st bundle = 12.3 cm (range, 9.7-14.5); GM-1st bundle = 3.2 cm (range, 2.2-4); LT-1st bundle = 1.6 cm (range, 0.7-2.8); 1st bundle-2nd bundle = 3.3 cm (range, 1.8-6.1). A consistent pattern of 2 clearly distinguishable neurovascular bundles was seen in 85% of the specimens. Knowledge of the position of these neurovascular bundles in relation to the anatomic landmarks makes distal femoral extension of the DAA feasible. Further clinical studies are needed to confirm the safety of the extensile anterior approach. Copyright © 2016 Elsevier Inc. All rights reserved.

Interventional MSK procedures: the hip.

PubMed

Dodré, Emilie; Lefebvre, Guillaume; Cockenpot, Eric; Chastanet, Patrick; Cotten, Anne

2016-01-01

Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures.

Is the evaluation of the anterior inferior iliac spine (AIIS) in the AP pelvis possible? Analysis of conventional X-rays and 3D-CT reconstructions.

PubMed

Krueger, David R; Windler, Markus; Geßlein, Markus; Schuetz, Michael; Perka, Carsten; Schroeder, Joerg H

2017-07-01

A hypertrophic AIIS has been identified as a cause for extraarticular hip impingement and is classified according to Hetsroni using 3D-CT reconstructions. The role of the conventional AP pelvis X-ray, which is the first standard imaging step for the evaluation of hip pain, has not been investigated yet. AP pelvis X-rays and 3D-CT reconstructions of patients were evaluated regarding their morphology of the AIIS. The conventional X-rays were categorized into three groups according to the projection of the AIIS: above (A) or below (B) the acetabular sourcil or even exceeding the anterior acetabular rim (C). They were compared to the morphologic types in the 3D-CT reconstruction (Hetsroni type I-III). Ninety patients with an equal distribution of type A, B or C projection in the AP pelvis were evaluated and compared to the morphology in the 3D-CT reconstruction. The projection of the AIIS below the acetabular sourcil (B + C) showed only moderate sensitivity (0.76) and specificity (0.64) for a hypertrophic AIIS (Hetsroni type II + III), but if the AIIS exceeds the anterior rim, all cases showed a hypertrophic AIIS in the 3D-CT reconstructions (Hetsroni type II + III). Distinct differentiation of the AIIS morphology in the AP pelvis is not possible, but the projection of the AIIS below the anterior acetabular rim represented a hypertrophic AIIS in all cases and should, therefore, be critically investigated for a relevant AIIS impingement.

Effects of hip strengthening on early outcomes following anterior cruciate ligament reconstruction.

PubMed

Garrison, J Craig; Bothwell, Jim; Cohen, Kiley; Conway, John

2014-04-01

It is not clear whether the addition of hip strengthening exercises will improve outcomes during the early stages of ACL rehabilitation. The purpose of this study was to determine the effects of the addition of isolated hip strengthening exercises to traditional rehabilitation on early outcomes (within the first 3 months) after ACL reconstruction (ACLR). A total of 43 subjects (18.8±6.9, 21 females, 22 males) who were in the process of rehabilitation following ACLR participated. Subjects were randomly assigned to one of two different treatment groups (1= traditional rehabilitation [NoHip], 2= traditional plus isolated hip strengthening rehabilitation [Hip]). Assessment included the International Knee Documentation Committee (IKDC) Subjective Knee Form, Visual Analog Scale (VAS) for pain during activities of daily living, and knee extension range of motion (ROM) side to side difference taken at weeks 1, 4, 8, and 12. In addition, dynamic balance was assessed with the Y Balance Test™ at 8 and 12 weeks. A mixed model repeated measures ANOVA was performed for IKDC, VAS, and ROM. A one-way ANOVA was used to assess mean group differences for Y Balance Test - Lower Quarter (YBT-LQ) side to side difference scores at 8 and 12 weeks. There was no significant interaction for group by time across VAS (p = .463), IKDC (p = .819), or ROM (p = .513) side to side differences A significant difference was found between groups for YBT-LQ Anterior Reach (ANT) side to side difference at 12 weeks (p = .008) with the Hip group demonstrating smaller side to side reach differences than the NoHip group. No significant side to side differences were seen between groups for YBT-LQ Posteromedial (PM) or Posterolateral (PL) at 12 weeks (PM: p = .254; PL: p = .617). Rehabilitation including hip strengthening exercises appears to improve sagittal plane dynamic balance at three months post ACLR as compared to traditional rehabilitation. No differences were seen between groups for pain, ROM, and

Chronological changes in functional cup position at 10 years after total hip arthroplasty.

PubMed

Okanoue, Yusuke; Ikeuchi, Masahiko; Takaya, Shogo; Izumi, Masashi; Aso, Koji; Kawakami, Teruhiko

2017-09-19

This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.

Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip.

PubMed

Pozzi, Grazia; Lanza, Ezio; Parra, Cleber Garcia; Merli, Ilaria; Sconfienza, Luca Maria; Zerbi, Alberto

2017-03-01

We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome. Hip MRA performed at our institution (3/2012-1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed. N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen. GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.

Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion.

PubMed

Spencer-Gardner, Luke; Bedi, Asheesh; Stuart, Michael J; Larson, Christopher M; Kelly, Bryan T; Krych, Aaron J

2017-01-01

The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Ten patients with a mean age of 18 years (range 14-28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7-3.5), the median post-operative mHHS was 89.7 (65.7-96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. IV.

Interventions for Hip Pain in the Maturing Athlete

PubMed Central

Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

2014-01-01

Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good

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

Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

PubMed

Crespo Rodríguez, A M; de Lucas Villarrubia, J C; Pastrana Ledesma, M A; Millán Santos, I; Padrón, M

2015-01-01

To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

The deep layer of the tractus iliotibialis and its relevance when using the direct anterior approach in total hip arthroplasty: a cadaver study.

PubMed

Putzer, David; Haselbacher, Matthias; Hörmann, Romed; Klima, Günter; Nogler, Michael

2017-12-01

Surgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA). The morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining. The superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length). The length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

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

Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

PubMed Central

Cvetanovich, Gregory L.; Heyworth, Benton E.; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S.; Millis, Michael B.

2015-01-01

To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery. PMID:27011852

Analysis of Arthroscopic Therapy for hip Pathologies.

PubMed

Przybył, Michał; Walenczak, Krzysztof; Lebiedziński, Radosław; Domżalski, Marcin

2017-05-10

[b]Background. [/b]This paper analyses the outcomes of treatment of avascular necrosis (AVN), femoroacetabular impingement (FAI), hip labral tear (HLT) and snapping hip syndrome (SHS). Moreover, the results of individual groups are also compared. The study group consisted of 70 persons (surgeries of 72 hips). AVN - 14 patients, FAI - 38 patients (39 hips), HLT - 12 patients (13 hips), SHS - 6 patients. Two questionnaires, namely the MHHS (Modified Harris Hip Score) and NAHS (Non Arthritic Hip Score), were used to evaluate the patients before the surgery and at 6- and 12-month follow-up.[b]Results. [/b]AVN : local improvement was recorded at both 6 and 12 months, FAI: local improvement was recorded at both 6 and 12 months, HLT: local improvement was recorded at both 6 and 12 months, SHS: local improvement was recorded at both 6 and 12 months. Comparison of the results between the groups showed that: At baseline, local status in AVN was poorer than in FAI. At 6- and 12-month follow-up, local status in AVN was poorer than in FAI, HLT and SHS.[b]Conclusions.[/b] AVN Group 1. The study demonstrates that arthroscopic treatment of avascular necrosis produced fairly good outcomes at 6 and 12 months after the surgery. 2. Treatment of avascular necrosis showed significantly poorer results than therapy of femoroacetabular impingement, hip labral tear and snapping hip syndrome at 6 and 12 months. FAI Group 1. Arthroscopic treatment of femoroacetabular impingement produced good outcomes at 6 and 12 months after the surgery. HLT Group 1. Arthroscopic treatment of hip labral tear produced excellent outcomes at 6 and 12 months after the surgery. SHS Group 1. Arthroscopic treat ment of snapping hip syndrome produced excellent outcomes at 6 and 12 months after the surgery.Additional conclusions. 1. Studies showing long-term effect of arthroscopic treatment of selected conditions are necessary to further assess the effectiveness of this treatment. 2. It is necessary to evaluate the

Assessment of acetabular retroversion following long term review of Salter's osteotomy.

PubMed

Robb, Curtis A; Datta, Amit; Nayeemuddin, Mohammed; Bache, Christopher E

2009-01-01

Salter's innominate osteotomy may predispose to anterior over-coverage of the acetabulum. Over cover or retroversion has been demonstrated to be a cause of hip pain, impingement and subsequent osteoarthritis. We reviewed the long-term follow up of seventeen skeletally mature hips in sixteen patients who had previously undergone a Salter's osteotomy in childhood. The Salter pelvic osteotomy was performed at a mean average age of 5 years and follow up at a mean average age of 20 years. Patients were assessed by clinical examination for signs of impingement, Harris Hip Score and pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of the acetabulum using templates applied to the pelvic radiograph as described by Hefti. The median acetabular cover averaged 17 degrees of anteversion with 2 patients (12%) demonstrating retroversion, neither of whom, had signs of impingement on examination. The mean average Harris Hip Score was 85 indicating a good outcome at long-term follow-up. We believe acetabular remodelling may occur with age after Salter's innominate osteotomy and have found good results in patients after skeletal maturation. Fears of long-term anterior over-coverage and retroversion with this operation may be unfounded.

Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes.

PubMed

Domb, Benjamin G; Sgroi, Terrance A; VanDevender, Jeremy C

2016-07-01

Femoroacetabular impingement (FAI) was first described by Ganz in 2003 and is a significant cause of decreased function and mobility. Femoroacetabular impingement must be treated in an individualized, goal-oriented, stepwise fashion. This protocol was developed with biomechanical considerations of soft tissue and bony structures surrounding the hip joint. The PubMed database was searched for scientific and review articles from the years 2000 to 2015 utilizing the search terms: hip rehabilitation, femoroacetabular impingement, and arthroscopy. Clinical review. Level 5. Five hundred ninety-five of 738 patients were available for follow-up showing improvement from preoperative to 2-year follow-up of 61.29 to 82.02 for modified Harris Hip Score (mHHS), 62.79 to 83.04 for Hip Outcome Score-Activities of Daily Living (HOS-ADL), 40.96 to 70.07 for Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and 57.97 to 80.41 for Non-Arthritic Hip Score (NAHS); visual analog scale (VAS) scores decreased from 5.86 preoperatively to 2.94 postoperatively. Following a structured, criteria-based program, appropriate patients undergoing hip arthroscopy may achieve excellent outcomes and return to full independent activities of daily living as well as sport. © 2016 The Author(s).

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

Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty.

PubMed

Homma, Yasuhiro; Baba, Tomonori; Ochi, Hironori; Ozaki, Yu; Kobayashi, Hideo; Matsumoto, Mikio; Yuasa, Takahito; Kaneko, Kazuo

2016-08-01

The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons' learning curve. From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included. The incidence of chip fracture of the greater trochanter, the size of the greater trochanter as measured by computed tomography, and the patients' characteristics were retrospectively investigated. After exclusion of 11 hips, the remaining 109 hips were investigated. Chip fracture of the greater trochanter was identified in 32 hips (29.4 %). Univariate analysis with and without fractures showed that the width and depth of the greater trochanter were statistically significant risk factors (p = 0.02 and p < 0.001, respectively). Multivariate analysis using a logistic regression model demonstrated that the depth of the greater trochanter was an independent risk factor for chip fracture of the greater trochanter (OR 1.725; 95 % CI 1.367-2.177; p < 0.001). The size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter. Novice surgeons should pay attention to the size of the greater trochanter when performing THA by the DAA.

Athletic Hip Injuries.

PubMed

Lynch, T Sean; Bedi, Asheesh; Larson, Christopher M

2017-04-01

Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

Arthroscopic debridement for soft tissue ankle impingement.

PubMed

Brennan, S A; Rahim, F; Dowling, J; Kearns, S R

2012-06-01

To assess the response to treatment in patients with soft tissue impingement of the ankle managed with arthroscopic debridement. Forty-one ankle arthroscopies were performed for soft tissue impingement between April 2007 and April 2009. There were 26 men and 15 women and the mean age was 30.1 years. Arthroscopy was performed on an average of 21 months after injury. The Visual-Analogue-Scale Foot and Ankle (VASFA) score and Meislin's criteria were used to assess the response to treatment. The mean pre-operative VASFA score was 44.5. This increased to 78.3 postoperatively (p < 0.0001). According to Meislin's criteria, there were 34 good or excellent results, five fair and two poor results. Pre-operative magnetic resonance imaging was useful in detecting tears of the anterior talofibular ligament and excluding osteochondral defects; however, synovitis and soft tissue impingement was under-reported. Arthroscopy is an effective method for the diagnoses and treatment of soft tissue impingement of the ankle joint. This condition is under-reported on MRI.

Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair.

PubMed

Cvetanovich, Gregory L; Lizzio, Vincent; Meta, Fabien; Chan, Derek; Zaltz, Ira; Nho, Shane J; Makhni, Eric C

2017-11-01

To assess comprehensiveness and variability of postoperative physical therapy protocols published online following hip arthroscopy for femoroacetabular impingement (FAI) and/or labral repair. Surgeons were identified by the International Society for Hip Arthroscopy "Find a Surgeon" feature in North America (http://www.isha.net/members/, search August 10, 2016). Exclusion criteria included nonsurgeons and protocols for conditions other than hip arthroscopy for FAI and/or labral tear. Protocols were identified by review of surgeons' personal and departmental websites and evaluated for postoperative restrictions, rehabilitation components, and the time points for ending restrictions and initiating activities. Of 111 surgeons available online, 31 (27.9%) had postoperative hip arthroscopy physical therapy protocols available online. Bracing was used in 54.8% (17/31) of protocols for median 2-week duration (range, 1-6 weeks). Most protocols specified the initial postoperative weight-bearing status (29/31, 93.5%), most frequently partial weight-bearing with 20 pounds foot flat (20/29, 69.0%). The duration of weight-bearing restriction was median 3 weeks (range, 2-6) for FAI and median 6 weeks (range, 3-8) for microfracture. The majority of protocols specified initial range of motion limitations (26/31, 83.9%) for median 3 weeks (range, 1.5-12). There was substantial variation in the rehabilitation activities and time points for initiating activities. Time to return to running was specified by 20/31 (64.5%) protocols at median 12 weeks (range, 6-19), and return to sport timing was specified by 13/31 (41.9%) protocols at median 15.5 weeks (range, 9-23). There is considerable variability in postoperative physical therapy protocols available online following hip arthroscopy for FAI, including postoperative restrictions, rehabilitation activities, and time points for activities. This information offers residents, fellows, and established hip arthroscopists a centralized

High Rate of Return to Running for Athletes After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Capsular Plication.

PubMed

Levy, David M; Kuhns, Benjamin D; Frank, Rachel M; Grzybowski, Jeffrey S; Campbell, Kirk A; Brown, Sara; Nho, Shane J

2017-01-01

Femoroacetabular impingement (FAI) is most commonly diagnosed in athletes who sustain repetitive flexion loading to their hips. No studies to date have focused solely on patients' return-to-running ability after hip arthroscopy. To evaluate patients' ability to return to running after hip arthroscopy for FAI and capsular plication. Case series; Level of evidence, 4. Clinical data were retrospectively retrieved for 51 consecutive patients with FAI (22 men, 29 women) who had undergone hip arthroscopy for the treatment of FAI and identified themselves as recreational or competitive runners on intake forms. Two-year outcome measures included the modified Harris Hip Score (mHHS) and the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales. A postoperative return-to-running survey was used to obtain running-specific information. Patient age and body mass index (BMI) were a mean (±SD) of 26.3 ± 7.8 years and 23.7 ± 3.3 kg/m 2 , respectively. Before surgery, patients had refrained from running because of pain for a mean of 8.1 ± 5.7 months. After surgery, 48 patients (94%) returned to running at a mean of 8.5 ± 4.2 months. Patients who had discontinued running for more than 8 months before surgery had a longer return-to-running time than did those who had stopped for less than 8 months (10.6 ± 4.2 vs 7.6 ± 4.1 months; P = .01). After 2 years, mean preoperative distance had decreased significantly ( P < .01) from 9.5 ± 6.5 miles per week when healthy to 6.4 ± 5.8 miles postoperatively. Despite decreased mileage, all 2-year outcomes scores improved significantly ( P < .001). Recreational and competitive runners with FAI returned to running 94% of the time at a mean of 8.5 months after hip arthroscopy. However, runners should be counseled before their surgery that they may run fewer miles than when they were pain free. Additionally, patients with a higher BMI and/or longer preoperative lull may have a longer recovery time.

Trunk and hip biomechanics influence anterior cruciate loading mechanisms in physically active participants.

PubMed

Frank, Barnett; Bell, David R; Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2013-11-01

Excessive trunk motion and deficits in neuromuscular control (NMC) of the lumbopelvic hip complex are risk factors for anterior cruciate ligament (ACL) injury. However, the relationship between trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads during a sidestep cutting task has not been examined. To determine if there is an association between multiplanar trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads with ACL injury during a sidestep cutting task. Descriptive laboratory study. The hip and knee biomechanics and trunk motion of 30 participants (15 male, 15 female) were analyzed during a sidestep cutting task using an optoelectric camera system interfaced to a force plate. Trunk and lower extremity biomechanics were calculated from the kinematic and ground-reaction force data during the first 50% of the stance time during the cutting task. Pearson product moment correlation coefficients were calculated between trunk and lower extremity biomechanics. Multiple linear regression analyses were carried out to determine the amount of variance in triplanar knee loading explained by trunk motion and hip moments. A greater internal knee varus moment (mean, 0.11 ± 0.12 N·m/kg*m) was associated with less transverse-plane trunk rotation away from the stance limb (mean, 20.25° ± 4.42°; r = -0.46, P = .011) and a greater internal hip adduction moment (mean, 0.33 ± 0.25 N·m/kg*m; r = 0.83, P < .05). A greater internal knee external rotation moment (mean, 0.11 ± 0.08 N·m/kg*m) was associated with a greater forward trunk flexion (mean, 7.62° ± 5.28°; r = 0.42, P = .020) and a greater hip internal rotation moment (mean, 0.15 ± 0.16 N·m/kg*m; r = 0.59, P = .001). Trunk rotation and hip adduction moment explained 81% (P < .05) of the variance in knee varus moment. Trunk flexion and hip internal rotation moment explained 48% (P < .05) of the variance in knee external rotation moment. Limited trunk rotation displacement

Hip instability: a review of hip dysplasia and other contributing factors

PubMed Central

Kraeutler, Matthew J.; Garabekyan, Tigran; Pascual-Garrido, Cecilia; Mei-Dan, Omer

2016-01-01

Summary Background Hip instability has classically been associated with developmental dysplasia of the hip (DDH) in newborns and children. However, numerous factors may contribute to hip instability in children, adolescents, and adults. Purpose This review aims to concisely present the literature on hip instability in patients of all ages in order to guide health care professionals in the appropriate diagnosis and treatment of the various disorders which may contribute to an unstable hip. Methods We reviewed the literature on the diagnosis and surgical management of hip dysplasia and other causes of hip instability. Conclusions Multiple intra- and extra-articular variables may contribute to hip instability, including acetabular bony coverage, femoral torsion, femoroacetabular impingement, and soft tissue laxity. Physical examination and advanced imaging studies are essential to accurately diagnose the pathology contributing to a patient’s unstable hip. Conservative management, including activity modification and physical therapy, may be used as a first-line treatment in patients with intra-articular hip pathology. Patients who continue to experience symptoms of pain or instability should proceed with arthroscopic or open surgical treatment aimed at correcting the underlying pathology. Level of evidence V. PMID:28066739

Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty

PubMed Central

Havelin, Leif I; Furnes, Ove; Baste, Valborg; Nordsletten, Lars; Hovik, Oystein; Dimmen, Sigbjorn

2014-01-01

Background The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach. Patients 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1–3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis. Results Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2–5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001). Interpretation Patients operated with the lateral approach reported worse outcomes 1–3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach. PMID:24954494

Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population.

PubMed

Ernat, J J; Song, D J; Brugman, S C; Shaha, S H; Tokish, J M; Lee, G Y

2015-08-05

Femoroacetabular impingement is a common cause of hip pain in young adults. Several preoperative risk factors for poor outcomes with surgery have been identified; however, to our knowledge, no study has attempted to determine the effect of psychiatric comorbidity on outcomes with femoroacetabular impingement surgery. A retrospective review was performed on active-duty patients at one institution undergoing surgery for femoroacetabular impingement over five years. Medical records were reviewed for demographic characteristics, radiographic data, and history of mental health medication use. Return-to-duty status was considered the primary outcome measure. Outcome scores obtained included modified Harris hip scores, Single Assessment Numeric Evaluation scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, patient satisfaction, and Veterans RAND-12 scores. Patients taking mental health medication were compared with those who were not with regard to return to duty and validated patient-reported outcome measures. Ninety-three patients (mean age, 32.2 years) were available for follow-up at a mean duration of 3.6 years. Of the seventeen patients discharged from service postoperatively, twelve (71%) were taking mental health medications. One-third (twenty-five) of seventy-six patients who returned to duty were taking mental health medication and this difference was significant (p < 0.006). Patients taking mental health medication had significantly poorer modified Harris hip scores (p < 0.02), WOMAC scores (p < 0.0008), and Veterans RAND-12 mental scores (p < 0.001). Antidepressant, antipsychotic, and multiple mental health medication use were all predictive of medical discharge due to hip pain. Psychiatric comorbidities are an important risk factor in active-duty military personnel undergoing surgery for femoroacetabular impingement. Mental health medication use is associated with poorer outcome scores and can significantly lower the

Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty.

PubMed

Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

2018-03-09

In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate. We evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery. The width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study. We cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate. Therapeutic, Level IV.

Muscle Damage After Total Hip Arthroplasty Through the Direct Anterior Approach for Developmental Dysplasia of the Hip.

PubMed

Kawasaki, Masashi; Hasegawa, Yukiharu; Okura, Toshiaki; Ochiai, Satoshi; Fujibayashi, Takayoshi

2017-08-01

Total hip arthroplasty (THA) through the direct anterior approach (DAA) is known to cause less muscle damage than other surgical approaches. However, more complex primary cases, such as developmental dysplasia of the hip (DDH), might often cause muscle damage. The objective of the present study was to clarify the muscle damage observed 1 year after THA through the DAA for DDH using magnetic resonance imaging. We prospectively compared the muscle cross-sectional area (M-CSA) and fatty atrophy (FA) in muscles by magnetic resonance imaging and the Harris hip score before and at 1-year follow-up after THA through the DAA in 3 groups: 37 patients with Crowe group 1 DDH (D1), 13 patients with Crowe group 2 and 3 DDH (D2 + 3), and 12 patients with osteonecrosis as a control. THA through the DAA for D1 displayed significantly decreased M-CSA and significantly increased FA in the gluteus minimus (Gmini), the tensor fasciae latae (TFL), and the obturator internus (OI). Patients with D2 + 3 group did not have decreased M-CSA in the TFL or increased FA in the Gmini. Postoperatively, a significant negative correlation was observed between the M-CSA and FA for the OI in patients with D1 and D2 + 3. THA through the DAA for DDH caused the damage in the Gmini, the TFL, and the OI; severe damage was observed in the OI, showing increased FA with decreased M-CSA in patients with both D1 and D2 + 3. Copyright © 2017 Elsevier Inc. All rights reserved.

Descriptive Epidemiology of Patients Undergoing Total Hip Arthroplasty in Korea with Focus on Incidence of Femoroacetabular Impingement: Single Center Study.

PubMed

Lee, Woo Yong; Hwang, Deuk Soo; Noh, Chang Kyun

2017-04-01

We analyzed the causes leading to total hip arthroplasty (THA), aimed to clarify the incidence of femoroacetabular impingement (FAI) among the causes, and compared the incidence in Korea with those in other countries. From January 2000 to December 2014, 1,206 hips of 818 patients who underwent primary THA at our institute were reviewed retrospectively in terms of radiographs and electronic charts. The radiographs and radiographic parameters were reviewed and measured by 2 of the authors, who are orthopedic surgeons. Patients were categorized in terms of the causes leading to THA as primary osteoarthritis (OA), rheumatoid arthritis (RA), posttraumatic arthritis, post infectious arthritis, avascular necrosis (AVN) of the femoral head, fracture of the femoral head or neck, ankylosing spondylitis (AS), developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), FAI, and others. There were 32 patients (3.91%) in the primary OA group, 41 (5.01%) in the RA group, 84 (10.27%) in the posttraumatic arthritis group, 39 (4.77%) in the post infectious arthritis group, 365 (44.62%) in the AVN group, 39 (4.77%) in the fracture group, 21 (2.57%) in the AS group, 52 (6.36%) in the DDH group, 71 (8.68%) in the LCPD group, 52 (6.36%) in the FAI group, and 22 (2.69%) in the 'other' group. The causes leading to THA in Korea differ from those in Western countries. FAI could be causes of severe secondary OA that requires THA in Korea, therefore symptomatic FAI should not be neglected. © 2017 The Korean Academy of Medical Sciences.

Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis.

PubMed

Kierkegaard, Signe; Langeskov-Christensen, Martin; Lund, Bent; Naal, Florian D; Mechlenburg, Inger; Dalgas, Ulrik; Casartelli, Nicola C

2017-04-01

To investigate pain, activities of daily living (ADL) function, sport function, quality of life and satisfaction at different time points after hip arthroscopy in patients with femoroacetabular impingement (FAI). Systematic review with meta-analysis. Weighted mean differences between preoperative and postoperative outcomes were calculated and used for meta-analysis. EMBASE, MEDLINE, SportsDiscus, CINAHL, Cochrane Library, and PEDro. Studies that evaluated hip pain, ADL function, sport function and quality of life before and after hip arthroscopy and postoperative satisfaction in patients with symptomatic FAI. Twenty-six studies (22 case series, 3 cohort studies, 1 randomised controlled trial (RCT)) were included in the systematic review and 19 in the meta-analysis. Clinically relevant pain and ADL function improvements were first reported between 3 and 6 months, and sport function improvements between 6 months and 1 year after surgery. It is not clear when quality of life improvements were first achieved. On average, residual mild pain and ADL and sport function scores lower than their healthy counterparts were reported by patients following surgery. Postoperative patient satisfaction ranged from 68% to 100%. On average, patients reported earlier pain and ADL function improvements, and slower sport function improvements after hip arthroscopy for FAI. However, average scores from patients indicate residual mild hip pain and/or hip function lower than their healthy counterparts after surgery. Owing to the current low level of evidence, future RCTs and cohort studies should investigate the effectiveness of hip arthroscopy in patients with FAI. CRD42015019649. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement.

PubMed

Ulici, Alexandru; Carp, Madalina; Tevanov, Iulia; Nahoi, Catalin Alexandru; Sterian, Alin Gabriel; Cosma, Dan

2018-06-01

Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar percentage of AVN. In severe slips, 85.7% of patients had an α angle higher than 60°. Conclusions This study shows that severe slips have a higher risk of developing AVN and hip impingement. Every patient who suffers from SCFE (even the mildest forms) should be regularly checked for FAI.

Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial.

PubMed

Murphy, Nicholas J; Eyles, Jillian; Bennell, Kim L; Bohensky, Megan; Burns, Alexander; Callaghan, Fraser M; Dickenson, Edward; Fary, Camdon; Grieve, Stuart M; Griffin, Damian R; Hall, Michelle; Hobson, Rachel; Kim, Young Jo; Linklater, James M; Lloyd, David G; Molnar, Robert; O'Connell, Rachel L; O'Donnell, John; O'Sullivan, Michael; Randhawa, Sunny; Reichenbach, Stephan; Saxby, David J; Singh, Parminder; Spiers, Libby; Tran, Phong; Wrigley, Tim V; Hunter, David J

2017-09-26

Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management. This is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and

Prevalence of Cam Deformity with Associated Femoroacetabular Impingement Syndrome in Hip Joint Computed Tomography of Asymptomatic Adults

PubMed Central

Han, Jun; Won, Seok-Hyung; Kim, Jung-Taek; Hahn, Myung-Hoon

2018-01-01

Purpose Femoroacetabular impingement (FAI) is considered an important cause of early degenerative arthritis development. Although three-dimensional (3D) imaging such as computed tomography (CT) and magnetic resonance imaging are considered precise imaging modalities for 3D morphology of FAI, they are associated with several limitations when used in out-patient clinics. The paucity of FAI morphologic data in Koreans makes it difficult to select the most effective radiographical method when screening for general orthopedic problems. We postulate that there might be an individual variation in the distribution of cam deformity in the asymptomatic Korean population. Materials and Methods From January 2011 to December 2015, CT images of the hips of 100 subjects without any history of hip joint ailments were evaluated. A computer program which generates 3D models from CT scans was used to provide sectional images which cross the central axis of the femoral head and neck. Alpha angles were measured in each sectional images. Alpha angles above 55° were regarded as cam deformity. Results The mean alpha angle was 43.5°, range 34.7–56.1°(3 o'clock); 51.24°, range 39.5–58.8°(2 o'clock); 52.45°, range 43.3–65.5°(1 o'clock); 44.09°, range 36.8–49.8°(12 o'clock); 40.71, range 33.5–45.8°(11 o'clock); and 39.21°, range 34.1–44.6°(10 o'clock). Alpha angle in 1 and 2 o'clock was significantly larger than other locations (P<0.01). The prevalence of cam deformity was 18.0% and 19.0% in 1 and 2 o'clock, respectively. Conclusion Cam deformity of FAI was observed in 31% of asymptomatic hips. The most common region of cam deformity was antero-superior area of femoral head-neck junction (1 and 2 o'clock). PMID:29564291

Clinical presentation of intra-articular osteoid osteoma of the hip and preliminary outcomes after arthroscopic resection: a case series

PubMed Central

Rotter, Ben-Zion; Mintz, Douglas N; Kelly, Bryan T

2018-01-01

ABSTRACT Intra-articular osteoid osteoma (IAOO) of the hip is a relatively rare diagnosis, but one that can closely mimic symptomatic presentation of femoroacetabular impingement (FAI). Although there are multiple case reports of osteoid osteoma (OO) in the hip, we present the largest case series of hip IAOO treated with hip arthroscopy and discuss limited patient-reported outcomes after treatment with hip arthroscopy. We retrospectively identified patients diagnosed with IAOO of the hip with confirmatory computed tomography, magnetic resonance imaging or biopsy diagnoses of OO. We analyzed lesion location, main presenting symptoms, symptom duration and treatment undertaken. For the patients who underwent hip arthroscopy for treatment of their IAOO, we reviewed patient-reported outcome scores when available. Forty patients with confirmed IAOO were identified. Thirteen underwent excision with hip arthroscopy. The most common presenting symptom was groin pain. In limited patients who had pre- and post-operative outcome scores, we found significant improvements in modified Harris Hip Score (mHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and international Hip Outcomes Tool (iHot33) scores. Compared with patients undergoing hip arthroscopy for FAI alone, baseline mHHS, HOS-ADL, Hip Outcome Score–Sport-Specific Subscale and iHot33 scores were almost identical. We found that the presenting symptoms of hip IAOO closely mimic symptomatic FAI, including groin pain and anterior hip pain, so it is important to keep IAOO of the hip in the differential diagnosis of hip pain. Based on our experience, arthroscopy can be an effective treatment option for excision of intra-articular OO and is especially effective in patients with concomitant FAI in treating both pathologies. PMID:29423256

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

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

Modifications to the Hip Arthroscopy Technique When Performing Combined Hip Arthroscopy and Periacetabular Osteotomy.

PubMed

Spiker, Andrea M; Gumersell, Kate R; Sink, Ernest L; Kelly, Bryan T

2017-10-01

In the realm of hip preservation, hip arthroscopy is often used to address intra-articular impingement pathology, whereas periacetabular osteotomy (PAO) is used to address dysplasia and instability. Indications to combine these 2 procedures include hip dysplasia and symptomatic instability with a concomitant symptomatic labral tear or the other symptomatic intra-articular pathology (i.e., loose body, chondral flap). The arthroscopic portion of the procedure allows repair of the injured labrum and close inspection of the hip joint, and the PAO addresses undercoverage and/or inappropriate version of the acetabulum. The open approach used in PAO also allows access to the peripheral compartment to debride a cam lesion, if present, and the subspine region is accessible to perform subspine decompression, if needed. In this technique, we highlight special considerations pertaining to hip arthroscopy that is performed in combination with a PAO. Hip arthroscopy is the first procedure that takes place in this combined case, and modifications to the standard hip arthroscopic technique can prevent unnecessary difficulty during the PAO that follows.

Outcomes of Hip Arthroscopy in Competitive Athletes.

PubMed

Perets, Itay; Hartigan, David E; Chaharbakhshi, Edwin O; Ashberg, Lyall; Ortiz-Declet, Victor; Domb, Benjamin G

2017-08-01

To evaluate the minimum 2-year postoperative clinical outcomes and the rate of return to sports in athletes who underwent capsular plication for the treatment of ligamentous laxity and/or borderline dysplasia during hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology. Since 2008, data were prospectively collected on patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Inclusion criteria were as follows: athlete at the high school, collegiate, or professional levels preoperatively, underwent capsular plication, and preoperatively recorded patient-reported outcome scores including modified Harris hip score (mHHS), nonarthritic athletic hip score (NAHS), hip outcome score-sports-specific subscale (HOS-SSS), and visual analog scale (VAS). Exclusion criteria were as follows: <16 years old, preoperative Tönnis grade >1, and previous hip conditions. Sports activity and competitive levels were collected at a minimum of 2 years postoperatively. Fifty-one hips (49 patients) met the inclusion criteria, and 41 hips (39 patients) had minimum 2-year follow-up (80.4% follow-up). Mean mHHS increased from 67.1 preoperatively to 83.5 (P < .0001). Mean NAHS increased from 66.8 to 88.8 (P < .0001). Mean HOS-SSS improved from 46.8 to 80.1 (P < .0001). Mean VAS decreased from 5.1 to 1.7 (P < .0001). Thirty-five (85.4%) hip arthroscopies allowed the patients to return to sports at follow-up. Thirty-four (82.9%) hip arthroscopies allowed the patients to maintain their competitive physical abilities at follow-up. Patient-reported outcomes and VAS in athletes significantly improved at a minimum of 2 years after capsular plication as a part of hip arthroscopy addressing varying pathologies. In addition, most patients returned to sports at similar or higher competitive levels. These results suggest that capsular plication is a favorable treatment option in athletes with ligamentous laxity and

Effect of posture on hip angles and moments during gait.

PubMed

Lewis, Cara L; Sahrmann, Shirley A

2015-02-01

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ultrasound of the coracoacromial ligament in asymptomatic volunteers and patients with shoulder impingement.

PubMed

Dietrich, Tobias J; Jonczy, Maciej; Buck, Florian M; Sutter, Reto; Puskas, Gabor J; Pfirrmann, Christian Wa

2016-08-01

The coracoacromial ligament is part of the coracoacromial arch, which is considered to be involved in shoulder impingement. To compare the coracoacromial ligament on ultrasound in asymptomatic volunteers and in patients with subacromial shoulder impingement. Twenty-nine asymptomatic volunteers (mean age, 35.5 years) and 29 patients (mean age, 49.9 years) with shoulder impingement, diagnosed by experienced shoulder surgeons, were prospectively included. Two radiologists obtained and analyzed ultrasound images of the coracoacromial ligament in the longitudinal axis. The ligament thickness was 1.4 ± 0.2 mm at its midportion, 1.8 ± 0.4 mm at the coracoid, and 2.1 ± 0.6 mm at the acromion in asymptomatic volunteers compared with 1.3 ± 0.2 mm, 1.9 ± 0.5 mm, and 1.9 ± 0.5 mm in impingement patients for observer 1. The ligament length was 30.6 ± 2.4 mm in asymptomatic volunteers compared with 30.4 ± 3.6 mm in impingement patients for observer 1. An anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers for both observers (observer 1: 10% (3/29) versus 45% (13/29), P value <0.01; observer 2: 10% (3/29) versus 38% (11/29), P value <0.03). The comparison of the remaining parameters of the coracoacromial ligament, such as the thickness, length, echogenicity, and fibrillation did not reveal significant differences between volunteers and patients. While thickness or length of the coracoacromial ligament were similar in volunteers and patients with shoulder impingement, an anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers. © The Foundation Acta Radiologica 2015.

Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage?

PubMed

Cvetanovich, Gregory L; Levy, David M; Weber, Alexander E; Kuhns, Benjamin D; Mather, Richard C; Salata, Michael J; Nho, Shane J

2017-07-01

The literature contains conflicting reports regarding whether outcomes of hip arthroscopic surgery for patients with borderline dysplasia are inferior to outcomes in patients with normal acetabular coverage. To assess differences in the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) in groups of patients with borderline dysplasia and normal coverage. Cohort study; Level of evidence, 3. A registry of consecutive patients who had undergone primary hip arthroscopic surgery with capsular plication for FAI between January 2012 and January 2014 were divided based on the preoperative lateral center-edge angle (LCEA) into 2 distinct groups: (1) borderline dysplasia (LCEA 18°-25°) and (2) normal acetabular coverage (LCEA 25.1°-40°). There were 36 patients in the borderline dysplastic group and 312 patients in the normal coverage group. The primary outcome measure was the Hip Outcome Score-Activities of Daily Living (HOS-ADL) at a minimum of 2 years postoperatively. Secondary outcome measures included the HOS-Sports and modified Harris Hip Score (mHHS). The mean preoperative LCEA differed significantly between groups (23.4° ± 1.5° for borderline dysplastic, 32.5° ± 3.8° for normal coverage; P < .001). The borderline dysplastic group had a higher percentage of female patients than the normal coverage group (27/36 [75%] vs 177/312 [57%], respectively; P = .048). There were no differences in other preoperative demographics and radiographic parameters. At a minimum 2 years after hip arthroscopic surgery (mean follow-up, 2.6 ± 0.6 years), both groups demonstrated significant improvements in all patient-reported outcome scores ( P < .001 in all cases). There were no significant differences between the borderline dysplastic and normal coverage groups in final outcome scores, score improvements, or percentage of patients experiencing clinically significant improvements. One patient in the borderline dysplastic group (3%) underwent revision hip

Comparison of femoroacetabular impingement-related radiographic features in a convenience sample of Japanese patients with and without herniation pits.

PubMed

Mineta, Kazuaki; Goto, Tomohiro; Wada, Keizo; Tamaki, Yasuaki; Hamada, Daisuke; Higashino, Kosaku; Sairyo, Koichi

2016-08-01

To examine the prevalence of herniation pits (HPs) and to evaluate differences in radiographic features related to femoroacetabular impingement-a hip disorder with abnormal abutment between the acetabulum and femur-between hips with and without HPs in a convenience sample of Japanese patients. We reviewed 1,178 hips on each side (695 men, 483 women; mean age, 58.2 years) using computed tomographic images. The radiological assessments of hip morphology were performed by measuring the lateral center edge angle, acetabular index, acetabular version, alpha angle, and femoral head-neck offset. HPs were defined as the round or oval cystic lesions surrounded by sclerotic bone located below the anterior femoral neck cortex. Intraclass and interclass reproducibility of all radiographic measurements was acceptable (ICC: 0.71-0.98). The prevalence of HPs was 13.9 % in all subjects and was significantly higher in men (18.1 %) than in women (7.8 %; p < 0.001). HPs were larger in male (p < 0.001) and elderly subjects (p < 0.005). In subjects with HPs, the alpha angle was larger and femoral head-neck offset and offset ratio were smaller in the cohort overall and in men. Logistic regression analysis revealed the association between radiological cam-type FAI and HPs in all subjects (odds ratio: 1.86, p < 0.001). We revealed the prevalence of HPs and showed it has a predilection for men in this Japanese cohort. Femoral head asphericity or small head-neck offset was more common in subjects with HPs than those without HPs.

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

Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?

PubMed

Reiman, Michael P; Thorborg, Kristian

2015-06-01

Femoroacetabuler impingement (FAI) is becoming increasingly recognised as a potential pathological entity for individuals with hip pain. Surgery described to correct FAI has risen exponentially in the past 10 years with the use of hip arthroscopy. Unfortunately, the strength of evidence supporting both the examination and treatment of FAI does not appear to accommodate this exponential growth. In fact, the direction currently taken for FAI is similar to previously described paths of other orthopaedic and sports medicine pathologies (eg, shoulder impingement, knee meniscus tear) for which we have learned valuable lessons. The time has come for improved terminology, study design, and focus on delineation of successful treatment variables in the interest of those individuals with clinical indications of FAI so that we can appropriately address their needs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mastering the Physical Examination of the Athlete's Hip.

PubMed

Trofa, David P; Mayeux, Sophie E; Parisien, Robert L; Ahmad, Christopher S; Lynch, T Sean

In this review, we describe precise methods for evaluating the athlete's hip or groin with an emphasis on recognizing the most common extra-articular and intra-articular pathologies, including adductor strains, athletic pubalgia, osteitis pubis, and femoroacetabular impingement with labral tears.

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

PubMed

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

2012-01-01

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. 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. 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. The patients with painful symptoms after hip hyperflexion exercises associated with femoroacetabular impingement presented improvements after arthroscopic treatment.

Factors influencing discomfort during anterior ultrasound-guided injection for hip arthrography.

PubMed

Hsu, Yi-Chih; Wu, Yu-Cheng; Kao, Hao-Lun; Pan, Ru-Yu; Lee, Meei-Shyuan; Huang, Guo-Shu

2013-09-01

Although ultrasound (US)-guided injection techniques for magnetic resonance arthrography of the hip have been used with increasing frequency to diagnose internal joint derangements, little is known about patient tolerance, which is relevant information for patients. The objective of this study was to evaluate prospectively the association between possible influencing factors and discomfort felt during the performance of anterior US-guided injection techniques targeting the femoral head-neck junction during hip arthrography. Forty-four consecutive patients (21 women and 23 men; mean age, 41 years) undergoing magnetic resonance hip arthrography were sequentially assigned to receive injection alternating between fixed and freehand US-guided injection. Discomfort was assessed using a visual analog scale and relative ratings. Patient body mass index, extra-articular contrast leakage, the duration of the procedure, the needle advancement distance, and the fixed trajectory of the needle were assessed. Pearson's correlation coefficients and multiple logistic regression analysis were used to determine the association. Puncture was successfully accomplished in all cases, and no relevant complications were reported. The only significant relationships were between discomfort and the time required for needle manipulation (r = 0.8) and fixed US-guided injection (r = 0.6; p < 0.001). Compared with the freehand technique, the fixed technique resulted in significantly less pain and took significantly less time to perform (p < 0.001). The procedure time during needle manipulation in the fixed US-guided injections (4.0 ± 0.9 seconds) was significantly less than that in the freehand US-guided injections (19.4 ± 17.6 seconds; p < 0.001). No significant relationships were found between discomfort and other parameters (r < 0.3, p > 0.05). The procedure time appears to be the most important factor influencing patient discomfort. Fixed US-guided injection is a time

Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence.

PubMed

Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Schwindel, Leslie; Domb, Benjamin G

2014-10-01

The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level IV, systematic review of Level II to V studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The effectiveness of manual physical therapy interventions in pediatric patients with anterior hip pain: a retrospective study.

PubMed

Galleher, Mindy; Crowe, Briana; Selhorst, Mitchell

2017-12-01

The purposes of this study were to: (1) assess the benefit of adding manual therapy (MT) to physical therapy care in pediatric patients with anterior hip pain; (2) assess the relative risk of adverse reactions when MT is used; and (3) report the types of MT used. This study was a retrospective chart review of patients treated in a hospital-based sports medicine clinic. The charts of 201 patients (mean age = 14.23 ± 2.15 years) met the inclusion criteria and were reviewed. Patients were grouped into those who received MT during their episode of care, and those who did not. Pain efficiency (change in pain/number of visits), number and type of adverse reactions, as well as frequency and type of manual therapy interventions used, were the outcomes of interest. The mean pain efficiency was significantly less if manual therapy was performed (MT = 0.60 [95% CI 0.47-0.72], no MT = 0.80 [95% CI 0.71-0.90] p  = 0.01). There was no significant difference between groups in risk of adverse reactions (MT = 5, no MT = 5). The number of visits was significantly different between groups (MT = 9.43 ± 3.9 sessions, and no MT = 7.6 ± 5.2 sessions). MT did not increase the risk of an adverse reaction in pediatric patients with anterior hip pain. While it appears to be a safe intervention, it did not improve pain efficiency or patient adherence. Future research should be performed to assess the effectiveness of MT, when performed by skilled therapists, in pediatric patients with hip pain in a controlled manner. Level of Evidence: 3b.

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

Hip Arthroscopy Update

PubMed Central

Buly, Robert L.

2005-01-01

The management of hip injuries in the athlete has evolved significantly in the past few years with theadvancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in recreational and elite athletes alike. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular pathology that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and thus, left untreated. Current indications for hip arthroscopy include management of labral tears, osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition, patients with long-standing, unresolved hip joint pain and positive physical findings may benefit from arthroscopic evaluation. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after surgical intervention. Strict attention to thorough diagnostic examination, detailed imaging, and adherence to safe and reproducible surgical techniques, as described in this review, are essential for the success of this procedure. PMID:18751808

Medial versus anterior open reduction for developmental hip dislocation in age-matched patients.

PubMed

Hoellwarth, Jason S; Kim, Young-Jo; Millis, Michael B; Kasser, James R; Zurakowski, David; Matheney, Travis H

2015-01-01

The difference between medial (MAOR) and anterior (AAOR) approaches for open reduction of developmental hip dysplasia in terms of risk for avascular necrosis (AVN) and need for further corrective surgery (FCS, femoral and/or acetabular osteotomy) is unclear. This study compared age-matched cohorts undergoing either MAOR or AAOR in terms of these 2 primary outcomes. Prognostic impact of presence of ossific nucleus at time of open reduction was also investigated. Institutional review board approval was obtained. Nineteen hips (14 patients) managed by MAOR were matched with 19 hips (18 patients) managed by AAOR based on age at operation (mean 6.0; range, 1.4 to 14.9 mo). Patients with neuromuscular conditions and known connective tissue disorders were excluded. Primary outcomes assessed at minimum 2 years' follow-up included radiographic evidence of AVN (Kalamchi and MacEwen) or requiring FCS. MAOR and AAOR cohorts were similar regarding age at open reduction, sex, laterality, and follow-up duration. One hip in each group had AVN before open reduction thus were excluded from AVN analysis. At minimum 2 years postoperatively (mean 6.2; range, 1.8 to 11.7 y), 4/18 (22%) MAOR and 5/18 (28%) AAOR met the same criteria for AVN (P=1.0). No predictors of AVN could be identified by regression analysis. Presence of an ossific nucleus preoperatively was not a protective factor from AVN (P=0.27). FCS was required in 4/19 (21%) MAOR and 7/19 (37%) AAOR hips (P=0.48). However, 7/12 (54%) hips failing closed reduction required FCS compared with 4/26 (16%) hips without prior failed closed reduction (P=0.024). Cox regression analysis showed that patients who failed closed reduction had an annual risk of requiring FCS approximately 6 times that of patients without a history of failed closed reduction (hazard ratio=6.1; 95% CI, 1.5-24.4; P=0.009), independent of surgical approach (P=0.55) or length of follow-up (P=0.78). In this study of age-matched patients undergoing either MAOR or

Patellofemoral pain and asymmetrical hip rotation.

PubMed

Cibulka, Michael T; Threlkeld-Watkins, Julie

2005-11-01

Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.

Refractory pain following hip arthroscopy: evaluation and management

PubMed Central

de SA, Darren L; Burnham, Jeremy M; Mauro, Craig S

2018-01-01

ABSTRACT With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role. Patients with failed hip arthroscopy should undergo a thorough history and physical examination, as well as indicated imaging. A treatment plan should then be developed based on pertinent findings from the workup and in conjunction with the patient. Depending on the etiology of failed hip arthroscopy, management may be nonsurgical or surgical, which may include revision arthroscopic or open surgery, periacetabular osteotomy or joint arthroplasty. Revision surgery may be appropriate in settings including, but not limited to, incompletely treated femoroacetabular impingement, postoperative adhesions, heterotopic ossification, instability, hip dysplasia or advanced degeneration. PMID:29423245

Indications and Outcomes for Microfracture as an Adjunct to Hip Arthroscopy for Treatment of Chondral Defects in Patients With Femoroacetabular Impingement: A Systematic Review.

PubMed

MacDonald, Austin E; Bedi, Asheesh; Horner, Nolan S; de Sa, Darren; Simunovic, Nicole; Philippon, Marc J; Ayeni, Olufemi R

2016-01-01

To evaluate the indications, preoperative workup outcomes, and postoperative rehabilitation of patients with femoroacetabular impingement (FAI) receiving microfracture as an adjunct to hip arthroscopy for chondral defects. The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving patients with FAI treated arthroscopically with microfracture of the hip for chondral defects either solely or as an adjunct to hip arthroscopy. Data regarding indications, investigations, outcomes, and postoperative rehabilitation were abstracted from eligible studies. The references of included studies were additionally searched, and descriptive statistics are provided. There were 12 studies included in this review, involving 267 patients. With the exception of a single, one-patient case report, 11 of the 12 studies reported positive outcomes after hip arthroscopy with microfracture. Only 0.7% of the total patients experienced a complication, and 1.1% required further surgery on the basis of outcomes evaluated at a mean follow-up of 29.5 (range, 4 to 60) months across the studies. Eight of 12 studies discussed the preoperative workup of these patients, with X-rays and magnetic resonance imaging being the most common preoperative imaging used. There was little reported on weight-bearing status during postoperative rehabilitation. The outcomes reported in the literature after hip arthroscopy with microfracture for chondral defects are, in general, positive, with a very low percentage of patients requiring further surgery or experiencing complications. The most common indication used in the literature for microfracture is a full-thickness, focal chondral defect (Outerbridge grade IV). The vast majority of literature recommends limited weight bearing after microfracture; however, there was significant variation among the specific rehabilitation protocols used. More research is needed to explore what indications and postoperative

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

Effect of increased pushoff during gait on hip joint forces.

PubMed

Lewis, Cara L; Garibay, Erin J

2015-01-02

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

PubMed Central

Atsumi, Satoru; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2016-01-01

Avulsion fracture of the anterior tibial eminence is an uncommon injury. If bone union does not occur, knee extension will be limited by impingement of the avulsed fragment and knee instability will be induced by dysfunction of the anterior cruciate ligament (ACL). This report describes a 55-year-old woman who experienced an avulsion fracture of the right anterior tibial eminence during recreational skiing. Sixteen months later, she presented at our hospital with limitation of right knee extension. Plain radiography showed nonunion of the avulsion fracture region, and arthroscopy showed that the avulsed fragment impinged the femoral intercondylar notch during knee extension. The anterior region of the bony fragment was debrided arthroscopically until the knee could be extended completely. There was no subsequent instability, and the patient was able to climb a mountain 6 months after surgery. These findings indicate that arthroscopic debridement of an avulsed fragment for nonunion of an avulsion fracture of the anterior tibial eminence is a minimally invasive and effective treatment for middle-aged and elderly patients with a low level of sports activity. PMID:27119035

Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.

PubMed

Hanchard, Nigel C A; Lenza, Mário; Handoll, Helen H G; Takwoingi, Yemisi

2013-04-30

95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the

A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18-50) femoroacetabular impingement.

PubMed

2015-03-20

Several cross-sectional studies have estimated that the prevalence of femoroacetabular impingement (FAI) ranges from 14-17% among asymptomatic young adults to almost 95% among competitive athletes. With FAI, there is abnormal contact between the proximal femur and the acetabulum, resulting in abnormal mechanics with terminal motion such as hip flexion and rotation. This condition results from bony anomalies of the acetabular rim (Pincer) and or femoral head/neck junction (CAM) and typically causes hip pain and decreased hip function. The development of hip pain potentially serves as an indicator for early cartilage and labral damage that may result in hip osteoarthritis. Although surgical correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to improve hip pain and alter the natural history of degenerative disease, the supportive evidence is based upon low quality observational studies. The Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) compares outcomes following surgical correction of the impingement morphology (arthroscopic osteochondroplasty) with/without labral repair versus arthroscopic lavage of the hip joint in adults aged 18 to 50 diagnosed with FAI. FIRST is a multi-centre, randomized controlled trial with a sample size of 220 patients. Exclusion criteria include the presence of hip syndromes, previous surgery or trauma to the affected hip, and significant medical comorbidities. The primary outcome is pain and the secondary outcomes include patient function, quality of life, complications, and cost-effectiveness--all within one year of follow-up. Patients are stratified based on centre and impingement sub-type. Patients, outcome assessors, data analysts, and the Steering Committee are blinded to surgical allocation. Using an intention-to-treat approach, outcome analyses will be performed using an analysis of covariance and descriptive statistics. Symptomatic FAI is associated

Clinical Biomechanics of Wear in Total Hip Arthroplasty

PubMed Central

Callaghan, John J; Pedersen, Douglas R; Johnston, Richard C; Brown, Thomas D

2003-01-01

Complementary clinical and laboratory studies were performed to identify variables associated with polyethylene wear following total hip replacement, and to elucidate the mechanisms responsible for accelerated wear in the total hip arthroplasty construct. Observational cohort studies were performed using a prospective clinical database of more than 4000 consecutive primary total hip arthroplasties performed by a single surgeon, to identify wear-related variables. These variables included head size, acetabular/femoral component impingement, and third body debris. Novel digital edge detection techniques were developed and employed to accurately measure wear, and to determine the relationships of head size and third body debris to acceleration of wear. A novel slidingdistance-coupled finite element model was formulated and employed to examine the mechanisms responsible for wear. The long-term cohort studies demonstrated smaller head sizes to be associated with less wear. Third body debris generated from cable fretting was associated with an increase in wear, osteolysis, and acetabular loosening, especially with larger head sizes. The sliding-distance-coupled finite element model replicated the wear rates occurring in vitro and in vivo, demonstrating the importance of sliding distance on polyethylene wear following total hip arthroplasty. It also demonstrated substantial increases in wear associated with femoral head scratching from third body debris. Further extension of the finite element formulation demonstrated the potential for acetabular component rim damage from impingement wear, and the enhanced potential for third body ingress to the bearing surface with larger head sizes. Edge detection wear measurement techniques demonstrated that early wear rates were predictive of long-term wear rates. These complementary clinical and laboratory investigations have provided insight into 1) the significance of sliding distance and physiologic loci of motion as contributing

Variability of ischiofemoral space dimensions with changes in hip flexion: an MRI study.

PubMed

Johnson, Adam C; Hollman, John H; Howe, Benjamin M; Finnoff, Jonathan T

2017-01-01

with respect to hip flexion and supine versus prone positions. This finding has implications when evaluating for ischiofemoral impingement, an entity resulting in hip and/or buttock pain secondary to impingement of the quadratus femoris muscle within a pathologically narrowed IFS. One will need to account for patient hip flexion and supine versus prone positioning when evaluating individuals with suspected ischiofemoral impingement.

Professional golfers' hips: prevalence and predictors of hip pain with clinical and MR examinations.

PubMed

Dickenson, Edward; Ahmed, Imran; Fernandez, Miguel; O'Connor, Philip; Robinson, Philip; Campbell, Robert; Murray, Andrew; Warner, Martin; Hutchinson, Charles; Hawkes, Roger; Griffin, Damian

2016-09-01

This study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics predicted hip symptoms. Male elite professional golf players were invited to complete questionnaires and undergo clinical and MR examinations while attending the Scottish Hydro Challenge 2015. Questionnaires determined player demographics, self-reported hip pain and an International Hip Outcome Tool 12 (iHOT12) score (hip-related quality of life). Clinical examinations determined hip range of motion and the presence of a positive impingement test. MR scans determined the presence of labral pathology and player hip morphology with measures of α angle (cam), acetabular depth (pincer) and femoral neck antetorsion. A total of 109 (70% of tournament field) of players completed questionnaires, 73 (47%) underwent clinical examination and 55 (35%) underwent MR examination. 19.3% of players reported of hip pain. 11.9% of lead and 9.1% of trail hips were painful (p=0.378), iHOT12 scores were lower in the lead (94.1) compared to the trail hip (95.3) (p=0.007). Stepwise multiple linear regression modelling was able to predict 20.7% of the variance in iHOT12 scores with mean α angles between 12 and 3 o'clock, and increasing age-significant variables (R(2)=0.207, p<0.001; β=-0.502, p<0.001 and β=-0.399, p=0.031, respectively). 19.3% of male professional golfers reported hip pain. The presence of an increasing α angle and increasing age were significant predictors of reduced hip-related quality of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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)

Hip external rotation strength predicts hop performance after anterior cruciate ligament reconstruction.

PubMed

Kline, Paul W; Burnham, Jeremy; Yonz, Michael; Johnson, Darren; Ireland, Mary Lloyd; Noehren, Brian

2018-04-01

Quadriceps strength and single-leg hop performance are commonly evaluated prior to return to sport after anterior cruciate ligament reconstruction (ACLR). However, few studies have documented potential hip strength deficits after ACLR, or ascertained the relative contribution of quadriceps and hip strength to hop performance. Patients cleared for return to sports drills after ACLR were compared to a control group. Participants' peak isometric knee extension, hip abduction, hip extension, and hip external rotation (HER) strength were measured. Participants also performed single-leg hops, timed hops, triple hops, and crossover hops. Between-limb comparisons for the ACLR to control limb and the non-operative limb were made using independent two-sample and paired sample t tests. Pearson's correlations and stepwise multiple linear regression were used to determine the relationships and predictive ability of limb strength, graft type, sex, and limb dominance to hop performance. Sixty-five subjects, 20 ACLR [11F, age 22.8 (15-45) years, 8.3 ± 2 months post-op, mass 70.47 ± 12.95 kg, height 1.71 ± 0.08 m, Tegner 5.5 (3-9)] and 45 controls [22F, age 25.8 (15-45) years, mass 74.0 ± 15.2 kg, height 1.74 ± 0.1 m, Tegner 6 (3-7)], were tested. Knee extension (4.4 ± 1.5 vs 5.4 ± 1.8 N/kg, p = 0.02), HER (1.4 ± 0.4 vs 1.7 ± 0.5 N/kg, p = 0.04), single-leg hop (146 ± 37 vs 182 ± 38% limb length, p < 0.01), triple hop (417 ± 106 vs 519 ± 102% limb length, p < 0.01), timed hop (3.3 ± 2.0 vs 2.3 ± 0.6 s, p < 0.01), and crossover hop (364 ± 107 vs 446 ± 123% limb length, p = 0.01) were significantly impaired in the operative versus control subject limbs. Similar deficits existed between the operative and non-operative limbs. Knee extension and HER strength were significantly correlated with each of the hop tests, but only HER significantly predicted hop performance. After ACLR, patients have persistent HER strength

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

Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes.

PubMed

Cvetanovich, Gregory L; Harris, Joshua D; Erickson, Brandon J; Bach, Bernard R; Bush-Joseph, Charles A; Nho, Shane J

2015-07-01

To determine indications for, operative findings of, and outcomes of revision hip arthroscopy. A systematic review was registered with PROSPERO and performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Therapeutic clinical outcome studies reporting the indications for, operative findings of, and outcomes of revision hip arthroscopy were eligible for inclusion. All study-, patient-, and hip-specific data were extracted and analyzed. The Modified Coleman Methodology Score was used to assess study quality. Five studies were included (348 revision hip arthroscopies; 333 patients; mean age, 31.4 ± 4.2 years; 60% female patients). All 5 studies were either Level III or IV evidence. The surgeon performing revision hip arthroscopy was the same as the primary hip surgeon in only 25% of cases. The mean time between primary and revision hip arthroscopy was 27.8 ± 7.0 months (range, 2 to 193 months). Residual femoroacetabular impingement was the most common indication for and operative finding of revision hip arthroscopy (81% of cases). The most commonly reported revision procedures were femoral osteochondroplasty (24%) and acetabuloplasty (18%). The modified Harris Hip Score was used in all 5 analyzed studies, with significant (P < .05) improvements observed in all 5 studies (weighted mean, 56.8 ± 3.6 preoperatively v 72.0 ± 8.3 at final follow-up [22.4 ± 9.8 months]; P = .01). Other patient-reported outcomes (Non-Arthritic Hip Score, Hip Outcome Score, 33-item International Hip Outcome Tool, Short Form 12) showed significant improvements but were not used in all 5 analyzed studies. After revision hip arthroscopy, subsequent reported operations were hip arthroplasty in 11 patients and re-revision hip arthroscopy in 8 patients (5% total reoperation rate). Revision hip arthroscopy is most commonly performed for residual femoroacetabular impingement, with statistically significant and clinically relevant improvements

Sex differences of hip morphology in young adults with hip pain and labral tears.

PubMed

Hetsroni, Iftach; Dela Torre, Katrina; Duke, Gavin; Lyman, Stephen; Kelly, Bryan T

2013-01-01

To compare hip morphology between young men and women who presented with hip pain and labral tears. A retrospective review of our hip arthroscopy registry from March 2008 to June 2010 was completed. We identified 217 patients (249 hips) who were between the ages of 18 to 30 years. The inclusion criteria were (1) insidious-onset hip pain or worsening pain after low-energy sports trauma, (2) positive hip impingement sign, (3) Tönnis grades 0 to 1, (4) magnetic resonance imaging showing labral tear, and (5) primary hip arthroscopy confirming labral tear. Forty-five patients (52 hips) were excluded for the following reasons: (1) revision hip arthroscopy, (2) high-energy hip trauma, (3) history of surgery involving the femur or pelvis, (4) previous fractures of the femur or pelvis, (5) Tönnis grades 2 or above, (6) proliferative disease of the hip (i.e., synovial chondromatosis, pigmented villonodular synovitis), (7) neuromuscular disease (i.e., cerebral palsy), and (8) deformities related to Legg-Calvé-Perthes disease or developmental dysplasia of the hip. Therefore, the cohort study group included 105 (61%) men (123 [62.4%] hips) and 67 (39%) women (74 [37.6%] hips). Sex comparisons were made for the following variables measured on preoperative hip computed tomography scans: alpha angle, acetabular version, femoral version, lateral center-edge angle, and neck-shaft angle. Women had smaller alpha angles (47.8°v 63.6°, P < .001), increased acetabular version (17.3°v 13.9°, P < .001), and increased femoral anteversion (14.4°v 12.1°, P = .05). In young adults with hip pain and labral tears, women have smaller alpha angles and hips that are generally more anteverted. Therefore, in women, cam lesions may be more subtle, preoperative hip version analyses should be encouraged, and rim trimming may need to be cautiously planned to avoid increasing contact stresses at weight-bearing areas after such a procedure. Level III, retrospective comparative study. Copyright �

Anterior total hip arthroplasty using a metaphyseal bone-sparing stem: component alignment and early complications.

PubMed

Ahmed, Mohammed M; Otto, Thomas J; Moed, Berton R

2016-04-22

Limited-incision total hip arthroplasty (THA) preserves hip abductors, posterior capsule, and external rotators potentially diminishing dislocation risk. However, potential complications also exist, such as component malposition. Specific implants have been manufactured that enhance compatibility with this technique, while preserving metaphyseal bone; however, little data exists documenting early complications and component position. The purpose was to evaluate primary THA using a curved, bone-sparing stem inserted through the anterior approach with respect to component alignment and early complications. In a retrospective analysis of 108 cases, the surgical technique was outlined and the occurrence of intraoperative fractures, postoperative dislocations, infection, and limb length inequality was determined. Femoral stem and acetabular cup alignment was quantified using the initial postoperative radiographs. Patient follow-up averaged 12.9 (range 2 to 36) months. There were eight (7.4 %) complications requiring revision surgery in three (2.8 %) patients with three (2.8 %) infections and three (2.8 %) dislocations. Intraoperative complications included one calcar fracture above the lesser trochanter. Leg length inequality >5 mm was present in three (2.8 %) patients. Radiographic analysis showed that femoral neutral alignment was achieved in 95 hips (88.0 %). All femoral stems demonstrated satisfactory fit and fill and no evidence of subsidence, osteolysis, or loosening. An average abduction angle of 44.8° (± 5.3) and average cup anteversion of 16.2° (± 4.2) were also noted. Although the technique with this implant and approach is promising, it does not appear to offer important advantages over standard techniques. However, the findings merit further, long-term study.

The Relationship Between Pulsatile Flow Impingement and Intraluminal Thrombus Deposition in Abdominal Aortic Aneurysms.

PubMed

Lozowy, Richard J; Kuhn, David C S; Ducas, Annie A; Boyd, April J

2017-03-01

Direct numerical simulations were performed on four patient-specific abdominal aortic aneurysm (AAA) geometries and the resulting pulsatile blood flow dynamics were compared to aneurysm shape and correlated with intraluminal thrombus (ILT) deposition. For three of the cases, turbulent vortex structures impinged/sheared along the anterior wall and along the posterior wall a zone of recirculating blood formed. Within the impingement region the AAA wall was devoid of ILT and remote to this region there was an accumulation of ILT. The high wall shear stress (WSS) caused by the impact of vortexes is thought to prevent the attachment of ILT. WSS from impingement is comparable to peak-systolic WSS in a normal-sized aorta and therefore may not damage the wall. Expansion occurred to a greater extent in the direction of jet impingement and the wall-normal force from the continuous impact of vortexes may contribute to expansion. It was shown that the impingement region has low oscillatory shear index (OSI) and recirculation zones can have either low or high OSI. No correlation could be identified between OSI and ILT deposition since different flow dynamics can have similar OSI values.

Arthroscopy of the Nondistractable Hip: A Novel Extracapsular Approach

PubMed Central

Doron, Ran; Amar, Eyal; Rath, Ehud; Sampson, Thomas; Ochiai, Derek; Matsuda, Dean K.

2014-01-01

Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy. The anterolateral portal is established under fluoroscopic guidance. The arthroscope is positioned on the lateral rim of the acetabulum. A shaver, introduced through a modified anterior portal, is used to facilitate capsular exposure. An arthroscopic capsular incision is made proximal to the lateral acetabular rim and extended anteriorly with a radiofrequency probe. Osteoplasty of the anterolateral acetabular rim is carried out with a burr while protecting the labrum. Distraction of the hip is then possible, allowing safe central-compartment access and subsequent chondrolabral procedures. PMID:25685682

Scapular notching in reverse shoulder arthroplasty: validation of a computer impingement model.

PubMed

Roche, Christopher P; Marczuk, Yann; Wright, Thomas W; Flurin, Pierre-Henri; Grey, Sean G; Jones, Richard B; Routman, Howard D; Gilot, Gregory J; Zuckerman, Joseph D

2013-01-01

The purpose of this study is to validate a reverse shoulder computer impingement model and quantify the impact of implant position on scapular impingement by comparing it to that of a radiographic analysis of 256 patients who received the same prosthesis and were followed postoperatively for an average of 22.2 months. A geometric computer analysis quantified anterior and posterior scapular impingement as the humerus was internally and externally rotated at varying levels of abduction and adduction relative to a fixed scapula at defined glenoid implant positions. These impingement results were compared to radiographic study of 256 patients who were analyzed for notching, glenoid baseplate position, and glenosphere overhang. The computer model predicted no impingement at 0° humeral abduction in the scapular plane for the 38 mm, 42 mm, and 46 mm devices when the glenoid baseplate cage peg is positioned 18.6 mm, 20.4 mm, and 22.7 mm from the inferior glenoid rim (of the reamed glenoid) or when glenosphere overhang of 4.6 mm, 4.7 mm, and 4.5 mm was obtained with each size glenosphere, respectively. When compared to the radiographic analysis, the computer model correctly predicted impingement based upon glenoid base- plate position in 18 of 26 patients with scapular notching and based upon glenosphere overhang in 15 of 26 patients with scapular notching. Reverse shoulder implant positioning plays an important role in scapular notching. The results of this study demonstrate that the computer impingement model can effectively predict impingement based upon implant positioning in a majority of patients who developed scapular notching clinically. This computer analysis provides guidance to surgeons on implant positions that reduce scapular notching, a well-documented complication of reverse shoulder arthroplasty.

Editorial Commentary: Put Me in Coach! Hip Arthroscopy Gets Patients Back in the Game.

PubMed

Kane, Patrick; Philippon, Marc J

2017-04-01

A significant proportion of patients undergoing hip arthroscopy for treatment of femoroacetabular impingement are athletes attempting to return to sport. Emerging data suggest hip arthroscopy has a high success rate in athletes returning to play at all competitive levels and ages. Although several factors are important in determining return to athletics, the results of hip arthroscopy appear promising in all athletes, from weekend warriors to elite professionals. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Modifying the hip abduction angle during bridging exercise can facilitate gluteus maximus activity.

PubMed

Kang, Sun-Young; Choung, Sung-Dae; Jeon, Hye-Seon

2016-04-01

To investigate how the erector spinae (ES) and gluteus maximus (GM) muscle activity and the anterior pelvic tilt angle change with different hip abduction angles during a bridging exercise. Twenty healthy participants (10 males and 10 females, aged 21.6 ± 1.6) voluntarily participated in this study. Surface electromyography (EMG) signals were recorded from the ES and GM during bridging at three hip abduction angles: 0°, 15°, and 30°. Simultaneously, the anterior pelvic tilt angle was measured using Image J software. The EMG amplitude of the GM muscle and the GM/ES EMG ratio were greatest at 30° hip abduction, followed by 15° and then 0° hip abduction during the bridging exercise. In contrast, the ES EMG amplitude at 30° hip abduction was significantly lesser than that at 0° and 15° abduction. Additionally, the anterior pelvic tilt angle was significantly lower at 30° hip abduction than at 0° or 15°. Bridging with 30° hip abduction can be recommended as an effective method to selectively facilitate GM muscle activity, minimize compensatory ES muscle activity, and decrease the anterior pelvic tilt angle. Copyright © 2015 Elsevier Ltd. All rights reserved.

Acetabular overcoverage in the horizontal plane: an underdiagnosed trigger of early hip arthritis. A CT scan study in young adults.

PubMed

Valera, Màrius; Ibáñez, Natalia; Sancho, Rogelio; Llauger, Jaume; Gich, Ignasi

2018-01-01

Acetabular overcoverage promotes hip osteoarthritis causing a pincer-type femoroacetabular impingement. Acetabular coverage in the horizontal plane is usually poorly defined in imaging studies and may be misdiagnosed. The goal of this study was to analyze the role of acetabular overcoverage measured in the frontal plane and in the horizontal plane by CT scan and to determine its relationship with other anatomic features in the onset of hip arthritis in young adults. We compared prospectively CT scans from two groups of adults of 55 years or younger: the patient group (n = 30) consisted of subjects with diagnosis of early hip arthritis (Tönnis Grade I or II) and the control group (n = 31) consisted of subjects with healthy hips. Two independent observers analyzed centre edge angle (CEA), acetabular anteversion angle (AAA), anterior sector acetabular angle (AASA), posterior sector acetabular angle (PASA), horizontal acetabular sector angle (HASA), femoral anteversion angle (FAVA), alpha angle (AA), and Mckibbin Instability Index (MI). Angles measuring the acetabular coverage on the horizontal plane (AASA, PASA and, HASA) were significantly higher in the patient group (p < 0.001, p = 0.03 and p < 0.001, respectively). Pearson's correlation coefficient showed a positive correlation between CEA and HASA in patients (r = 0.628) and in controls (r = 0.660). However, a high CEA (> 35º) was strongly associated with a high HASA (> 160º) in patients (p = 0.024) but not in controls (p = 0.21), suggesting that pincer should be simultaneously present in the horizontal and frontal plane to trigger hip degeneration. No significant association was detected between a high alpha angle (> 60º) and a high CEA (> 35º suggesting that a mixed pincer-cam aetiology was not prevalent in our series. Multivariate regression analysis showed the most significant predictors of degenerative joint disease were HASA (p = 0.008), AA (p = 0.048) and ASAA (p = 0

Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype.

PubMed

Hogervorst, Tom; Eilander, Wouter; Fikkers, Joost T; Meulenbelt, Ingrid

2012-12-01

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not. We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with hip ontogenesis. We performed a systematic literature review of mechanical and genetic factors of hip ontogeny. We focused on three fields that in recent years have advanced our knowledge of adult hip morphology: imaging, evolution, and genetics. WHERE ARE WE NOW?: Mechanical factors can be understood in view of human evolutionary peculiarities and may summate to load histories conducive to DHD. Genetic factors most likely act through multiple genes, each with modest effect sizes. Single genes that explain a DHD are therefore unlikely to be found. Apparently, the interplay between genes and load history not only determines hip morphotype, but also joint cartilage robustness ("cartilotype") and resistance to symptomatic OA. WHERE DO WE NEED TO GO?: We need therapies that can improve both morphotype and cartilotype. HOW DO WE GET THERE?: Better phenotyping, improving classification systems of hip morphology, and comparative population studies can be done with existing methods. Quantifying load histories likely requires new tools, but proof of principle of modifying morphotype in treatment of DDH and of cartilotype with exercise is available.

Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players.

PubMed

Lahner, Matthias; Walter, Philipp Alexander; von Schulze Pellengahr, Christoph; Hagen, Marco; von Engelhardt, Lars Victor; Lukas, Carsten

2014-08-01

Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI. According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18-30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18-29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests. In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group. Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at

What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

PubMed

Hanke, Markus S; Steppacher, Simon D; Anwander, Helen; Werlen, Stefan; Siebenrock, Klaus A; Tannast, Moritz

2017-04-01

Magnetic resonance arthrogram (MRA) with radial cuts is presently the best available preoperative imaging study to evaluate chondrolabral lesions in the setting of femoroacetabular impingement (FAI). Existing followup studies for surgical treatment of FAI have evaluated predictors of treatment failure based on preoperative clinical examination, intraoperative findings, and conventional radiography. However, to our knowledge, no study has examined whether any preoperative findings on MRA images might be associated with failure of surgical treatment of FAI in the long term. The purposes of this study were (1) to identify the preoperative MRA findings that are associated with conversion to THA, any progression of osteoarthritis, and/or a Harris hip score of < 80 points after acetabuloplasty and/or osteochondroplasty of the femoral head-neck junction through a surgical hip dislocation (SHD) for FAI at a minimum 10-year followup; and (2) identify the age of patients with symptomatic FAI when these secondary degenerative findings were detected on preoperative radial MRAs. We retrospectively studied 121 patients (146 hips) who underwent acetabuloplasty and/or osteochondroplasty of the femoral head-neck junction through SHD for symptomatic anterior FAI between July 2001 and March 2003. We excluded 35 patients (37 hips) with secondary FAI after previous surgery and 11 patients (12 hips) with Legg-Calvé-Perthes disease. All patients underwent preoperative MRA to further specify chondrolabral lesions except in 19 patients (32 hips) including 17 patients (20 hips) who presented with an MRI from an external institution taken with a different protocol, 10 patients with no preoperative MRA because the patients had already been operated on the contralateral side with a similar appearance, and two patients (two hips) refused MRA because of claustrophobia. This resulted in 56 patients (65 hips) with idiopathic FAI and a preoperative MRA. Of those, three patients (three hips) did

Sagittal Plane Hip, Knee, and Ankle Biomechanics and the Risk of Anterior Cruciate Ligament Injury: A Prospective Study

PubMed Central

Leppänen, Mari; Pasanen, Kati; Krosshaug, Tron; Kannus, Pekka; Vasankari, Tommi; Kujala, Urho M.; Bahr, Roald; Perttunen, Jarmo; Parkkari, Jari

2017-01-01

Background: Stiff landings with less knee flexion and high vertical ground-reaction forces have been shown to be associated with an increased risk of anterior cruciate ligament (ACL) injury. The literature on the association between other sagittal plane measures and the risk of ACL injuries with a prospective study design is lacking. Purpose: To investigate the relationship between selected sagittal plane hip, knee, and ankle biomechanics and the risk of ACL injury in young female team-sport athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 171 female basketball and floorball athletes (age range, 12-21 years) participated in a vertical drop jump test using 3-dimensional motion analysis. All new ACL injuries, as well as match and training exposure data, were recorded for 1 to 3 years. Biomechanical variables, including hip and ankle flexion at initial contact (IC), hip and ankle ranges of motion (ROMs), and peak external knee and hip flexion moments, were selected for analysis. Cox regression models were used to calculate hazard ratios (HRs) with 95% CIs. The combined sensitivity and specificity of significant test variables were assessed using a receiver operating characteristic (ROC) curve analysis. Results: A total of 15 noncontact ACL injuries were recorded during follow-up (0.2 injuries/1000 player-hours). Of the variables investigated, landing with less hip flexion ROM (HR for each 10° increase in hip ROM, 0.61 [95% CI, 0.38-0.99]; P < .05) and a greater knee flexion moment (HR for each 10-N·m increase in knee moment, 1.21 [95% CI, 1.04-1.40]; P = .01) was significantly associated with an increased risk of ACL injury. Hip flexion at IC, ankle flexion at IC, ankle flexion ROM, and peak external hip flexion moment were not significantly associated with the risk of ACL injury. ROC curve analysis for significant variables showed an area under the curve of 0.6, indicating a poor combined sensitivity and specificity of the test

[Prevalence of X-ray signs of femoroacetabular impingement in Mexican population].

PubMed

Gutiérrez-Ramos, R; Ávalos-Calderón, S A; Bahena-Peniche, L A

2017-01-01

Femoroacetabular impingement (FAI) is a suggested diagnosis for pain in the hip in the absence of other apparent causes. It is thought to be a cause of progressive arthrosis of the hip. Our objective was to determine the prevalence of radiographic data of FAI in the adult population without hip pathology over a period of six months. Analytical, observational, multicentric, ambispective and transverse study based on digital X-rays analysis. Measurements of the lateral center-edge angle of Wiberg, acetabular inclination, Tönnis angle and the neck shaft angle of the proximal femur were made; a pistol grip deformity of the femoral head, the triangular index and the shape of the coxofemoral joint were also evaluated. From a total of 212 hips evaluated, 104 were in males and 108 in females, with an average age of 42.81 years; 21 had a pistol grip deformity and a positive triangular index for cam type. The pincer type was found in 12 hips. In this multicentric study, the FAI cam type predominated in men on the right side; the pincer type predominated in women on the left side; this is similar to what has been reported in other populations. This study is limited by the wide variation in the femoral rotation; as an advantage, it was randomly carried out and provides some data on the prevalence of deformities of the hip, not previously registered.

Hip2Norm: an object-oriented cross-platform program for 3D analysis of hip joint morphology using 2D pelvic radiographs.

PubMed

Zheng, G; Tannast, M; Anderegg, C; Siebenrock, K A; Langlotz, F

2007-07-01

We developed an object-oriented cross-platform program to perform three-dimensional (3D) analysis of hip joint morphology using two-dimensional (2D) anteroposterior (AP) pelvic radiographs. Landmarks extracted from 2D AP pelvic radiographs and optionally an additional lateral pelvic X-ray were combined with a cone beam projection model to reconstruct 3D hip joints. Since individual pelvic orientation can vary considerably, a method for standardizing pelvic orientation was implemented to determine the absolute tilt/rotation. The evaluation of anatomically morphologic differences was achieved by reconstructing the projected acetabular rim and the measured hip parameters as if obtained in a standardized neutral orientation. The program had been successfully used to interactively objectify acetabular version in hips with femoro-acetabular impingement or developmental dysplasia. Hip(2)Norm is written in object-oriented programming language C++ using cross-platform software Qt (TrollTech, Oslo, Norway) for graphical user interface (GUI) and is transportable to any platform.

[Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases].

PubMed

Tang, J; Lv, M; Zhou, Y X; Zhang, J

2017-04-18

To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA). We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed. We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01). The DAA THA can achieve faster recovery and flexible hip joint after operation. However it is a kind of surgery with high technique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral

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

Impact of Anterior vs Posterior Approach for Total Hip Arthroplasty on Post-Acute Care Service Utilization.

PubMed

L'Hommedieu, Coles E; Gera, James J; Rupp, Gerald; Salin, Jeffery W; Cox, John S; Duwelius, Paul J

2016-09-01

Controversy exists as to which surgical approach is best for total hip arthroplasty (THA). Previous studies suggested that the tissue-sparing anterior approach should result in a more rapid recovery requiring fewer postacute services, ultimately decreasing overall episodic cost. The purpose of this cross-sectional study was to determine if any significant differences exist between the anterior vs posterior approaches on postacute care service utilization, readmissions, or episodic cost. Claims data from 26,773 Medicare fee-for-service beneficiaries receiving elective THAs (Medical Severity-Diagnosis Related Groups (MS-DRGs) 469/470) were analyzed. Claims data were collected from the 2-year period, January 2013 through December 2014. The posterior surgical approach was performed on 23,653 patients while 3120 patients received the anterior approach. Data analysis showed negligible effect sizes in postacute care service utilization, readmission rate, and cost between the surgical approaches for elective THA (MS-DRG 469 and 470). Average THA total episode cost was negligibly higher for procedures using the anterior approach compared to the posterior approach ($22,517 and $22,068, respectively). Statistically significant differences were observed in inpatient rehab and home health cost and service utilization. However, the effect sizes of these comparisons are negligible when accounting for the large sample size. All other comparisons showed minimal and statistically insignificant variation. The results indicate that surgical approach alone is not the primary driver of postacute care service utilization, quality outcomes, or cost. Other factors such as physician-led patient-focused care pathways, care coordination, rapid rehabilitation protocols, perioperative pain management protocols, and patient education are integral for effective patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

Iliotibial band syndrome following hip arthroscopy: An unreported complication.

PubMed

Seijas, Roberto; Sallent, Andrea; Galán, María; Alvarez-Diaz, Pedro; Ares, Oscar; Cugat, Ramón

2016-09-01

Hip arthroscopy is considered a safe procedure, considering the relatively low rate of complications. Despite several complications have been described following this surgical procedure, the present event has not yet been described. The purpose of the present study is to report an unpublished complication following hip arthroscopy, after reviewing 162 hip arthroscopies and finding iliotibial band syndrome (ITBS) in the knee during followup. A retrospective review of 162 hip arthroscopies performed between September 2007 and June 2011 was carried out, evaluating patients who presented ITBS during followup. Indication for hip arthroscopy was failure of conservative treatment in patients with symptomatic femoroacetabular impingement. During a minimum followup of 2 years, nine patients (5.5%) developed ITBS. All patients were diagnosed with ITBS within the first 45 postoperative days. Conservative treatment was successful in 6 patients while 3 had to undergo surgery. The increased internal rotation, synovitis and increased adduction of the hip can be attributed as predisposing factors to the development of ITBS. This is a newly described observation within followup of hip arthroscopy. These findings may help orthopedic surgeons when planning rehabilitation after hip arthroscopy, including stretching exercises to prevent this syndrome.

Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial

PubMed Central

Wall, Peter DH; Dickenson, Edward J; Robinson, David; Hughes, Ivor; Realpe, Alba; Hobson, Rachel; Griffin, Damian R; Foster, Nadine E

2016-01-01

Introduction Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. Methods In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. Results The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12–26 weeks in 6–10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. Conclusion PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). Trial registration number ISRCTN 09754699. PMID:27629405

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

Outcomes After Diagnostic Hip Injection.

PubMed

Lynch, T Sean; Steinhaus, Michael E; Popkin, Charles A; Ahmad, Christopher S; Rosneck, James

2016-08-01

To provide a comprehensive review of outcomes associated with local anesthetic (LA) or LA and corticosteroid (CS) diagnostic hip injections, and how well response predicts subsequent operative success. A systematic review from database (PubMed, Medline, Scopus, Embase) inception to January 2015 for English-language articles reporting primary patient outcomes data was performed, excluding studies with >50% underlying osteoarthritis. Studies were assessed by 2 reviewers who collected pertinent data. Seven studies were included, reporting on a total 337 patients undergoing diagnostic hip injection. The mean age was 34.4 years, with 5 studies reporting 94 (35.2%) males and 173 (64.8%) females. One study examined the rate of pain relief with LA (92.5%); 2 CS studies reported relief on a scale from 0% to 100% (no to complete relief), ranging from 61% to 82.3%; and 3 studies used 10-point pain scales, with a CS study noting a pain score of 1.0, an LA study with a score of 3.03, and 1 study using either CS or LA scores of 3 to 5.6. Duration of pain relief was 9.8 (CS) and 2.35 days (LA). By pathology, greatest relief was achieved in acetabular chondral injury (93.3%) and least in cam impingement (81.6%), with clinical and imaging findings being unreliable predictors of relief. One study showed nonresponse to be a strong predictor of negative surgical outcome for femoroacetabular impingement. Diagnostic hip injections provide substantial pain relief for patients with various hip pathologies, with limited data to suggest greatest relief for those with chondral injury. Clinical and imaging findings are unreliable predictors of injection response, and nonresponse to injection is a strong negative predictor of surgical outcome. Future research should focus on elucidating differences by underlying pathology and predicting future operative success. Level IV, systematic review. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights

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

Sex-Based Differences in the Clinical Presentation of Patients With Symptomatic Hip Labral Tears.

PubMed

Lindner, Dror; El Bitar, Youssef F; Jackson, Timothy J; Sadik, Adam Y; Stake, Christine E; Domb, Benjamin G

2014-06-01

An increasing body of literature describes the clinical presentation and demographics of patients with hip labral tears. The differences in pelvic structure and joint laxity between sexes have been described; however, no study has evaluated differences in the clinical presentation of patients with symptomatic labral tears between sexes. To describe the differences between sexes in demographics, clinical history, physical examination, and intraoperative findings in patients with symptomatic labral tears. Cohort study; Level of evidence, 3. Data were prospectively collected between February 2008 and February 2013 on 1401 patients who had symptomatic labral tears and underwent arthroscopic surgery. Hips with previous pathologic disorders were excluded. Data on demographics and clinical history were gathered, and a physical examination was performed. Preoperative pain was estimated on the visual analog scale (VAS), and 4 hip-specific patient-reported outcomes (PROs) were administered to evaluate functional status. Intraoperative findings were recorded. A total of 654 patients met our inclusion/exclusion criteria, with 320 males and 334 females. The median age for males was 38.3 years (range, 15.0-69.6 years) and for females 40.4 years (range, 13.1-66.8 years). Male patients had a higher incidence of acute injury than females (39.6% vs 27.6%, respectively; P < .05) and a higher incidence of workers' compensation status (14.1% vs 4.5%, respectively; P < .05). Females had increased range of motion compared with males, which was statistically significant for all range of motion measurements (P < .05). The anterior impingement test was positive in 94.4% of females and 92.9% of males, the flexion/abduction/external rotation test was positive in 59.5% of females and 61.5% of males, and the lateral impingement test was positive in 55.0% of females and 59.2% of males, but there was no statistically significant difference between sexes in any of the tests. Pain with palpation

Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

PubMed

Sakamoto, Junya; Manabe, Yoshitaka; Oyamada, Joichi; Kataoka, Hideki; Nakano, Jiro; Saiki, Kazunobu; Okamoto, Keishi; Tsurumoto, Toshiyuki; Okita, Minoru

2018-07-01

Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705-709, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

2016-01-01

Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task

Femoral head-neck junction deformity is related to osteoarthritis of the hip.

PubMed

Barros, Hilton José Melo; Camanho, Gilberto Luis; Bernabé, Antônio Carlos; Rodrigues, Marcelo Bordalo; Leme, Luiz Eugênio Garcez

2010-07-01

Primary or idiopathic osteoarthritis (OA) of the hip has increasingly been attributed to the presence of presumably minor femoral or acetabular deformities that are not routinely identified. The alpha angle reflects one such deformity of the femoral neck and reflects a risk for femoroacetabular impingement, which in turn reportedly is associated with OA. If impingement is in fact associated with OA, then one might expect the mean alpha angle to be greater in patients with presumed idiopathic hip OA. We therefore compared the alpha angle among a group of elderly patients with idiopathic OA with that in a control group of elderly individuals without OA. We measured the alpha angles in 50 individuals (72 hips) with a mean age of 70 years (range, 60-84 years) with apparently idiopathic OA and compared their angles with those from a control group of 56 individuals without OA. The alpha angle was measured by means of radiographs of their hips using the Dunn view at 45 degrees flexion. The patients with OA had a greater percentage with abnormal alpha angles than did the normal subjects: 82% versus 30%, respectively. The mean alpha angle in the group with OA was larger than in the control subjects: 66.4 masculine (range, 28 degrees -108 degrees ) versus 48.1 masculine (range, 34 degrees -68 degrees ). Hips with presumably idiopathic OA had more abnormalities at the femoral head-neck junction than did the control hips without OA and may relate to the risk of OA developing. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Hip and Groin Injuries in Baseball Players.

PubMed

Mlynarek, Ryan A; Coleman, Struan H

2018-03-01

To discuss the clinical significance of the most common hip and groin injuries in baseball players, as well as an algorithmic approach to diagnosis and treatment of these injuries. (a) Limitations in throwing velocity, pitch control, and bat swing speed may be secondary to decreased mobility and strength within the proximal kinetic chain, which must harness power from the lower extremities and core. (b) Approximately 5.5% of all baseball injuries per year involve the hip/groin and may lead to a significant amount of time spent on the disabled list. Injuries involving the hip and groin are relatively common in baseball players. Our knowledge of the mechanics of overhead throwing continues to evolve, as does our understanding of the contribution of power from the lower extremities and core. It is paramount that the team physician be able to accurately diagnose and treat injuries involving the hip/groin, as they may lead to significant disability and inability to return to elite levels of play. This review focuses on hip- and groin-related injuries in the baseball player, including femoroacetabular impingement, core muscle injury, and osteitis pubis.

Current Concepts in Hip Preservation Surgery

PubMed Central

Adler, Kelly L.; Cook, P. Christopher; Geisler, Paul R.; Yen, Yi-Meng; Giordano, Brian D.

2016-01-01

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction. PMID:26733593

Hip morphology in elite golfers: asymmetry between lead and trail hips.

PubMed

Dickenson, Edward; O'Connor, Philip; Robinson, Philip; Campbell, Robert; Ahmed, Imran; Fernandez, Miguel; Hawkes, Roger; Charles, Hutchinson; Griffin, Damian

2016-09-01

During a golf swing, the lead hip (left hip in a right-handed player) rotates rapidly from external to internal rotation, while the opposite occurs in the trail hip. This study assessed the morphology and pathology of golfers' hips comparing lead and trail hips. A cohort of elite golfers were invited to undergo MRI of their hips. Hip morphology was evaluated by measuring acetabular depth (pincer shape=negative measure), femoral neck antetorsion (retrotorsion=negative measure) and α angles (cam morphology defined as α angle >55° anteriorly) around the axis of the femoral neck. Consultant musculoskeletal radiologists determined the presence of intra-articular pathology. 55 players (mean age 28 years, 52 left hip lead) underwent MRI. No player had pincer morphology, 2 (3.6%) had femoral retrotorsion and 9 (16%) had cam morphology. 7 trail hips and 2 lead hips had cam morphology (p=0.026). Lead hip femoral neck antetorsion was 16.7° compared with 13.0° in the trail hip (p<0.001). The α angles around the femoral neck were significantly lower in the lead compared with trail hips (p<0.001), with the greatest difference noted in the anterosuperior portion of the head neck junction; 53° vs 58° (p<0.001) and 43° vs 47° (p<0.001). 37% of trail and 16% of lead hips (p=0.038) had labral tears. Golfers' lead and trail hips have different morphology. This is the first time side-to-side asymmetry of cam prevalence has been reported. The trail hip exhibited a higher prevalence of labral tears. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial.

PubMed

Wall, Peter Dh; Dickenson, Edward J; Robinson, David; Hughes, Ivor; Realpe, Alba; Hobson, Rachel; Griffin, Damian R; Foster, Nadine E

2016-10-01

Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). ISRCTN 09754699. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Intra- and extra-articular planes of reference for use in total hip arthroplasty: a preliminary study.

PubMed

Hausselle, Jerome; Moreau, Pierre Etienne; Wessely, Loic; de Thomasson, Emmanuel; Assi, Ayman; Parratte, Sebastien; Essig, Jerome; Skalli, Wafa

2012-08-01

Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference. Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens. Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°). Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP.

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.

Anterior delayed gadolinium-enhanced MRI of cartilage values predict joint failure after periacetabular osteotomy.

PubMed

Kim, Sang Do; Jessel, Rebecca; Zurakowski, David; Millis, Michael B; Kim, Young-Jo

2012-12-01

Several available compositional MRIs seem to detect early osteoarthritis before radiographic appearance. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) has been most frequently used in clinical studies and reportedly predicts premature joint failure in patients undergoing Bernese periacetabular osteotomies (PAOs). We asked, given regional variations in biochemical composition in dysplastic hips, whether the dGEMRIC index of the anterior joint would better predict premature joint failure after PAOs than the coronal dGEMRIC index as previously reported. We retrospectively reviewed 43 hips in 41 patients who underwent Bernese PAO for hip dysplasia. Thirty-seven hips had preserved joints after PAOs and six were deemed premature failures based on pain, joint space narrowing, or subsequent THA. We used dGEMRIC to determine regional variations in biochemical composition. Preoperative demographic and clinical outcome score, radiographic measures of osteoarthritis and severity of dysplasia, and dGEMRIC indexes from different hip regions were analyzed in a multivariable regression analysis to determine the best predictor of premature joint failure. Minimum followup was 24 months (mean, 32 months; range, 24-46 months). The two cohorts were similar in age and sex distribution. Severity of dysplasia was similar as measured by lateral center-edge, anterior center-edge, and Tönnis angles. Preoperative pain, joint space width, Tönnis grade, and coronal and sagittal dGEMRIC indexes differed between groups. The dGEMRIC index in the anterior weightbearing region of the hip was lower in the prematurely failed group and was the best predictor. Success of PAO depends on the amount of preoperative osteoarthritis. These degenerative changes are seen most commonly in the anterior joint. The dGEMRIC index of the anterior joint may better predict premature joint failure than radiographic measures of hip osteoarthritis and coronal dGEMRIC index. Level II, prognostic study. See

Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture.

PubMed

Hébert-Losier, Kim; Schelin, Lina; Tengman, Eva; Strong, Andrew; Häger, Charlotte K

2018-03-01

Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop-jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts. Subjects with unilateral ACL ruptures treated more than two decades ago (17-28years) conservatively with physiotherapy (ACL PT , n=26) or in combination with reconstructive surgery (ACL R , n=28) and healthy-knee controls (n=25) performed 40-cm drop-jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACL PT and ACL R vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods. Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACL R also showed less trunk flexion during Rebound. Between-leg differences were observed in ACL R only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACL R and ACL PT . However, compared to controls, deviations spanned a greater proportion of the drop-jump movement at the hip in ACL R and at the knee in ACL PT . Trunk and bilateral leg kinematics during double-leg drop-jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACL PT and ACL R compared to controls. Copyright © 2018 Elsevier B.V. All rights reserved.

The Horsens-Aarhus Femoro Acetabular Impingement (HAFAI) cohort: outcome of arthroscopic treatment for femoroacetabular impingement. Protocol for a prospective cohort study

PubMed Central

Kierkegaard, Signe; Lund, Bent; Dalgas, Ulrik; Sørensen, Henrik; Søballe, Kjeld; Mechlenburg, Inger

2015-01-01

Introduction During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. Methods and analysis In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and accelerometry. In addition, data on surgical procedure, rehabilitation progress, adverse events and failure will be recorded. Patients will be compared with an age-matched and gender-matched reference group of 30 persons with no hip, knee, ankle or back problems. Long-term follow-up of this cohort may evaluate possible reoperations and development of hip osteoarthritis. Furthermore, analysis on how subgroups respond to the treatment could be performed together with identification of possible “non-responders”. Ethics and dissemination The study is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-239-14). The results from this study will be presented at national and international congresses and published in peer-reviewed journals. Trial registration number NCT02306525. PMID:26346877

Numerical simulation of artificial hip joint motion based on human age factor

NASA Astrophysics Data System (ADS)

Ramdhani, Safarudin; Saputra, Eko; Jamari, J.

2018-05-01

Artificial hip joint is a prosthesis (synthetic body part) which usually consists of two or more components. Replacement of the hip joint due to the occurrence of arthritis, ordinarily patients aged or older. Numerical simulation models are used to observe the range of motion in the artificial hip joint, the range of motion of joints used as the basis of human age. Finite- element analysis (FEA) is used to calculate stress von mises in motion and observes a probability of prosthetic impingement. FEA uses a three-dimensional nonlinear model and considers the position variation of acetabular liner cups. The result of numerical simulation shows that FEA method can be used to analyze the performance calculation of the artificial hip joint at this time more accurate than conventional method.

Radiographic Evidence of Hip Microinstability in Elite Ballet.

PubMed

Mitchell, Ronald J; Gerrie, Brayden J; McCulloch, Patrick C; Murphy, Andrew J; Varner, Kevin E; Lintner, David M; Harris, Joshua D

2016-06-01

To determine prevalence, magnitude, and predisposing radiographic features of hip subluxation in elite ballet dancers. A cross-sectional investigation of professional male and female ballet dancers was performed using 5 plain radiographs. A "splits" anteroposterior (AP) radiograph was performed with legs abducted parallel to the trunk in the coronal plane (splits position; grand écart facial). Hip center position (HCP) was measured on standing AP pelvis and AP pelvis splits views and the difference calculated (subluxation distance) to determine prevalence and magnitude of femoral head subluxation. Student t test compared HCP on AP pelvis and splits radiographs. Pearson correlations were used to correlate splits HCP with radiographic measures of femoroacetabular impingement and dysplasia. Analyzing 47 dancers (21 men, 26 women; 23.8 ± 5.4 years), mean HCP on standing AP pelvis was 9.39 ± 3.33 mm versus 10.8 ± 2.92 mm on splits radiograph, with mean subluxation distance of 1.41 mm (P = .035). Forty-two dancers' femoral heads translated laterally with splits positioning, and 17 dancers (36%) exhibited a "vacuum sign" (bilateral in 71% of subjects with at least 1 hip vacuum sign). There was strong positive correlation (r = 0.461, P = .001) with splits HCP and alpha angle (Dunn 45°), and moderate negative correlation (r = -0.332, P = .022) with subluxation distance and neck-shaft angle. In men, splits HCP increased as lateral center edge angle (CEA) decreased (r = -0.437, P = .047), as anterior CEA decreased (r = -0.482, P = .027), as Tönnis angle increased (r = 0.656, P = .001), and as femoral head extrusion index increased (r = 0.511, P = .018). In women, there was moderate negative correlation (r = -0.389, P = .049) with subluxation distance and neck-shaft angle. Hip subluxation occurs during splits in most professional ballet dancers, with a significantly greater magnitude of subluxation in women than men. Subluxation magnitude

Using multidimensional topological data analysis to identify traits of hip osteoarthritis.

PubMed

Rossi-deVries, Jasmine; Pedoia, Valentina; Samaan, Michael A; Ferguson, Adam R; Souza, Richard B; Majumdar, Sharmila

2018-05-07

Osteoarthritis (OA) is a multifaceted disease with many variables affecting diagnosis and progression. Topological data analysis (TDA) is a state-of-the-art big data analytics tool that can combine all variables into multidimensional space. TDA is used to simultaneously analyze imaging and gait analysis techniques. To identify biochemical and biomechanical biomarkers able to classify different disease progression phenotypes in subjects with and without radiographic signs of hip OA. Longitudinal study for comparison of progressive and nonprogressive subjects. In all, 102 subjects with and without radiographic signs of hip osteoarthritis. 3T, SPGR 3D MAPSS T 1ρ /T 2 , intermediate-weighted fat-suppressed fast spin-echo (FSE). Multidimensional data analysis including cartilage composition, bone shape, Kellgren-Lawrence (KL) classification of osteoarthritis, scoring hip osteoarthritis with MRI (SHOMRI), hip disability and osteoarthritis outcome score (HOOS). Analysis done using TDA, Kolmogorov-Smirnov (KS) testing, and Benjamini-Hochberg to rank P-value results to correct for multiple comparisons. Subjects in the later stages of the disease had an increased SHOMRI score (P < 0.0001), increased KL (P = 0.0012), and older age (P < 0.0001). Subjects in the healthier group showed intact cartilage and less pain. Subjects found between these two groups had a range of symptoms. Analysis of this subgroup identified knee biomechanics (P < 0.0001) as an initial marker of the disease that is noticeable before the morphological progression and degeneration. Further analysis of an OA subgroup with femoroacetabular impingement (FAI) showed anterior labral tears to be the most significant marker (P = 0.0017) between those FAI subjects with and without OA symptoms. The data-driven analysis obtained with TDA proposes new phenotypes of these subjects that partially overlap with the radiographic-based classical disease status classification and also shows the

Prevalence of radiological findings related to femoroacetabular impingement in professional baseball players in Japan.

PubMed

Fukushima, Kensuke; Takahira, Naonobu; Imai, Sousuke; Yamazaki, Tetsuya; Kenmoku, Tomonori; Uchiyama, Katsufumi; Takaso, Masashi

2016-11-01

Femoroacetabular impingement (FAI) is a known patho-mechanism that causes hip pain and osteoarthritis (OA) and is considered uncommon in Japan, while secondary OA due to hip dysplasia is considered common. However, no studies have specifically targeted athletes in Japan and/or Asia. This study aimed to determine FAI prevalence using radiological findings among baseball players playing on a professional, Japanese team. We retrospectively assessed 63 plain anteroposterior (AP) hip radiographs (126 hips from 47 [74.6%] Asian players and 16 [25.3%] non-Asian players) obtained for medical evaluations. Radiographs were used to measure lateral center-edge (LCE) angle; acetabular roof obliquity (ARO); and the presence of crossover sign (COS), posterior wall sign (PWS), coxa profunda, pistol grip deformity, herniation pits, and labral ossification. Further, the prevalence of radiographic indicators related to FAI was compared between Asian and non-Asian players. In the 126 hips examined, 10 hips (7.94%) were classified as having hip dysplasia (LCE angles < 20°). Of the remaining 116 hips, eight (6.9%) had LCE angles > 40°, and 24 hips (20.7%) had AROs of <0°, indicating acetabular over-coverage. In Asian players, COS was identified in 47 hips (54.0%), positive PWS in 38 hips (43.7%), positive coxa profunda in 8 hips (9.2%), and pistol grip deformity in 37 hips (42.5%). Further, herniation pits and positive labral ossification were identified in 25 (28.7%) and 11 (12.6%) hips, respectively. A comparative review of COS prevalence (Asians vs. non-Asians) revealed that COS was significantly higher in Asian players. No differences were observed in the mean LCE angle, mean ARO, or other radiographic indicators. Radiological indicators related to FAI were identified in 76.6% (72/94 hips) of the Asian professional baseball players; this prevalence was considerably higher than that reported for general Asian populations. We consider that elite Asian athletes may frequently

Neurodynamic responses to the femoral slump test in patients with anterior knee pain syndrome.

PubMed

Lin, Pei-Ling; Shih, Yi-Fen; Chen, Wen-Yin; Ma, Hsiao-Li

2014-05-01

Matched-control, cross-sectional study. The purpose of this study was to compare the responses to the femoral slump test (FST), including the change in hip range of motion and level of discomfort, between subjects with and without anterior knee pain. Anterior knee pain syndrome is a common problem among adults. The FST is the neurodynamic test used to assess the mechanosensitivity of the femoral component of the nervous system. However, as of yet, there is no literature discussing the use of the FST in patients with anterior knee pain. Thirty patients with anterior knee pain and 30 control participants, matched by gender, age, and dominant leg, were recruited. The subjects received the FST, during which the hip extension angle and the location and intensity of pain/discomfort were recorded. Reproduction of symptoms that were alleviated by neck extension was interpreted as a positive test. Differences in hip extension angle and pain intensity between groups were examined using a 2-way, repeated-measures analysis of variance and a Kruskal-Wallis analysis. The level of significance was set at α = .05. Subjects with anterior knee pain had a smaller hip extension angle than that of controls (-3.6° ± 5.3° versus 0.6° ± 6.1°; mean difference, 4.2°; 95% confidence interval [CI]: 1.24°, 7.15°; P = .006). Eight patients with anterior knee pain showed a positive FST, and those with a positive FST had a smaller hip extension angle (-5.7° ± 4.5°) than that of controls (mean difference, 6.3°; 95% CI: 0.8°, 11.8°; P = .007). There was no difference in the hip extension angle between the positive and negative FST groups (mean difference, 2.9°; 95% CI: -8.5°, 2.0°) or between the negative FST and control groups (mean difference, 3.4°; 95% CI: -0.4°, 7.3°). Results of this study suggest that altered mechanosensitivity of the femoral nerve occurred in the patients with anterior knee pain who presented with a positive FST. The role of increased mechanosensitivity

Imaging of femoroacetabular impingement-current concepts

PubMed Central

Albers, Christoph E.; Wambeek, Nicholas; Hanke, Markus S.; Schmaranzer, Florian; Prosser, Gareth H.; Yates, Piers J.

2016-01-01

Following the recognition of femoroacetabular impingement (FAI) as a clinical entity, diagnostic tools have continuously evolved. While the diagnosis of FAI is primarily made based on the patients’ history and clinical examination, imaging of FAI is indispensable. Routine diagnostic work-up consists of a set of plain radiographs, magnetic resonance imaging (MRI) and MR-arthrography. Recent advances in MRI technology include biochemically sensitive sequences bearing the potential to detect degenerative changes of the hip joint at an early stage prior to their appearance on conventional imaging modalities. Computed tomography may serve as an adjunct. Advantages of CT include superior bone to soft tissue contrast, making CT applicable for image-guiding software tools that allow evaluation of the underlying dynamic mechanisms causing FAI. This article provides a summary of current concepts of imaging in FAI and a review of the literature on recent advances, and their application to clinical practice. PMID:29632685

Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years.

PubMed

Mardones, Rodrigo; Via, Alessio Giai; Rivera, Alvaro; Tomic, Alexander; Somarriva, Marcelo; Wainer, Mauricio; Camacho, Daniel

2016-01-01

The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2-9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series.

Planar dGEMRIC Maps May Aid Imaging Assessment of Cartilage Damage in Femoroacetabular Impingement.

PubMed

Bulat, Evgeny; Bixby, Sarah D; Siversson, Carl; Kalish, Leslie A; Warfield, Simon K; Kim, Young-Jo

2016-02-01

Three-dimensional (3-D) delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) helps quantify biochemical changes in articular cartilage that correlate with early-stage osteoarthritis. However, dGEMRIC analysis is performed slice by slice, limiting the potential of 3-D data to give an overall impression of cartilage biochemistry. We previously developed a computational algorithm to produce unfolded, or "planar," dGEMRIC maps of acetabular cartilage, but have neither assessed their application nor determined whether MRI-based grading of cartilage damage or dGEMRIC measurements predict intraoperative findings in hips with symptomatic femoroacetabular impingement (FAI). (1) Does imaging-based assessment of acetabular cartilage damage correlate with intraoperative findings in hips with symptomatic FAI? (2) Does the planar dGEMRIC map improve this correlation? (3) Does the planar map improve the correlation between the dGEMRIC index and MRI-based grading of cartilage damage in hips with symptomatic FAI? (4) Does the planar map improve imaging-based evaluation time for hips with symptomatic FAI? We retrospectively studied 47 hips of 45 patients with symptomatic FAI who underwent hip surgery between 2009 and 2013 and had a 1.5-T 3-D dGEMRIC scan within 6 months preoperatively. Our cohort included 25 males and 20 females with a mean ± SD age at surgery of 29 ± 11 years. Planar dGEMRIC maps were generated from isotropic, sagittal oblique TrueFISP and T1 sequences. A pediatric musculoskeletal radiologist with experience in hip MRI evaluated studies using radially reformatted sequences. For six acetabular subregions (anterior-peripheral [AP]; anterior-central [AC]; superior-peripheral [SP]; superior-central [SC]; posterior-peripheral [PP]; posterior-central [PC]), modified Outerbridge cartilage damage grades were recorded and region-of-interest T1 averages (the dGEMRIC index) were measured. Beck's intraoperative cartilage damage grades were compared with the Outerbridge

Internal Impingement of the Shoulder: A Risk of False Positive Test Outcomes in External Impingement Tests?

PubMed

Leschinger, Tim; Wallraff, Christopher; Müller, Dirk; Hackenbroch, Matthias; Bovenschulte, Henning; Siewe, Jan

2017-01-01

External impingement tests are considered as being particularly reliable for identifying subacromial and coracoid shoulder impingement mechanisms. The purpose of the present study was to evaluate if these tests are likely to provoke an internal shoulder impingement mechanism which, in cases of a pathologic condition, can lead to a positive test result. In 37 subjects, the mechanical contact between the glenoid rim and the rotator cuff (RC) was measured quantitatively and qualitatively in external impingement test positions using an open MRI system. Mechanical contact of the supraspinatus with the posterosuperior glenoid was present in 30 subjects in the Neer test. In the Hawkins test, the subscapularis was in contact with the anterosuperior glenoid in 33 subjects and the supraspinatus in 18. In the horizontal impingement test, anterosuperior contact of the supraspinatus with the glenoid was identified in 35 subjects. The Neer, Hawkins, and horizontal impingement tests are likely to provoke the mechanism of an internal shoulder impingement. A posterosuperior internal impingement mechanism is being provoked predominately in the Neer test. The Hawkins test narrows the distance between the insertions of the subscapularis and supraspinatus and the anterosuperior labrum, which leads to an anterosuperior impingement mechanism.

Ankle impingement syndromes.

PubMed

Umans, Hilary

2002-06-01

The term "ankle impingement" encompasses a broad range of conditions that are typically post-traumatic and often chronic. Various forms of mechanical impingement can result from synovial proliferation, bone spur formation, or ligamentous scarring and hypertrophy. Since symptoms and physical findings can mimic a variety of disorders, accurate diagnosis may remain elusive, and proper effective therapy may be delayed. The objective of this article is to define and elucidate the etiology of the various forms of ankle impingement, clarify the range of associated osseous and soft-tissue pathology, and describe the imaging features and therapeutic options.

The feasibility of conducting a randomised controlled trial comparing arthroscopic hip surgery to conservative care for patients with femoroacetabular impingement syndrome: the FASHIoN feasibility study.

PubMed

Griffin, D R; Dickenson, E J; Wall, P D H; Realpe, A; Adams, A; Parsons, N; Hobson, R; Achten, J; Costa, M L; Foster, N E; Hutchinson, C E; Petrou, S; Donovan, J L

2016-10-01

To determine whether it was feasible to perform a randomized controlled trial (RCT) comparing arthroscopic hip surgery to conservative care in patients with femoroacetabular impingement (FAI). This study had two phases: a pre-pilot and pilot RCT. In the pre-pilot, we conducted interviews with clinicians who treated FAI and with FAI patients to determine their views about an RCT. We developed protocols for operative and conservative care. In the pilot RCT, we determined the rates of patient eligibility, recruitment and retention, to investigate the feasibility of the protocol and we established methods to assess treatment fidelity. In the pre-pilot phase, 32 clinicians were interviewed, of which 26 reported theoretical equipoise, but in example scenarios 7 failed to show clinical equipoise. Eighteen patients treated for FAI were also interviewed, the majority of whom felt that surgery and conservative care were acceptable treatments. Surgery was viewed by patients as a 'definitive solution'. Patients were motivated to participate in research but were uncomfortable about randomization. Randomization was more acceptable if the alternative was available at the end of the trial. In the pilot phase, 151 patients were assessed for eligibility. Sixty were eligible and invited to take part in the pilot RCT; 42 consented to randomization. Follow-up was 100% at 12 months. Assessments of treatment fidelity were satisfactory. An RCT to compare arthroscopic hip surgery with conservative care in patients with FAI is challenging but feasible. Recruitment has started for a full RCT.

What is the learning curve for the anterior approach for total hip arthroplasty?

PubMed

de Steiger, Richard Noel; Lorimer, Michelle; Solomon, Michael

2015-12-01

There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon's individual learning curve when using this approach. (1) What was the revision rate for all surgeons adopting the anterior approach for placement of a particular implant? (2) What was the revision rate for surgeons who performed > 100 cases in this fashion? (3) Is there a minimum number of cases required to complete a learning curve for this procedure? The Australian Orthopaedic Association National Joint Replacement Registry prospectively collects data on all primary and revision joint arthroplasty surgery. We analyzed all conventional THAs performed up to December 31, 2013, with a primary diagnosis of osteoarthritis using a specific implant combination and secondarily those associated with surgeons performing more than 100 procedures. Ninety-five percent of these procedures were performed through the direct anterior approach. Procedures using this combination were ordered from earliest (first procedure date) to latest (last procedure date) for each individual surgeon. Using the order number for each surgeon, five operation groups were defined: one to 15 operations, 16 to 30 operations, 31 to 50 operations, 51 to 100 operations, and > 100 operations. The primary outcome measure was time to first revision using Kaplan-Meier estimates of survivorship. Sixty-eight surgeons performed 5499 THAs using the specified implant combination. The cumulative percent revision at 4 years for all 68 surgeons was 3% (95% confidence interval [CI], 2.5-3.8). For surgeons who had performed over 100 operations, the cumulative revision rate was 3% (95% CI, 2.0-3.5). It was not until surgeons had performed over 50 operations that there was no difference in the cumulative percent revision compared with over 100

Posttraumatic impingement syndrome of the ankle--indication and results of arthroscopic therapy.

PubMed

Arnold, Heino

2011-06-01

Persisting pain after an ankle sprain is often caused by the development of intraarticular fibrous scars or even tibiotalar spurs due to repetitive trauma. This may result in a posttraumatic impingement syndrome of the ankle. Pain is typically provoked by dorsiflexion of the ankle and palpation of the tibiotalar anterior joint space. The study evaluates the outcome of arthroscopic treatment of the ankle impingement syndrome. 32 patients are included (16-65 years, mean age 38 years) who underwent an arthroscopic operation because of an impingement syndrome of the ankle grades I-III (Scranton) due to a trauma without therapeutic response to conservative therapy over 3 months. Diagnostic criteria were palpatoric anterior ankle joint pain and pain provoked by dorsiflexion, in cases of grades II and III lesions spurs on the X-ray as well. The mean follow-up time was 49 months. The evaluation of the results was done with the West Point Ankle Score. The study is designed as a retrospective case series. 26 patients reached more than 80 points in the West Point Ankle Score corresponding to a good or excellent result (mean result 86 points, ranging from 80 to 98 points). The preoperative mean score reached up to 64 points overall (57-70). Five patients rated the postoperative result fair, one bad with 73 points at mean (62-78). Preoperatively they reached 56 point on an average (48-62). The fair and the poor results were associated with severe ankle sprain leading to ligament ruptures or fractures where severe chondral lesions were to be found with arthroscopy. The results of the study show that ankle arthroscopy with resection of hypertrophic synovium and fibrous bands (type I) or tibial spurs (types II and III injuries) after an ankle sprain haven proven to be a reliable therapy for a posttraumatic impingement syndrome of the ankle that does not respond to conservative treatment. It is characterized by low morbidity and good to excellent results in most cases. The outcome

The Horsens-Aarhus Femoro Acetabular Impingement (HAFAI) cohort: outcome of arthroscopic treatment for femoroacetabular impingement. Protocol for a prospective cohort study.

PubMed

Kierkegaard, Signe; Lund, Bent; Dalgas, Ulrik; Sørensen, Henrik; Søballe, Kjeld; Mechlenburg, Inger

2015-09-07

During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and accelerometry. In addition, data on surgical procedure, rehabilitation progress, adverse events and failure will be recorded. Patients will be compared with an age-matched and gender-matched reference group of 30 persons with no hip, knee, ankle or back problems. Long-term follow-up of this cohort may evaluate possible reoperations and development of hip osteoarthritis. Furthermore, analysis on how subgroups respond to the treatment could be performed together with identification of possible "non-responders". The study is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-239-14). The results from this study will be presented at national and international congresses and published in peer-reviewed journals. NCT02306525. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Are Self-Reported Medication Allergies Associated With Worse Hip Outcome Scores Prior to Hip Arthroscopy?

PubMed

Sochacki, Kyle R; Jack, Robert A; Bekhradi, Arya; Delgado, Domenica; McCulloch, Patrick C; Harris, Joshua D

2018-06-01

To determine if there are significant differences in preoperative patient-reported outcome (PRO) scores in patients with and without self-reported medication allergies undergoing hip arthroscopy. Consecutive subjects undergoing hip arthroscopy for femoroacetabular impingement (FAI) syndrome by a single surgeon were retrospectively reviewed. PROs were collected within 6 weeks of the date of surgery. PROs included International Hip Outcome Tool (iHOT-12), Hip Outcome Score (HOS), and Short-Form (SF-12) scores. Allergies to medications were self-reported preoperatively within 6 weeks of the date of surgery. Patient demographics were recorded. Bivariate correlations and multivariate regression models were calculated to identify associations with baseline hip outcome scores. Two hundred twelve subjects were analyzed (56% female, mean age 35.1 ± 13.2 years). Seventy-two subjects (34%) self-reported allergies (range 1-10; 41 subjects had 1 allergy; 14 subjects had 2; 8 subjects had 3; 2 subjects had 4; 7 subjects had 5 or more). The most commonly reported allergies included penicillin (18), sulfa (13), and codeine (11). Female gender was significantly correlated with number of allergies (Pearson correlation coefficient, 0.188; P < .001). SF-12 Mental Component Score (MCS) was significantly correlated with HOS-ADL (Pearson correlation coefficient, 0.389; P < .001), HOS-SSS (Pearson correlation coefficient, 0.251; P < .001), and iHOT-12 (Pearson correlation coefficient, 0.385; P < .001). There was no significant correlation between number of allergies and all hip PROs. In all multivariate models, the SF-12 MCS had the strongest association with HOS-ADL, HOS-SSS, and iHOT-12 (P < .001 for all). Allergies were not significantly associated with any hip PROs. In patients undergoing hip arthroscopy for FAI syndrome, self-reported medication allergies are not significantly associated with preoperative patient-reported hip outcome scores. Level III, retrospective comparative

Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

PubMed

Nistor, Dan-Viorel; Caterev, Sergiu; Bolboacă, Sorana-Daniela; Cosma, Dan; Lucaciu, Dan Osvald Gheorghe; Todor, Adrian

2017-11-01

We conducted this study to establish if the transition from a lateral approach (LA) to the direct anterior approach (DAA) for a low volume hip arthroplasty surgeon during the steep learning curve can be performed maintaining the muscle sparing approach of the DAA without increasing the complication rates. In this controlled, prospective, randomized clinical study we investigated 70 patients (35 DAA, 35 LA) with similar demographics that underwent a total hip arthroplasty. Assessment of the two approaches consisted of determining the invasiveness through serum markers for muscle damage (i.e. myoglobin, creatine kinase and lactate dehydrogenase), the operative parameters such as post-operative pain and rescue medication consumption, the component positioning and complication rates. Post-operative myoglobin levels were higher (p < 0.001) in the LA group (326.42 ± 84.91 ng/mL) as compared to the DAA group (242.80 ± 71.03 ng/mL), but with no differences regarding other biomarkers for muscle damage. Pain levels were overall lower in the DAA group, with a statistical and clinical difference during surgery day (p < 0.001) associated with lower (p < 0.001) rescue medication consumption (median 1 (1; 3) mg morphine vs. 3 (2; 4) mg morphine). Most patients in the LA group reported chronic post-operative pain throughout all three evaluated months, while the majority of patients in the DAA group reported no pain after week six. Component positioning did not differ significantly between groups and neither did complication rates. The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

Vibratory sense deficits in patients with symptomatic femoroacetabular impingement

PubMed Central

Farkas, G.J.; Shakoor, N.; Cvetanovich, G.L.; Fogg, L.F.; Orías, A.A. Espinoza; Nho, S.J.

2016-01-01

Objective: Sensory deficits, measured through vibratory perception threshold (VPT), have been recognized in hip and knee osteoarthritis (OA), but have not been evaluated in femoroacetabular impingement (FAI), thought to be a pre-OA condition. This study aimed to assess VPT in symptomatic FAI pre- and 6-months post-arthroscopy vs. controls. Methods: FAI patients and controls were assessed for VPT at the first metatarsophalangeal joint. Pain was assessed using a visual analog pain scale. FAI participants were evaluated again 6-months after surgery for FAI. Differences between groups and pre- and post- surgery were evaluated with independent and paired sample t-tests, respectively. Secondary analysis was performed using repeated-measures ANOVA to evaluate the effect of pain and time since surgery on VPT pre- and post-operatively. Results: No differences in age and BMI were seen between groups (p>0.05). Reduced VPT (higher value is worse) was evident in the pre- (8.0±3.9V, t=2.81, p=0.009) and post-operative (6.8±2.8V, t=2.34, p=0.027) patients compared to controls (4.7±1.3V). After hip arthroscopy, there was a trend toward improved VPT (t=1.97, p=0.068). Preoperative and 6-months postoperative pain and time since surgery were not found to influence VPT (F-ratio≥0.00, p≥0.427). Conclusion: Sensory deficits were observed in FAI patients both before and 6-months after hip arthroscopy. PMID:26944822

The validity and accuracy of MRI arthrogram in the assessment of painful articular disorders of the hip.

PubMed

Rajeev, Aysha; Tuinebreijer, Wim; Mohamed, Abdalla; Newby, Mike

2018-01-01

The assessment of a patient with chronic hip pain can be challenging. The differential diagnosis of intra-articular pathology causing hip pain can be diverse. These includes conditions such as osteoarthritis, fracture, and avascular necrosis, synovitis, loose bodies, labral tears, articular pathology and, femoro-acetabular impingement. Magnetic resonance imaging (MRI) arthrography of the hip has been widely used now for diagnosis of articular pathology of the hip. A retrospective analysis of 113 patients who had MRI arthrogram and who underwent hip arthroscopy was included in the study. The MRI arthrogram was performed using gadolinium injection and reported by a single radiologist. The findings were then compared to that found on arthroscopy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated for each pathology. Labral tear-sensitivity 84% (74.3-90.5), specificity 64% (40.7-82.8), PPV 91% (82.1-95.8), NPV 48% (29.5-67.5), accuracy 80%. Delamination -sensitivity 7% (0.8-22.1), specificity 98% (91.6-99.7), PPV 50% (6.8-93.2), NPV 74% (65.1-82.2) and accuracy 39%. Chondral changes-sensitivity 25% (13.3-38.9), specificity 83% (71.3-91.1), PPV 52% (30.6-73.2), NPV 59% (48.0-69.2) and accuracy 58%. Femoro-acetabular impingement (CAM deformity)-sensitivity 34% (19.6-51.4), specificity 83% (72.2-90.4), PPV 50% (29.9-70.1), NPV 71% (60.6-80.5) and accuracy 66%. Synovitis-sensitivity 11% (2.3-28.2), specificity 99% (93.6-100), PPV 75% (19.4-99.4), NPV 77% (68.1-84.6) and accuracy 77%. Our study conclusions are MRI arthrogram is a useful investigation tool in detecting labral tears, it is also helpful in the diagnosis of femoro-acetabular impingement. However, when it comes to the diagnosis of chondral changes, defects and cartilage delamination, the sensitivity and accuracy are low.

Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review.

PubMed

Pacheco-Carrillo, Aitana; Medina-Porqueres, Ivan

2016-09-01

Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy. To summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI. A search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. The systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion-Abduction-External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI. The diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area. Copyright © 2016 Elsevier Ltd. All rights reserved.

In vitro validation and reliability study of electromagnetic skin sensors for evaluation of end range of motion positions of the hip.

PubMed

Audenaert, E A; Vigneron, L; Van Hoof, T; D'Herde, K; van Maele, G; Oosterlinck, D; Pattyn, C

2011-12-01

There is growing evidence that femoroacetabular impingement (FAI) is a probable risk factor for the development of early osteoarthritis in the nondysplastic hip. As FAI arises with end range of motion activities, measurement errors related to skin movement might be higher than anticipated when using previously reported methods for kinematic evaluation of the hip. We performed an in vitro validation and reliability study of a noninvasive method to define pelvic and femur positions in end range of motion activities of the hip using an electromagnetic tracking device. Motion data, collected from sensors attached to the bone and skin of 11 cadaver hips, were simultaneously obtained and compared in a global reference frame. Motion data were then transposed in the hip joint local coordinate systems. Observer-related variability in locating the anatomical landmarks required to define the local coordinate system and variability of determining the hip joint center was evaluated. Angular root mean square (RMS) differences between the bony and skin sensors averaged 3.2° (SD 3.5°) and 1.8° (SD 2.3°) in the global reference frame for the femur and pelvic sensors, respectively. Angular RMS differences between the bony and skin sensors in the hip joint local coordinate systems ranged at end range of motion and dependent on the motion under investigation from 1.91 to 5.81°. The presented protocol for evaluation of hip motion seems to be suited for the 3-D description of motion relevant to the experimental and clinical evaluation of femoroacetabular impingement.

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

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.

Cam and Pincer Type of Femoroacetabular Impingement.

PubMed

Ersoy, Hale; Trane, R Nicholas; Pomeranz, Stephen J

Femoroacetabular impingement (FAI) has gained considerable attention for the past 20 years and has been accepted as a predisposing factor for early osteoarthritis in young patients, particularly in the population participating in sports. Patients with FAI typically present with deep, intermittent groin discomfort during or after activities involving repetitive or persistent hip flexion. Symptomatic improvement can be achieved from arthroscopic debridement of unstable cartilage flaps, shaving of cartilage irregularities, and surgical correction of deformity of the femoral head\\endash neck junction. Early and correct diagnosis of FAI has paramount importance for appropriate and timely management of the disorder before the development of osteoarthritis. Magnetic resonance (MR) imaging offers a noninvasive means of assessing the degree of damage to cartilage and adjacent labrum and bone and also evaluating the effectiveness of treatment. This article describes the morphologic types of FAI with emphasis on MR findings.

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.

The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

PubMed

Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G

2017-02-01

Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Improved Arthroscopic Visualization of Peripheral Compartment

PubMed Central

Suslak, Adam G.; Mather, Richard C.; Kelly, Bryan T.; Nho, Shane J.

2012-01-01

Femoroacetabular impingement is a recognized cause of hip pain and motion restrictions. Advancements in hip arthroscopy have allowed surgeons the ability to treat this condition more effectively. However, the learning curve is steep for osteochondroplasty of the femoral head-neck junction in the peripheral compartment. Therefore we present a reproducible technique that allows improved visualization of the peripheral compartment and treatment of the cam lesion with hip arthroscopy. Our technique uses the anterior portal as a viewing portal, a distal anterolateral accessory portal as a working portal, and the anterolateral portal for soft-tissue retraction. PMID:23766977

Hip morphologic measurements in an Egyptian population.

PubMed

Aly, Tarek A

2011-04-11

The study of acetabular morphology has shown that there are geographic differences in the morphology and prevalence of acetabular dysplasia among different ethnic groups. However, few data exist on the shape of the acetabulum in various populations around the world. In this study, we examined samples of pelvic radiographs from Egyptian adults. Acetabular dysplasia in adults is characterized by a shallow and relatively vertical acetabulum.The aim of this study was to examine acetabular morphology to determine the prevalence of hip dysplasia in adult Egyptians. This included 244 adults, 134 men and 110 women between 18 and 60 years, who were used to measure center edge angle, acetabular Sharp angle, acetabular head index on anteroposterior radiographic views of the hip joints, and vertical center anterior margin angle on false profile views. The radiographs were taken of patients with no hip complaints at Tanta University Hospital.The results were statistically studied according to the age, height, and weight of patients. The prevalence of acetabular dysplasia was 2.25% for Egyptian men and 3.6% for women with respect to center edge angles, vertical center anterior margin angle, and acetabular head index.We concluded that gender variations in the morphology of the acetabulum and sex influences geometrical measurements of the acetabulum. Egyptian women were more dysplastic than men using the 4 parameters of hip measurements. There are also racial variations in hip morphology. Copyright 2011, SLACK Incorporated.

Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report.

PubMed

MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D'Angelo, Kevin

2015-12-01

To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury.

The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury.

PubMed

Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2010-12-01

Greater total energy absorption by the lower extremity musculature during landing may reduce stresses placed on capsuloligamentous tissues with differences in joint contributions to energy absorption potentially affecting anterior cruciate ligament injury risk. However, the relationships between energy absorption and prospectively identified biomechanical factors associated with non-contact anterior cruciate ligament injury have yet to be demonstrated. Sagittal plane total, hip, knee and ankle energy absorption, and peak vertical ground reaction force, anterior tibial shear force, knee flexion and knee valgus angles, and internal hip extension and knee varus moments were measured in 27 individuals (14 females, 13 males) performing double leg jump landings. Correlation coefficients assessed the relationships between energy absorption during three time intervals (initial impact phase, terminal phase, and total landing) and biomechanical factors related to anterior cruciate ligament injury. More favorable values of biomechanical factors related to non-contact anterior cruciate ligament injury were associated with: 1) Lesser total (R(2)=0.178-0.558), hip (R(2)=0.229-0.651) and ankle (R(2)=0.280), but greater knee (R(2)=0.147) energy absorption during the initial impact phase; 2) Greater total (R(2)=0.170-0.845), hip (R(2)=0.599), knee (R(2)=0.236-0.834), and ankle (R(2)=0.276) energy absorption during the terminal phase of landing; and 3) Greater knee (R(2)=0.158-0.709), but lesser hip (R(2)=0.309) and ankle (R(2)=0.210-0.319) energy absorption during the total landing period. These results suggest that biomechanical factors related to anterior cruciate ligament injury are influenced by both the magnitude and timing of lower extremity energy absorption during landing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Anterior Impingement Syndrome of the Ankle Caused by Osteoid Osteoma in the Talar Neck Treated with Arthroscopy and 3D C-Arm-Based Imaging.

PubMed

Ikegami, Masachika; Matsumoto, Takumi; Chang, Song Ho; Kobayashi, Hiroshi; Shinoda, Yusuke; Tanaka, Sakae

2017-01-01

Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging.

On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement.

PubMed

Tramer, Joseph S; Deneweth, Jessica M; Whiteside, David; Ross, James R; Bedi, Asheesh; Goulet, Grant C

2015-01-01

Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown. The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. Clinical research. Level 5. An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements. Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°). On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is

Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging.

PubMed

Kolo, Frank C; Charbonnier, Caecilia; Pfirrmann, Christian W A; Duc, Sylvain R; Lubbeke, Anne; Duthon, Victoria B; Magnenat-Thalmann, Nadia; Hoffmeyer, Pierre; Menetrey, Jacques; Becker, Christoph D

2013-05-01

To determine the prevalence of femoroacetabular impingement (FAI) of the cam or pincer type based on magnetic resonance imaging (MRI) in a group of adult female professional ballet dancers, and to quantify, in vivo, the range of motion (ROM) and congruence of the hip joint in the splits position. Institutional review board approval and informed consent from each volunteer were obtained. Thirty symptomatic or asymptomatic adult female professional ballet dancers (59 hips) and 14 asymptomatic non-dancer adult women (28 hips, control group) were included in the present study. All subjects underwent MRI in the supine position, while, for the dancers, additional images were acquired in the splits position. Labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim were assessed at six positions around the acetabulum. A morphological analysis, consisting of the measurement of the α angle, acetabular depth, and acetabular version, was performed. For the dancers, ROM and congruency of the hip joint in the splits position were measured. Acetabular cartilage lesions greater than 5 mm were significantly more frequent in dancer's hips than in control hips (28.8 vs 7.1%, p = 0.026), and were mostly present at the superior position in dancers. Distribution of labral lesions between the dancers and the control group showed substantially more pronounced labral lesions at the superior, posterosuperior, and anterosuperior positions in dancers (54 lesions in 28 dancer's hips vs 10 lesions in 8 control hips). Herniation pits were found significantly more often (p = 0.002) in dancer's hips (n = 31, 52.5%), 25 of them being located in a superior position. A cam-type morphology was found for one dancer and a retroverted hip was noted for one control. Femoroacetabular subluxations were observed in the splits position (mean: 2.05 mm). The prevalence of typical FAI of the cam or pincer type was low in this selected population of professional ballet

Reasons for and functional results of repeated hip arthroscopy: A continuous prospective study of 17 revisions out of 295 primary hip arthroscopies at mean 28months' follow-up.

PubMed

Tissot, C; Merlini, L; Mercier, M; Bonin, N

2017-09-01

The rate of iterative arthroscopy has been increasing over the last decade as the technique has grown. The results of and reasons for these revision procedures, however, are not exactly known. We therefore conducted a prospective study to shed light on: 1) functional results and patient satisfaction following repeated arthroscopy, and 2) the relevant indications. Functional scores and patient satisfaction increase following repeated arthroscopy. MATERIALS AND METHOD: A single-center continuous prospective study without control group included patients undergoing repeated hip arthroscopy between September 2010 and September 2014, with a mean 28months' follow-up (median, 23.3months; range, 12-62months). Preoperative and follow-up functional assessment used the modified Harris hip, WOMAC and Christensen (NHAS) questionnaires, and a satisfaction scale. On etiological analysis, repeated arthroscopy was indicated if a cause of recurrent or persistent pain accessible to arthroscopic treatment was identified. Seventeen patients were included out of 295 primary arthroscopies (5.7%): 9 male, 8 female; median age, 29.6years (range, 16-48years). Indications for primary arthroscopy comprised 13 cases of femoroacetabular impingement, 3 labrum lesions with instability, 1 chondromatosis and 1 case of osteoarthritis. Eleven of the 17 primary lesions showed persistence, including 9 of the 13 cases of femoroacetabular impingement. There were 3 failures in 17 repeated arthroscopies. All functional scores improved, with a gain of 7 points (P<0.06) on modified Harris hip score, 25 points (P<0.0006) on WOMAC score, and 27 points (P<0.001) on NHAS score. Ten of the 17 patients were satisfied or very satisfied with the repeated arthroscopy (59%). Although less good than on primary arthroscopy, functional results on repeated hip arthroscopy were satisfactory in the short term. The main reason for repeated arthroscopy was persistence of initial abnormality due to insufficient treatment

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

Radiographic evidence of femoroacetabular impingement in athletes with athletic pubalgia.

PubMed

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

2014-03-01

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. We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI. Case series. Level 4. 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. 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. The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia. Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI.

Changes in Gait with Anteriorly Added Mass: A Pregnancy Simulation Study

PubMed Central

Ogamba, Maureen I.; Loverro, Kari L.; Laudicina, Natalie M.; Gill, Simone V.; Lewis, Cara L.

2016-01-01

During pregnancy, the female body experiences structural changes, such as weight gain. As pregnancy advances, most of the additional mass is concentrated anteriorly on the lower trunk. The purpose of this study is to analyze kinematic and kinetic changes when load is added anteriorly to the trunk, simulating a physical change experienced during pregnancy. Twenty healthy females walked on a treadmill while wearing a custom made pseudo-pregnancy sac (1 kg) under three load conditions: sac only, 10 pound condition (4.535 kg added anteriorly), and 20 pound condition (9.07 kg added anteriorly), used to simulate pregnancy, in the second trimester and at full term pregnancy, respectively. The increase in anterior mass resulted in kinematic changes at the knee, hip, pelvis, and trunk in the sagittal and frontal planes. Additionally, ankle, knee, and hip joint moments normalized to baseline mass increased with increased load; however, these moments decreased when normalized to total mass. These kinematic and kinetic changes may suggest that women modify gait biomechanics to reduce the effect of added load. Furthermore, the increase in joint moments increases stress on the musculoskeletal system and may contribute to musculoskeletal pain. PMID:26958743

Which is the most useful patient-reported outcome in femoroacetabular impingement? Test-retest reliability of six questionnaires.

PubMed

Hinman, Rana S; Dobson, Fiona; Takla, Amir; O'Donnell, John; Bennell, Kim L

2014-03-01

The most reliable patient-reported outcomes (PROs) for people with femoroacetabular impingement (FAI) is unknown because there have been no direct comparisons of questionnaires. Thus, the aim was to evaluate the test-retest reliability of six existing PROs in a single cohort of young active people with hip/groin pain consistent with a clinical diagnosis of FAI. Young adults with clinical FAI completed six PRO questionnaires on two occasions, 1-2 weeks apart. The PROs were modified Harris Hip Score, Hip dysfunction and Osteoarthritis Score, Hip Outcome Score, Non-Arthritic Hip Score, International Hip Outcome Tool, Copenhagen Hip and Groin Outcome Score. 30 young adults (mean age 24 years, SD 4 years, range 18-30 years; 15 men) with stable symptoms participated. Intraclass correlation coefficient(3,1) values ranged from 0.73 to 0.93 (95% CI 0.38 to 0.98) indicating that most questionnaires reached minimal reliability benchmarks. Measurement error at the individual level was quite large for most questionnaires (minimal detectable change (MDC95) 12.4-35.6, 95% CI 8.7 to 54.0). In contrast, measurement error at the group level was quite small for most questionnaires (MDC95 2.2-7.3, 95% CI 1.6 to 11). The majority of the questionnaires were reliable and precise enough for use at the group level. Samples of only 23-30 individuals were required to achieve acceptable measurement variation at the group level. Further direct comparisons of these questionnaires are required to assess other measurement properties such as validity, responsiveness and meaningful change in young people with FAI.

Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1,476 patients 1-3 years after surgery.

PubMed

Amlie, Einar; Havelin, Leif I; Furnes, Ove; Baste, Valborg; Nordsletten, Lars; Hovik, Oystein; Dimmen, Sigbjorn

2014-09-01

The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach. 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1-3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis. Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2-5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001). Patients operated with the lateral approach reported worse outcomes 1-3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach.

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

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.

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.

Case report: Osteonecrosis of the femoral head after hip arthroscopy.

PubMed

Scher, Danielle L; Belmont, Philip J; Owens, Brett D

2010-11-01

Hip arthroscopy is a common orthopaedic procedure used as a diagnostic and therapeutic tool with a multitude of surgical indications. The complication rate is reportedly between 1.3% and 23.3%. Major complications are related to traction, fluid extravasation, and iatrogenic chondral injury. Although osteonecrosis is a concern with any surgical procedure about the hip, this complication has been primarily a theoretical concern with hip arthroscopy. We report the case of a 24-year-old man who presented with a 2-year history of left hip pain. He underwent hip arthroscopy to include débridement of a torn labrum and removal of a prominent pincer lesion for femoroacetabular impingement. Traction was initiated by applying manual traction to the traction bar until 10 mm of joint distraction was obtained. Traction was removed at 90 minutes. At the 3-month followup, MRI showed osteonecrosis in the subcapital region of the left femoral head. It generally is agreed the magnitude and duration of traction during hip arthroscopy increase the risk of traction-related injuries. Only one previous case of femoral head osteonecrosis associated with hip arthroscopy has been reported, and this may have resulted from the initial traumatic event. Based on anatomic studies, the use of standard arthroscopic portals would not put at risk any dominant normal vascular structures supplying the femoral head. In contrast, the literature shows that femoral head osteonecrosis may develop secondary to a combination of increased intraarticular pressure and traction. We suspect this case of femoral head osteonecrosis after hip arthroscopy was caused by traction used in the procedure.

Clinical Rating of Movement-Pattern Quality in Patients With Femoroacetabular Impingement Syndrome: A Methodological Study.

PubMed

Casartelli, Nicola C; Maffiuletti, Nicola A; Brunner, Romana; Büchi, Marcel; Sutter, Reto; Pfirrmann, Christian W; Naal, Florian D; Leunig, Michael; Bizzini, Mario

2018-04-01

Study Design Cross-sectional study. Objectives To evaluate intrarater and interrater agreement among physical therapists with different clinical experience in performing a visual rating of movement-pattern quality of patients with femoroacetabular impingement (FAI) syndrome using a semi-quantitative scale. Background Visual rating of movement patterns in patients with FAI syndrome is of interest, because poor control of dynamic hip motion is frequently noted. Methods A video camera was used to record the performance of 34 patients with FAI syndrome performing single-limb standing, squat, frontal lunge, hop lunge, bridge, and plank. Visual rating of movement, as recorded on video, was performed by a highly experienced, a moderately experienced, and a novice physical therapist on 2 occasions using a semi-quantitative scale. Hip abductor strength was assessed using dynamometry, and hip pain and function were assessed with a patient-reported questionnaire. Intrarater and interrater agreement among physical therapists was evaluated using Gwet's agreement coefficient 1. Construct validity was evaluated as the association between physical therapists' rating and patients' hip abductor strength, pain, and function. Results Good intrarater and interrater agreement was observed in the highly experienced and moderately experienced physical therapists when rating single-limb standing, bridge, and plank. Poor to moderate intrarater and interrater agreement was found when they rated squat, frontal lunge, and hop lunge. Poor performers, as rated by the highly experienced physical therapist only, demonstrated lower hip abductor strength (P<.05), and similar hip pain and hip function compared to those of good performers. Conclusion Movement-pattern quality of patients with FAI syndrome should be rated by a highly experienced physical therapist. J Orthop Sports Phys Ther 2018;48(4):260-269. doi:10.2519/jospt.2018.7840.

Effects of trunk-hip strengthening on standing in children with spastic diplegia: a comparative pilot study.

PubMed

Kim, Joong-Hwi; Seo, Hye-Jung

2015-05-01

[Purpose] This study evaluated the effects of trunk-hip strengthening exercise on trunk-hip activation and pelvic tilt motion during standing in children with spastic diplegia and compared the improvement of pelvic tilt between the modified trunk-hip strengthening exercise and conventional exercise. [Subjects and Methods] Ten ambulant children with spastic diplegia were randomized to the modified trunk-hip strengthening exercise (n = 5) or conventional exercise (n = 5) group. The intervention consisted of a 6-week modified trunk-hip strengthening exercise 3 times per week. The children were tested for trunk-hip muscles activation and pelvic tilt motion during standing by surface electromyography and an inclinometer before and after the intervention. [Results] The anterior pelvic tilt angle and activation of the extensor spinae, rectus femoris, and semitendinosus during standing decreased significantly in the modified exercise group. The activation of extensor spinae differed significantly between groups. [Conclusion] Compared to the conventional exercise, the modified exercise was more effective for trunk-hip activation improvement and anterior pelvic tilt motion decrease during standing in children with spastic diplegia. We suggest clinicians use an individually tailored modified trunk-hip strengthening exercise for strengthening the weakest muscle groups in children with standing ability problems.

Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review.

PubMed

Sardana, Vandit; Philippon, Marc J; de Sa, Darren; Bedi, Asheesh; Ye, Lily; Simunovic, Nicole; Ayeni, Olufemi R

2015-10-01

To identify the indications and outcomes in patients undergoing revision hip arthroscopy. The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 hips examined. The most common indications for revision hip arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision hip arthroscopy (8.0%), total hip replacement (5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision hip arthroscopy (59.7%). The current evidence examined in this review supports revision hip arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary hip arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation surgery because revisions tended to occur within this

IMU-based Real-time Pose Measurement system for Anterior Pelvic Plane in Total Hip Replacement Surgeries.

PubMed

Zhe Cao; Shaojie Su; Hao Tang; Yixin Zhou; Zhihua Wang; Hong Chen

2017-07-01

With the aging of population, the number of Total Hip Replacement Surgeries (THR) increased year by year. In THR, inaccurate position of the implanted prosthesis may lead to the failure of the operation. In order to reduce the failure rate and acquire the real-time pose of Anterior Pelvic Plane (APP), we propose a measurement system in this paper. The measurement system includes two parts: Initial Pose Measurement Instrument (IPMI) and Real-time Pose Measurement Instrument (RPMI). IPMI is used to acquire the initial pose of the APP, and RPMI is used to estimate the real-time pose of the APP. Both are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. To estimate the attitude of the measurement system, the Extended Kalman Filter (EKF) is adopted in this paper. The real-time pose of the APP could be acquired together with the algorithm designed in the paper. The experiment results show that the Root Mean Square Error (RMSE) is within 1.6 degrees, which meets the requirement of THR operations.

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.

Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report

PubMed Central

MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D’Angelo, Kevin

2015-01-01

Objective: To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. Clinical Features: A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. Summary: FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury. PMID:26816416

Hip and groin pain in the child athlete.

PubMed

Broadley, Penny; Offiah, Amaka C

2014-11-01

An increasing number of children are taking up sporting activities and at more competitive levels. For this reason (pediatric) radiologists should expect to receive greater numbers of requests from their orthopedic colleagues to image the athletic child who presents with hip or groin pain: "athletic pubalgia."Lower limb sports-related pathology is particularly common in sports such as ballet, football, hockey, rugby, and running. Injuries to the hip and groin may account for up to a quarter of injuries seen in athletic children and may be acute or chronic, osseous, cartilaginous, ligamentous, or muscular. The radiologist should also bear in mind the possibility of non-sports-related pathology such as inflammation or tumor and of complications related to previous trauma such as avascular necrosis or femoroacetabular impingement complicating previous slipped capital femoral epiphysis. Radiologists should avoid use of the term sports hernia and provide a more specific description of the true abnormality.The major imaging modalities are radiographs and MRI. In this article we provide an overview of the common sports-related pathologies of the hip and groin that may be encountered in the athletic child. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

No effect of the infiltration of local anaesthetic for total hip arthroplasty using an anterior approach: a randomised placebo controlled trial.

PubMed

den Hartog, Y M; Mathijssen, N M C; van Dasselaar, N T; Langendijk, P N J; Vehmeijer, S B W

2015-06-01

Only limited data are available regarding the infiltration of local anaesthetic for total hip arthroplasty (THA), and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated the effect of both standard and reverse infiltration of local anaesthetic in combination with the anterior approach for THA. The primary endpoint was the mean numeric rating score for pain four hours post-operatively. In addition, we recorded the length of hospital stay, the operating time, the destination of the patient at discharge, the use of pain medication, the occurrence of side effects and pain scores at various times post-operatively. Between November 2012 and January 2014, 75 patients were included in the study. They were randomised into three groups: standard infiltration of local anaesthetic, reversed infiltration of local anaesthetic, and placebo. There was no difference in mean numeric rating score for pain four hours post-operatively (p = 0.87). There were significantly more side effects at one and eight hours post-operatively in the placebo group (p = 0.02; p = 0.03), but this did not influence the mobilisation of the patients. There were no differences in all other outcomes between the groups. We found no clinically relevant effect when the infiltration of local anaesthetic with ropivacaine and epinephrine was used in a multimodal pain protocol for THA using the anterior approach. ©2015 The British Editorial Society of Bone & Joint Surgery.

Effects of Arthroscopy for Femoroacetabular Impingement Syndrome on Quality of Life and Economic Outcomes.

PubMed

Mather, Richard C; Nho, Shane J; Federer, Andrew; Demiralp, Berna; Nguyen, Jennifer; Saavoss, Asha; Salata, Michael J; Philippon, Marc J; Bedi, Asheesh; Larson, Christopher M; Byrd, J W Thomas; Koenig, Lane

2018-04-01

The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Economic and decision analysis; Level of evidence, 2. The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost

Prevalence of cam hip shape morphology: a systematic review.

PubMed

Dickenson, E; Wall, P D H; Robinson, B; Fernandez, M; Parsons, H; Buchbinder, R; Griffin, D R

2016-06-01

Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Hip-Abductor Fatigue and Single-Leg Landing Mechanics in Women Athletes

PubMed Central

Patrek, Mary F.; Kernozek, Thomas W.; Willson, John D.; Wright, Glenn A.; Doberstein, Scott T.

2011-01-01

Abstract Context: Reduced hip-abductor strength and muscle activation may be associated with altered lower extremity mechanics, which are thought to increase the risk for anterior cruciate ligament injury. However, experimental evidence supporting this relationship is limited. Objective: To examine the changes in single-leg landing mechanics and gluteus medius recruitment that occur after a hip-abductor fatigue protocol. Design: Descriptive laboratory study. Patients or Other Participants: Twenty physically active women (age  =  21.0 ± 1.3 years). Intervention(s): Participants were tested before (prefatigue) and after (postfatigue) a hip-abductor fatigue protocol consisting of repetitive side-lying hip abduction. Main Outcome Measure(s): Outcome measures included sagittal-plane and frontal-plane hip and knee kinematics at initial contact and at 60 milliseconds after initial contact during 5 single-leg landings from a height of 40 cm. Peak hip and knee sagittal-plane and frontal-plane joint moments during this time interval were also analyzed. Measures of gluteus medius activation, including latency, peak amplitude, and integrated signal, were recorded. Results: A small (<1°) increase in hip-abduction angle at initial contact and a small (<1°) decrease in knee-abduction (valgus) angle at 60 milliseconds after contact were observed in the postfatigue landing condition. No other kinematic changes were noted for the knee or hip at initial contact or at 60 milliseconds after initial contact. Peak external knee-adduction moment decreased 27% and peak hip adduction moment decreased 24% during the postfatigue landing condition. Gluteus medius activation was delayed after the protocol, but no difference in peak or integrated signal was seen during the landing trials. Conclusions: Changes observed during single-leg landings after hip-abductor fatigue were not generally considered unfavorable to the integrity of the anterior cruciate ligament. Further work may be

Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis.

PubMed

King, Matthew G; Lawrenson, Peter R; Semciw, Adam I; Middleton, Kane J; Crossley, Kay M

2018-05-01

(1) Identify differences in hip and pelvic biomechanics in patients with femoroacetabular impingement syndrome (FAIS) compared with controls during everyday activities (eg, walking, squatting); and (2) evaluate the effects of interventions on hip and pelvic biomechanics during everyday activities. Systematic review. Medline, CINAHL, EMBASE, Scopus and SPORTDiscus until February 2017. Primary aim: studies that investigated hip or pelvic kinematics and/or joint torques of everyday activities in patients with FAIS compared with the asymptomatic contralateral limb or a control group. Secondary aim: studies that evaluated effects of conservative or surgical interventions on patients with FAIS using pre-post or controlled clinical trial designs. Biomechanical data must have been collected using three-dimensional motion capture devices. Reporting quality was assessed using the Epidemiological Appraisal Instrument and data were pooled (standardised mean difference (SMD), 95% CI) where populations and primary outcomes were similar. Fourteen studies were included (11 cross-sectional and three pre/post intervention), varying between low and moderate reporting quality. Patients with FAIS walked with a lower: peak hip extension angle (SMD -0.40, 95% CI -0.71 to -0.09), peak internal rotation angle (-0.67, 95% CI -1.19 to -0.16) and external rotation joint torque (-0.71, 95% CI -1.07 to -0.35), and squatted to a lesser depth with no difference in hip flexion range. Pre/post intervention data were limited in number and quality, and to surgical cohorts. This review suggests that patients with FAIS may demonstrate hip biomechanical impairments during walking and squatting, with minimal literature available to comment on other tasks. The information presented in the review provides insight into the biomechanical differences associated with FAIS; however, the between-group differences were small to moderate. This information may aid in the development of management strategies for

Fluid extravasation during hip arthroscopy.

PubMed

Stafford, Giles H; Malviya, Ajay; Villar, Richard N

2011-01-01

The amount of fluid that may be lost into the soft tissues during hip arthroscopic surgery is unknown. We measured the volumes of irrigation fluid infused, operating time, fluid pressures and volumes of fluid recovered in 36 therapeutic hip arthroscopies. We excluded those where fluid was lost to the floor, leaving 28 patients. The majority were undergoing surgery for the treatment of femoroacetabular impingement. In 5 patients an intra-articular contrast medium was instilled, in order to establish the likely location of any extravasated fluid. The mean operating time was 68 minutes (31 to 120), and the mean infusion pressure was 46 mm Hg (30 to 70). The mean volume of infused fluid was 9677 ml (95% confidence interval (CI) 7715 to 11638) and the mean volume of fluid recovered was 8544 ml (95% CI 6715 to 10373). The mean fluid extravasation loss into the peri-articular tissues was 1132 ml (95% CI 808 ml to 1456 ml). There was a significant correlation between the volume of extravasated fluid and both the length of operation and the volume of infused fluid used. We had no adverse events in our series. During arthroscopic hip surgery more than a litre of irrigation fluid may be extravasated into the soft tissues. In order to reduce problems related to this we attempt to keep operating times low, and maintain intra-operative fluid pressures as low as possible.

Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review.

PubMed

Arjun, R H H; Kumar, Vishal; Saibaba, Balaji; John, Rakesh; Guled, Uday; Aggarwal, Sameer

2016-09-01

The incidence of traumatic hip dislocations in children is rising in this fast developing world along with increasing numbers of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared with posterior dislocation of the hip. We encountered a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of the shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature to date. Closed reduction of the hip using a hitherto undescribed technique and an intramedullary interlocking nail was performed in this case. At 6 months of follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb.

Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression

PubMed Central

Schenker, Mara; Briggs, Karen; Kuppersmith, David

2007-01-01

Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete’s return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport. PMID:17479250

The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

PubMed Central

van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

2015-01-01

In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

Aeroacoustic Characteristics of Supersonic Impinging Jets

NASA Astrophysics Data System (ADS)

Worden, Theodore James

High-speed impinging jets are often generated by the propulsive systems of aerospace launch vehicles and tactical aircraft. In many instances, the presence of these impinging jets creates a hazard for flight operations personnel due to the extremely high noise levels and unsteady loads produced by fluid-surface interaction. In order to effectively combat these issues, a fundamental understanding of the flow physics and dominant acoustic behavior is essential. There are inherent challenges in performing such investigations, especially with the need to simulate the flowfield under realistic operational conditions (temperature, Mach number, etc.) and in configurations that are relevant to full-scale application. A state-of-the-art high-temperature flow facility at Florida State University has provided a unique opportunity to experimentally investigate the high-speed impinging jet flowfield at application-relevant conditions. Accordingly, this manuscript reports the findings of several experimental studies on high-temperature supersonic impinging jets in multiple configurations. The overall objective of these studies is to characterize the complex relationship between the hydrodynamic and acoustic fields. A fundamental parametric investigation has been performed to document the flowfield and acoustic characteristics of an ideally-expanded supersonic air jet impinging onto a semi-infinite flat plate at ambient and heated jet conditions. The experimental program has been designed to span a widely-applicable geometric parameter space, and as such, an extensive database of the flow and acoustic fields has been developed for impingement distances in the range 1d to 12d, impingement angles in the range 45 degrees to 90 degrees, and jet stagnation temperatures from 289K to 811K (TTR = 1.0 to 2.8). Measurements include point-wise mean and unsteady pressure on the impingement surface, time-resolved shadowgraphy of the flowfield, and fully three-dimensional near field acoustics

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.

Large strengthening effect of a hip-flexor training programme: a randomized controlled trial.

PubMed

Thorborg, Kristian; Bandholm, Thomas; Zebis, Mette; Andersen, Lars Louis; Jensen, Jesper; Hölmich, Per

2016-07-01

To investigate the effect on hip-flexion strength of a 6-week hip-flexor training programme using elastic bands as resistance. We hypothesized that the training group, compared to a control group, would increase their hip-flexion strength more. Thirty-three healthy subjects (45 % females), 24(5) years of age, were included in a randomized controlled trial and allocated to heavy strength training of the hip-flexor muscles or to control (no strength training). Strength training of the hip-flexors (dominant leg) was performed three times 10 min per week for 6 weeks. The strength training group progressed from 15 repetition maximum (RM) (week 1) to 8 RM (week 6). Isometric hip-flexion strength (primary outcome) was measured by a blinded assessor using a reliable test procedure. In the strength training group, the isometric hip-flexion strength of the trained leg increased by 17 %, (p < 0.001). The between-group difference in hip-flexion strength change in the trained leg (dominant leg, training group) versus the non-trained leg (dominant leg, control group) was significantly different from baseline to follow-up, corresponding to a mean change of 0.34 (95 % CI 0.17-0.52) Nm/kg, in favour of the strength training group (p < 0.001). Simple hip-flexor strength training using elastic bands as external loading, for only 6 weeks, substantially improves hip-flexor muscle strength. This simple exercise programme seems promising for future prevention and treatment of acute and longstanding hip-flexor injuries, such as acute rectus femoris injuries and longstanding iliopsoas-related pain and impingement. I.

Effects of Hip Strengthening on Neuromuscular Control, Hip Strength, and Self-Reported Functional Deficits in Individuals With Chronic Ankle Instability.

PubMed

Smith, Brent I; Curtis, Denice; Docherty, Carrie L

2018-06-12

Deficits in ankle and hip strength and lower-extremity postural control are associated with chronic ankle instability (CAI). Following strength training, muscle groups demonstrate increased strength. This change is partially credited to improved neuromuscular control, and many studies have investigated ankle protocols for subjects with CAI. The effects of isolating hip musculature in strength training protocols in this population are not well understood. To examine the effects of hip strengthening on clinical and self-reported outcomes in patients with CAI. Prospective randomized controlled clinical trial. Athletic training facility. Twenty-six participants with CAI (12 males and 14 females; age = 20.9 [1.5] y, height = 170.0 [12.7] cm, and mass = 77.5 [17.5] kg) were randomly assigned to training or control groups. Participants completed either 4 weeks of supervised hip strengthening (resistance bands 3 times a week) or no intervention. Participants were assessed on 4 clinical measures (Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; Balance Error Scoring System; hip external rotation strength; and hip abduction strength) and a patient-reported measure (the Foot and Ankle Ability Measure activities of daily living and sports subscales) before and after the 4-week training period. The training group displayed significantly improved posttest measures compared with the control group for hip abduction strength (training: 446.3 [77.4] N, control: 314.7 [49.6] N, P < .01); hip external rotation strength (training: 222.1 [48.7] N, control: 169.4 [34.6] N, P < .01); Star Excursion Balance Test reach in the anterior (training: 93.1% [7.4%], control: 90.2% [7.9%], P < .01), posteromedial (training: 96.3% [8.9%], control: 88.0% [8.8%], P < .01), and posterolateral (training: 95.4% [11.1%], control: 86.6% [9.6%], P < .01) directions; Balance Error Scoring System total errors (training: 9.9 [6

Sports Injuries about the Hip: What the Radiologist Should Know.

PubMed

Hegazi, Tarek M; Belair, Jeffrey A; McCarthy, Eoghan J; Roedl, Johannes B; Morrison, William B

2016-10-01

Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. © RSNA, 2016.

Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty?

PubMed

Migaud, Henri; Putman, Sophie; Kern, Grégory; Isida, Ronald; Girard, Julien; Ramdane, Nassima; Delaunay, Christian P; Hamadouche, Moussa

2016-10-01

with MoP, osteolysis was rarely the reason for revision in CoC (four of 238 hips [2%]; OR, 0.12 [0.05-0.33]; p < 0.001), but this bearing was frequently revised because of iliopsoas irritation (18 of 238 hips [8%]; OR, 4.9 [2.7-9]; p < 0.001). The time elapsed before revision differed between bearings: median of 3 years (range, 3 days to 28 years) for CoC and 4 years (range, 14 days to 37 years) for MoM versus a median 13 years (range, 0 day to 42 years) for MoP (p < 0.001). Thirty-seven of the 238 revisions (16%) were directly related to ceramic use (ceramic breakage [n = 23], squeaking [n = 6], impingement [n = 7], incorrect ceramic insert insertion [n = 1]). No factors were identified that contributed to breakage of the 12 bulk ceramic components (eight heads, four inserts, four of 12 Delta ceramic). No factors were associated with squeaking, iliopsoas irritation, or impingement, but component orientation was not assessed. The reasons and time to first revision differed between CoC and other bearings. CoC THAs are revised earlier and are sensitive to mechanical problems such as impingement, squeaking, and ceramic rupture that did not disappear with introduction of Delta ceramics and large-diameter (≥ 36 mm) bearings. CoC was rarely revised for osteolysis, but a high rate of iliopsoas irritation requires further investigation. Level III, therapeutic study.

Treatment Success of Hip and Core or Knee Strengthening for Patellofemoral Pain: Development of Clinical Prediction Rules.

PubMed

Earl-Boehm, Jennifer E; Bolgla, Lori A; Emory, Carolyn; Hamstra-Wright, Karrie L; Tarima, Sergey; Ferber, Reed

2018-06-12

  Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is proximal muscle dysfunction.   To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP.   Secondary analysis of data from a randomized control trial.   Four university laboratories.   A total of 199 participants with PFP.   Participants were randomly allocated to either a hip and core-focused (n = 111) or knee-focused (n = 88) rehabilitation group for a 6-week program.   Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by ≥2 cm or an increase in the Anterior Knee Pain Scale score by ≥8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome.   Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity).   The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

Late septic hip dislocation with multifocal osteomyelitis and malaria: a case report.

PubMed

Sreenivas, T; Menon, Jagdish; Nataraj, A R

2012-12-01

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip.

The Physiotherapy for Femoroacetabular Impingement Rehabilitation STudy (physioFIRST): A Pilot Randomized Controlled Trial.

PubMed

Kemp, Joanne L; Coburn, Sally L; Jones, Denise M; Crossley, Kay M

2018-04-01

Study Design A pilot double-blind randomized controlled trial (RCT). Background The effectiveness of physical therapy for femoroacetabular impingement syndrome (FAIS) is unknown. Objectives To determine the feasibility of an RCT investigating the effectiveness of a physical therapy intervention for FAIS. Methods Participants were 17 women and 7 men (mean ± SD age, 37 ± 8 years; body mass index, 25.4 ± 3.4 kg/m 2 ) with FAIS who received physical therapy interventions provided over 12 weeks. The FAIS-specific physical therapy group received personalized progressive strengthening and functional retraining. The control group received standardized stretching exercises. In addition, both groups received manual therapy, progressive physical activity, and education. The primary outcome was feasibility, including integrity of the protocol, recruitment and retention, outcome measures, randomization procedure, and sample-size estimate. Secondary outcomes included hip pain and function (international Hip Outcome Tool-33 [iHOT-33]) and hip muscle strength. Poststudy interviews were conducted to determine potential improvements for future studies. Results Twenty-four (100%) patients with known eligibility agreed to participate. Four patients (17%) were lost to follow-up. All participants and the tester remained blinded, and the control intervention was acceptable to participants. The between-group mean differences in change scores were 16 (95% confidence interval [CI]: -9, 38) for the iHOT-33 and 0.24 (95% CI: 0.02, 0.47) Nm/kg for hip adduction strength, favoring the FAIS-specific physical therapy group. Using an effect size of 0.61, between-group improvements for the iHOT-33 suggest that 144 participants are required for a full-scale RCT. Conclusion A full-scale RCT of physical therapy for FAIS is feasible. A FAIS-specific physical therapy program has the potential for a moderate to large positive effect on hip pain, function, and hip adductor strength. Level of Evidence

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.

Subsampling program for the estimation of fish impingement

NASA Astrophysics Data System (ADS)

Beauchamp, John J.; Kumar, K. D.

1984-11-01

Federal regulations require operators of nuclear and coal-fired power-generating stations to estimate the number of fish impinged on intake screens. During winter months, impingement may range into the hundreds of thousands for certain species, making it impossible to count all intake screens completely. We present graphs for determinig the appropriate“optimal” subsample that must be obtained to estimate the total number impinged. Since the number of fish impinged tends to change drastically within a short time period, the subsample size is determined based on the most recent data. This allows for the changing nature of the species-age composition of the impinged fish. These graphs can also be used for subsampling fish catches in an aquatic system when the size of the catch is too large to sample completely.

Prevalence of asymptomatic femoroacetabular impingement in Turkey; cross sectional study.

PubMed

Polat, Gökhan; Şahin, Koray; Arzu, Ufuk; Kendirci, Alper Şükrü; Aşık, Mehmet

2018-01-01

Femoroacetabular impingement (FAI) is one of the causes of hip pain in young-adult patients. The purpose of our study is to determine the prevalence of radiological FAI findings in asymptomatic population in Turkey. Trauma patients aged 18-65 years who applied to the emergency service between September 2015 and September 2016 were retrospectively evaluated for this study. After a preliminary study and power analysis, 2152 hips of the 1076 previously asymptomatic patients were evaluated radiologically with pelvis antero-posterior and frog-leg radiographs. On radiographs of these patients; alpha angle, lateral central edge angle (LCEA), Tönnis angle (TA) and collodiaphyseal angle were measured. Alpha angle values higher than 55° were noted as cam type FAI. TA values lower than 0° or LCEA values higher than 39° were noted as pincer type FAI. LCEA values lower than 25° or TA values higher than 10° were noted as acetabular dysplasia. Mean age of 1076 patients (602 female, 474 male) was 42.1 ± 15.6 years. The assessment showed that 15.9% of the patients had cam type, 10.6% had pincer type, 3.1% had combined type FAI and 9.3% had findings of acetabular dysplasia. The prevalence of asymptomatic FAI is significantly more in males (46%) in comparison to females (17%) in Turkey. Even though FAI is considered to be a pathology associated with hip osteoarthritis; it is very common in asymptomatic population. In this respect, our study showed that prevalence of radiological FAI findings in asymptomatic adult population was 29.6% in Turkey. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty.

PubMed

Amanatullah, D F; Masini, M A; Roger, D J; Pagnano, M W

2016-08-01

We wished to quantify the extent of soft-tissue damage sustained during minimally invasive total hip arthroplasty through the direct anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side, and the DS approach on the other, a single brand of uncemented hip prosthesis was implanted by two surgeons, considered expert in their surgical approaches. Subsequent reflection of the gluteus maximus allowed the extent of muscle and tendon damage to be measured and the percentage damage to each anatomical structure to be calculated. The DA approach caused substantially greater damage to the gluteus minimus muscle and tendon when compared with the DS approach (t-test, p = 0.049 and 0.003, respectively). The tensor fascia lata and rectus femoris muscles were damaged only in the DA approach. There was no difference in the amount of damage to the gluteus medius muscle and tendon, piriformis tendon, obturator internus tendon, obturator externus tendon or quadratus femoris muscle between approaches. The posterior soft-tissue releases of the DA approach damaged the gluteus minimus muscle and tendon, piriformis tendon and obturator internus tendon. The DS approach caused less soft-tissue damage than the DA approach. However the clinical relevance is unknown. Further clinical outcome studies, radiographic evaluation of component position, gait analyses and serum biomarker levels are necessary to evaluate and corroborate the safety and efficacy of the DS approach. Cite this article: Bone Joint J 2016;98-B1036-42. ©2016 The British Editorial Society of Bone & Joint Surgery.

Analytical and experimental studies of impinging liquid jets

NASA Technical Reports Server (NTRS)

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

1994-01-01

Impinging injectors are a common type of injector used in liquid propellant rocket engines and are typically used in engines where both propellants are injected as a liquid, e.g., engines using LOX/hydrocarbon and storable propellant combinations. The present research program is focused on providing the requisite fundamental understanding associated with impinging jet injectors for the development of an advanced a priori combustion stability design analysis capability. To date, a systematic study of the atomization characteristics of impinging liquid jets under cold-flow conditions have been completed. Effects of orifice diameter, impingement angle, pre-impingement length, orifice length-to-diameter ratio, fabrication procedure, jet flow condition and jet velocity under steady and oscillating, and atmospheric- and high-pressure environments have been investigated. Results of these experimental studies have been compared to current models of sheet breakup and drop formation. In addition, the research findings have been scrutinized to provide a fundamental explanation for a proven empirical correlation used in the design of stable impinging injector-based rocket engines.

Outcomes of Revision Hip Arthroscopy: 2-Year Clinical Follow-up.

PubMed

Gupta, Asheesh; Redmond, John M; Stake, Christine E; Dunne, Kevin F; Hammarstedt, Jon E; Domb, Benjamin G

2016-05-01

To evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy with a minimum 2-year follow-up. From April 2008 to October 2011, data were prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris hip score (mHHS), nonarthritic hip score (NAHS), hip outcome score-activities of daily living (HOS-ADL), and hip outcome score-sport-specific subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. The number of patients who underwent subsequent revision arthroscopy or total hip arthroplasty during the study period is also reported. Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. Average follow-up time was 28 months (range, 20 to 47.4 months). In terms of residual femoroacetabular impingement morphology, 45.7% of patients had preoperative alpha angles ≥ 55°, and 7.14% of patients had a lateral center-edge angle ≥ 40°. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, and 55.65 to 70.79 for NAHS. VAS decreased from 6.72 to 4.08. All scores demonstrated statistically significant improvement (P < .001). Overall patient satisfaction was 7.67. Our success rate was 74.58%. Ten (14.29%) patients underwent total hip arthroplasty during the study period. Our hip survivorship was 85.7%. Five (7.14%) patients underwent secondary revision hip arthroscopy during the study period. We found an overall minor complication rate of 10%. Revision hip arthroscopy for all procedures performed on aggregate has improved clinical outcomes for all PROs, high survivorship, and high patient satisfaction scores at short-term follow-up. Patients should be counseled

Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

PubMed

Cibulka, Michael T

2014-05-01

Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.

RETRACTED ARTICLE: Clinical effectiveness of continuous passive motion (CPM) following femoroacetabular impingement surgery in adolescents.

PubMed

Hosalkar, Harish; Bomar, James D

2012-08-01

This study hypothesizes that the use of continuous passive motion (CPM) following open femoroacetabular impingement (FAI) surgery in the adolescent population improves clinical outcomes in terms of the modified Harris hip score (mHHS). Twenty-nine symptomatic adolescent FAI patients were postoperatively divided into one of three groups; no CPM, two days of inpatient CPM, and two weeks of CPM. mHHS was used preoperatively and postoperatively at six weeks, three months, six months, and nine months in all cases. Kruskal-Wallis (KW) analysis was performed to determine statistical differences in mHHS. mHHS was then re-evaluated using the Mann-Whitney test. There were no statistically significant differences in hip scores between the three groups preoperatively (p = 0.158). There were statistically significant differences (p < 0.001) in mHHS between the three groups at all postoperative time periods. The group that received two weeks of CPM had the best outcome scores. The results of this study suggest that postoperative CPM use following open hip preservation surgery for symptomatic FAI in adolescents improves clinical outcomes. These benefits seem to be related to the duration of CPM. Retrospective comparative study, Level III. Patients treated one way compared with patients treated another way at the same institution.

Does gender influence neuromotor control of the knee and hip?

PubMed

Cowan, Sallie M; Crossley, Kay M

2009-04-01

Patellofemoral pain (PFP) is a common condition that occurs more frequently in females. Anatomical, hormonal and neuromuscular factors have been proposed to contribute to the increased incidence of PFP in females, with neuromuscular factors considered to be of particular importance. This cross-sectional study aimed to evaluate differences in the neuromotor control of the knee and hip muscles between genders and to investigate whether clinical measures of hip rotation range and strength were associated with EMG measures of hip and thigh motor control. Twenty-nine (16 female and 13 male) asymptomatic participants completed a visual choice reaction-time stair stepping task. EMG activity was recorded from vastus medialis oblique, vastus lateralis, anterior and posterior gluteus medius muscles. In addition hip rotation range of motion and hip external rotation, abduction and trunk strength were assessed. There were no differences in the timing or peak of EMG activation of the vasti or gluteus medius muscle between genders during the stepping task. There were however significant associations between EMG measures of motor control of the vasti and hip strength in both females and males. These findings are suggestive of a link between hip muscle control and vasti neuromotor control.

Position-Specific Hip and Knee Kinematics in NCAA Football Athletes

PubMed Central

Deneweth, Jessica M.; Pomeroy, Shannon M.; Russell, Jason R.; McLean, Scott G.; Zernicke, Ronald F.; Bedi, Asheesh; Goulet, Grant C.

2014-01-01

Background: Femoroacetabular impingement is a debilitating hip condition commonly affecting athletes playing American football. The condition is associated with reduced hip range of motion; however, little is known about the range-of-motion demands of football athletes. This knowledge is critical to effective management of this condition. Purpose: To (1) develop a normative database of game-like hip and knee kinematics used by football athletes and (2) analyze kinematic data by playing position. The hypothesis was that kinematics would be similar between running backs and defensive backs and between wide receivers and quarterbacks, and that linemen would perform the activities with the most erect lower limb posture. Study Design: Descriptive laboratory study. Methods: Forty National Collegiate Athletic Association (NCAA) football athletes, representing 5 playing positions (quarterback, defensive back, running back, wide receiver, offensive lineman), executed game-like maneuvers while lower body kinematics were recorded via optical motion capture. Passive hip range of motion at 90° of hip flexion was assessed using a goniometer. Passive range of motion, athlete physical dimensions, hip function, and hip and knee rotations were submitted to 1-way analysis of variance to test for differences between playing positions. Correlations between maximal hip and knee kinematics and maximal hip kinematics and passive range of motion were also computed. Results: Hip and knee kinematics were similar across positions. Significant differences arose with linemen, who used lower maximal knee flexion (mean ± SD, 45.04° ± 7.27°) compared with running backs (61.20° ± 6.07°; P < .001) and wide receivers (54.67° ± 6.97°; P = .048) during the cut. No significant differences were found among positions for hip passive range of motion (overall means: 102° ± 15° [flexion]; 25° ± 9° [internal rotation]; 25° ± 8° [external rotation]). Several maximal hip measures were found

Bony morphology of the hip in professional ballet dancers compared to athletes.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2017-07-01

To compare hip bony morphology between ballet dancers and a sporting control group and to determine the relationship with hip pain. Thirty-three professional ballet dancers and 33 age- and sex-matched athletes completed questionnaires, including the Copenhagen Hip and Groin Outcome Score (HAGOS), and underwent clinical testing and 3.0-T magnetic resonance imaging to measure acetabular coverage with lateral centre edge angles, femoral head-neck junction concavity with alpha angles at anterior and superior positions, femoral neck-shaft angles, and acetabular version angles. Bony morphological measures fell within normal ranges. Dancers had higher neck-shaft angles (dancers 134.6 ± 4.6°/athletes130.8 ± 4.7°, p = 0.002), lower acetabular version angles (13.5 ± 4.7°/17.1 ± 4.7°, p = 0.003), lower superior alpha angles (38.9 ± 6.9°/46.7 ± 10.6°, p < 0.001), similar anterior alpha angles (43.6 ± 8.1/46 ± 7°, p = 0.2), and similar lateral centre edge angles (28.8 ± 4.6°/30.8 ± 4.5°, p = 0.07) compared to athletes. Abnormal morphology was detected in dancers: 3% acetabular dysplasia (athletes 0), 15% borderline dysplasia (6%), 24% cam morphology (33%), 24% coxa valga (6%), and 21% acetabular retroversion (18%). The HAGOS pain scores correlated moderately with acetabular version (r = -0.43, p = 0.02) in dancers, with no other correlation between pain and morphological parameters in either group. Professional ballet dancers have hip bony morphology that differentiates them from athletes. Hip pain correlated poorly with bony morphology. • Ballet dancers have hip bony morphology that may allow extreme hip motion. • Morphological parameter means fell within normal reference intervals in dancers. • Bony morphology correlates poorly with hip pain. • The risk of hip injury due to abnormal morphology requires prospective studies.

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

The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement.

PubMed

Robertson, William J; Kelly, Bryan T

2008-09-01

This study evaluated 11 arthroscopic portals (4 central, 4 peripheral, and 3 peritrochanteric) with regard to their proximity to neurovascular structures and the extra-articular path taken before entering their intended compartments. We established 11 standard portals in 10 cadaveric hips, under arthroscopic and fluoroscopic visualization, using 3/16-inch Steinmann pins. Each hip was dissected, and the relation of the pins to the pertinent anatomy was recorded to the nearest 1 mm. Only 2 of the 11 portals, the anterior and midanterior portals, came within 2 cm of a neurovascular structure before entering their respective compartments. The anterior portal placed the lateral femoral cutaneous nerve at risk, lying at a mean of 15.4 mm (range, 1 to 28 mm) away. The midanterior portal lies a mean of 19.2 mm (range, 5 to 42 mm) from the ascending branch of the lateral circumflex femoral artery. In addition, a small terminal branch of this artery courses a mean of 14.7 mm (range, 2 to 33 mm) and 10.1 mm (range, 1 to 23 mm) from the anterior portal and midanterior portal, respectively. This study showed that 11 arthroscopic portals can be safely inserted into the central, peripheral, and peritrochanteric compartments of the hip. The midanterior and anterior portals pass in close proximity to a small terminal branch of the ascending lateral circumflex femoral artery. The greatest risk still comes from the proximity of the anterior portal to the lateral femoral cutaneous nerve. However, a slightly more lateral location seems to provide substantial benefits. This study investigated 11 arthroscopic hip portals inserted in a standardized fashion. This knowledge should help surgeons place the necessary portals both safely and accurately.

Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement.

PubMed

Mihata, Teruhisa; McGarry, Michelle H; Kinoshita, Mitsuo; Lee, Thay Q

2010-02-01

The objective of this study was to determine the effects of increased horizontal abduction with maximum external rotation, as occurs during the late cocking phase of throwing motion, on shoulder internal impingement. An increase in glenohumeral horizontal abduction will cause overlap of the rotator cuff insertion with respect to the glenoid and increase pressure between the supraspinatus and infraspinatus tendon insertions on the greater tuberosity and the glenoid. Controlled laboratory study. Eight cadaveric shoulders were tested with a custom shoulder testing system with the specimens in 60 degrees of glenohumeral abduction and maximum external rotation. The amount of internal impingement was evaluated by assessing the location of the supraspinatus and infraspinatus articular insertions on the greater tuberosity relative to the glenoid using a MicroScribe 3DLX. Pressure in the posterior-superior quadrant of the glenoid was measured using Fuji prescale film. Data were obtained with the humerus in the scapular plane and 15 degrees , 30 degrees , and 45 degrees of horizontal abduction from the scapular plane. At 30 degrees and 45 degrees of horizontal abduction, the articular margin of the supraspinatus and infraspinatus tendons was anterior to the posterior edge of the glenoid and less than 2 mm from the glenoid rim in the lateral direction; the contact pressure was also greater than that found in the scapular plane and 15 degrees of horizontal abduction. Conclusion Horizontal abduction beyond the coronal plane increased the amount of overlap and contact pressure between the supraspinatus and infraspinatus tendons and glenoid. Excessive glenohumeral horizontal abduction beyond the coronal plane may cause internal impingement, which may lead to rotator cuff tears and superior labral anterior to posterior (SLAP) lesions.

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

PubMed

Wyatt, Michael; Weidner, Jan; Pfluger, Dominik; Beck, Martin

2017-03-01

The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making-specifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral center-edge angle (LCEA) and acetabular index (AI), with respect to intra- and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7-35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95% CI, 25.5-38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2-35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic

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.

Relationship between femoroacetabular contact areas and hip position in the normal joint: an in vitro evaluation.

PubMed

Signorelli, Cecilia; Lopomo, Nicola; Bonanzinga, Tommaso; Marcheggiani Muccioli, Giulio Maria; Safran, Marc R; Marcacci, Maurilio; Zaffagnini, Stefano

2013-02-01

Different approaches have been proposed to diagnose femoroacetabular impingement (FAI) condition and hip instability. It is still debatable which test is the most effective to make a correct diagnosis. The true mechanics of the hip during particular physical examination manoeuvres is unknown. Eight fresh frozen hips were passively taken through 3 different commonly used positions for FAI diagnosis and hip instability: 90° Flexion-Adduction-Internal Rotation, Hyperextension-Adduction-External Rotation and Hyperextension-Neutral-External Rotation. Kinematics and anatomical data were acquired by an optoelectronic system. The contact areas between acetabulum and femoral head were analysed to determine whether these tests are able to localize regions of the hip that may give patients pain. In the hip positions where the femur was in Hyperextension-External Rotation, the contact area was mainly concentrated in the posterosuperior area of the acetabulum, while during 90° Flexion-Adduction-Internal Rotation position, there was a wider distribution of contact, not specific to the anterolateral acetabulum. The results confirm the ability of the Hyperextension-External Rotation tests to particularly analyse the posterior region of the acetabulum. Placing the hip in 90° of Flexion-Adduction-Internal Rotation allows for testing a wider zone of the acetabulum and is not specific to abutment of the femoral head-neck region against the anterolateral acetabulum.

Aseptic loosening of cobalt chromium monoblock sockets after hip resurfacing.

PubMed

Amstutz, Harlan C; Le Duff, Michel J

2015-01-01

Acetabular component loosening is a leading cause for revision after metal-on-metal hip resurfacing arthroplasty (MMHRA). We aimed to identify potential risk factors and determine radiographic signs associated with this mode of failure. From a series of 1375 hips treated with MMHRA, 21 (20 patients) underwent revision surgery secondary to aseptic loosening of the acetabular component and 6 patients had a radiographically loose acetabular component. A control group of 27 hips (26 patients) was selected among the patients that did not have a revision, and was matched for age, gender, component size and diagnosis. Mean time to revision in the loosening group was 103.0 months and the mean time of follow-up in the control group was 161.4 months. We found greater activity levels, range of motion scores, and cup abduction angles in the loosening group. The centre-edge (CE) angle of Wiberg was 10° lower in the loosening group compared with the control group. In addition, 11 of the hips from the study group presented a sclerotic halo superior to the cup on the last radiograph vs. none in the control group. There was no difference in the prevalence of postoperative reaming gaps or radiographic signs of neck-cup impingement between the 2 groups. Risk factors for acetabular loosening included hip dysplasia with low CE angle, and a large cup abduction angle. The patient's level of activity influences the appearance of symptoms and the time to revision. We recommend selecting patients with a sufficient CE angle and properly orienting the cup.

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

PubMed Central

Sanders, Thomas L.; Maradit Kremers, Hilal; Schleck, Cathy D.; Larson, Dirk R.; Berry, Daniel J.

2017-01-01

in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:28244910

Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve?

PubMed

Kamara, Eli; Robinson, Jonathon; Bas, Marcel A; Rodriguez, Jose A; Hepinstall, Matthew S

2017-01-01

Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve. Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior [FA]) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior [RP]), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques. Component position was measured on plain radiographs. Radiographic measurements were taken by 2 blinded observers. The percentage of hips within the surgeons' "target zone" (inclination, 30°-50°; anteversion, 10°-30°) was calculated, along with the percentage within the "safe zone" of Lewinnek (inclination, 30°-50°; anteversion, 5°-25°) and Callanan (inclination, 30°-45°; anteversion, 5°-25°). Relative risk (RR) and absolute risk reduction (ARR) were calculated. Variances (square of the standard deviations) were used to describe the variability of cup position. Seventy-six percentage of MP THAs were within the surgeons' target zone compared with 84% of FA THAs and 97% of RP THAs. This difference was statistically significant, associated with a RR reduction of 87% (RR, 0.13 [0.04-0.40]; P < .01; ARR, 21%; number needed to treat, 5) for RP compared to MP THAs. Compared to FA THAs, RP THAs were associated with a RR reduction of 81% (RR, 0.19 [0.06-0.62]; P < .01; ARR, 13%; number needed to treat, 8). Variances were lower for acetabulum inclination and anteversion in RP

Increasing hip and knee flexion during a drop-jump task reduces tibiofemoral shear and compressive forces: implications for ACL injury prevention training.

PubMed

Tsai, Liang-Ching; Ko, Yi-An; Hammond, Kyle E; Xerogeanes, John W; Warren, Gordon L; Powers, Christopher M

2017-12-01

Although most ACL injury prevention programmes encourage greater hip and knee flexion during landing, it remains unknown how this technique influences tibiofemoral joint forces. We examined whether a landing strategy utilising greater hip and knee flexion decreases tibiofemoral anterior shear and compression. Twelve healthy women (25.9 ± 3.5 years) performed a drop-jump task before and after a training session (10-15 min) that emphasised greater hip and knee flexion. Peak tibiofemoral anterior shear and compressive forces were calculated using an electromyography (EMG)-driven knee model that incorporated joint kinematics, EMG and participant-specific muscle volumes and patella tendon orientation measured using magnetic resonance imaging (MRI). Participants demonstrated a decrease in peak anterior tibial shear forces (11.1 ± 3.3 vs. 9.6 ± 2.7 N · kg -1 ; P = 0.008) and peak tibiofemoral compressive forces (68.4 ± 7.6 vs. 62.0 ± 5.5 N · kg -1 ; P = 0.015) post-training. The decreased peak anterior tibial shear was accompanied by a decrease in the quadriceps anterior shear force, while the decreased peak compressive force was accompanied by decreased ground reaction force and hamstring forces. Our data provide justification for injury prevention programmes that encourage greater hip and knee flexion during landing to reduce tibiofemoral joint loading.

The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study.

PubMed

Hoell, Steffen; Sander, Marius; Gosheger, Georg; Ahrens, Helmut; Dieckmann, Ralf; Hauschild, Gregor

2014-03-12

There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm. A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months). The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations. THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular.

Evaluation of articular cartilage in patients with femoroacetabular impingement (FAI) using T2* mapping at different time points at 3.0 Tesla MRI: a feasibility study.

PubMed

Apprich, S; Mamisch, T C; Welsch, G H; Bonel, H; Siebenrock, K A; Kim, Y-J; Trattnig, S; Dudda, M

2012-08-01

To define the feasibility of utilizing T2* mapping for assessment of early cartilage degeneration prior to surgery in patients with symptomatic femoroacetabular impingement (FAI), we compared cartilage of the hip joint in patients with FAI and healthy volunteers using T2* mapping at 3.0 Tesla over time. Twenty-two patients (13 females and 9 males; mean age 28.1 years) with clinical signs of FAI and Tönnis grade ≤ 1 on anterior-posterior x-ray and 35 healthy age-matched volunteers were examined at a 3 T MRI using a flexible body coil. T2* maps were calculated from sagittal- and coronal-oriented gradient-multi-echo sequences using six echoes (TR 125, TE 4.41/8.49/12.57/16.65/20.73/24.81, scan time 4.02 min), both measured at beginning and end of the scan (45 min time span between measurements). Region of interest analysis was manually performed on four consecutive slices for superior and anterior cartilage. Mean T2* values were compared among patients and volunteers, as well as over time using analysis of variance and Student's t-test. Whereas quantitative T2* values for the first measurement did not reveal significant differences between patients and volunteers, either for sagittal (p = 0.644) or coronal images (p = 0.987), at the first measurement, a highly significant difference (p ≤ 0.004) was found for both measurements with time after unloading of the joint. Over time we found decreasing mean T2* values for patients, in contrast to increasing mean T2* relaxation times in volunteers. The study proved the feasibility of utilizing T2* mapping for assessment of early cartilage degeneration in the hip joint in FAI patients at 3 Tesla to predict possible success of joint-preserving surgery. However, we suggest the time point for measuring T2* as an MR biomarker for cartilage and the changes in T2* over time to be of crucial importance for designing an MR protocol in patients with FAI.

The Importance of Comprehensive Cam Correction: Radiographic Parameters Are Predictive of Patient-Reported Outcome Measures at 2 Years After Hip Arthroscopy.

PubMed

Lansdown, Drew A; Kunze, Kyle; Ukwuani, Gift; Waterman, Brian R; Nho, Shane J

2018-06-01

The specific influence of preoperative and postoperative radiographic measurements on patient-reported outcome measures after hip arthroscopy for femoroacetabular impingement (FAI) remains unclear. To investigate the relationship between radiographic measurements and 2-year outcomes after hip arthroscopy for the treatment of FAI. Case series; Level of evidence, 4. A clinical registry of patients undergoing primary hip arthroscopy for FAI between January 1, 2012, and December 31, 2014, was queried. Outcome measures included the Hip Outcome Score (HOS) Activities of Daily Living (ADL), HOS Sport-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Preoperative and postoperative radiographic measurements were recorded. Univariate analysis was conducted to identify relationships between all radiographic and demographic variables and outcome scores. A multivariate regression analysis, controlling for demographic factors, was used to identify independent associations between radiographic measurements on plain radiographs and patient-reported outcomes. The authors identified 707 patients who underwent primary hip arthroscopic management for FAI who were included for analysis. Two-year outcome surveys were completed for 78% to 84% of patients. The mean age of the patients was 33.2 ± 12.3 years, and 64.4% of the patients (n = 456) were female. The mean anteroposterior (AP) alpha angle decreased by 34.3° ( P < .0001), false profile alpha angle by 25.2° ( P < .0001), Dunn lateral alpha angle by 28.9° ( P < .0001), lateral center edge angle by 2.6° ( P < .0001), and anterior center edge angle by 3.4° ( P < .0001). The HOS-ADL score increased from 65.7 ± 18.7 preoperatively to 85.9 ± 16.7 postoperatively ( P < .0001), HOS-SSS increased from 43.4 ± 23.1 to 72.6 ± 27.2 ( P < .0001), and mHHS increased from 57.7 ± 14.0 to 79.1 ± 17.2 ( P < .0001). With multivariate analysis, independent predictors of the

Ankle impingement syndromes: an imaging review

PubMed Central

Tafur, Monica; Ahmed, Sonya S; Huang, Brady K; Chang, Eric Y

2017-01-01

Ankle impingement syndromes encompass a broad spectrum of post-traumatic and chronic degenerative changes that present with pain on specific movements about the ankle joint. Both amateur and professional athletes are disproportionately affected by these conditions, and while conservative measures can potentially treat an impingement syndrome, definitive therapy is often alleviated surgically. Imaging (including conventional radiography, ultrasound, CT and MRI) plays an invaluable role in the diagnosis and pre-surgical work-up. An anatomically based classification system is useful in these syndromes, as the aetiology, sites of pathology and preferred treatment methods are similarly based on anatomic locations about the ankle. This review focuses on the anatomic locations, pathophysiology, imaging considerations and brief discussion of therapies for each of the major anatomic ankle impingement syndromes. PMID:27885856

Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes.

PubMed

Prinold, Joe A I; Bull, Anthony M J

2016-08-01

Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. An observational study was performed with eleven participants (age=26.8±2.4 years) who regularly perform pull-ups. The upward motions of three pull-up techniques were analysed: palms facing anterior, palms facing posterior and wide-grip. A skin-fixed scapula tracking technique with attached retro-reflective markers was used. High intra-participant repeatability was observed: mean coefficients of multiple correlations of 0.87-1.00 in humerothoracic rotations and 0.77-0.90 for scapulothoracic rotations. Standard deviations of hand force was low: <5% body weight. Significantly different patterns of humerothoracic, scapulothoracic and glenohumeral kinematics were observed between the pull-up techniques. The reverse technique has extreme glenohumeral internal-external rotation and large deviation from the scapula plane. The wide technique has a reduced range of pro/retraction in the same HT plane of elevation and 90° of arm abduction with 45° external rotation was observed. All these factors suggest increased sub-acromial impingement risk. The scapula tracking technique showed high repeatability. High arm elevation during pull-ups reduces sub-acromial space and increases pressure, increasing the risk of impingement injury. Wide and reverse pull-ups demonstrate kinematics patterns linked with increased impingement risk. Weight-assisted front pull-ups require further investigation and could be recommended for weaker participants. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty.

PubMed

Nam, Denis; Nunley, Ryan M; Sauber, Timothy J; Johnson, Staci R; Brooks, Peter J; Barrack, Robert L

2015-11-01

Persistent pain following hip arthroplasty remains a concern, especially in young, active patients. Four hundred twenty patients less than 60 years of age with a pre-symptomatic UCLA score ≥ 6 (196 total hip arthroplasty [THA]; 224 surface replacement arthroplasty [SRA]) completed a pain-drawing questionnaire investigating the location, severity, and frequency of pain around the hip. At a mean of 2.9 years of follow-up, 40% reported pain in at least one location around the hip. There was no difference in the incidence of groin pain between SRA and THA patients (32% vs. 29%, P=0.6), but THA patients had a greater incidence of anterior (25% vs. 8%, P<0.001) and lateral (20% vs. 10%, P=0.01) thigh pain. A high percentage of young, active patients experience persistent pain following hip arthroplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of changes in trunk and pelvic posture during single leg standing on hip and thigh muscle activation in a pain free population.

PubMed

Prior, Simon; Mitchell, Tim; Whiteley, Rod; O'Sullivan, Peter; Williams, Benjamin K; Racinais, Sebastien; Farooq, Abdulaziz

2014-03-27

Thigh muscle injuries commonly occur during single leg loading tasks and patterns of muscle activation are thought to contribute to these injuries. The influence trunk and pelvis posture has on hip and thigh muscle activation during single leg stance is unknown and was investigated in a pain free population to determine if changes in body posture result in consistent patterns of changes in muscle activation. Hip and thigh muscle activation patterns were compared in 22 asymptomatic, male subjects (20-45 years old) in paired functionally relevant single leg standing test postures: Anterior vs. Posterior Trunk Sway; Anterior vs. Posterior Pelvic Rotation; Left vs. Right Trunk Shift; and Pelvic Drop vs. Raise. Surface EMG was collected from eight hip and thigh muscles calculating Root Mean Square. EMG was normalized to an "upright standing" reference posture. Repeated measures ANOVA was performed along with associated F tests to determine if there were significant differences in muscle activation between paired test postures. In right leg stance, Anterior Trunk Sway (compared to Posterior Sway) increased activity in posterior sagittal plane muscles, with a concurrent deactivation of anterior sagittal plane muscles (p: 0.016 - <0.001). Lateral hip abductor muscles increased activation during Left Trunk Shift (compared to Right) (p :≤ 0.001). Lateral Pelvic Drop (compared to Raise) decreased activity in hip abductors and increased hamstring, adductor longus and vastus lateralis activity (p: 0.037 - <0.001). Changes in both trunk and pelvic posture during single leg stance generally resulted in large, predictable changes in hip and thigh muscle activation in asymptomatic young males. Changes in trunk position in the sagittal plane and pelvis position in the frontal plane had the greatest effect on muscle activation. Investigation of these activation patterns in clinical populations such as hip and thigh muscle injuries may provide important insights into injury

Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain.

PubMed

Prather, Heidi; Cheng, Abby; Steger-May, Karen; Maheshwari, Vaibhav; VanDillen, Linda

2018-01-01

Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA. To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings. Prospective cohort study with cross-sectional design. Tertiary university. A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test. Hip radiographs were assessed by an independent examiner for hip OA and deformity. Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity. Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function. Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP. II. Copyright © 2018 American Academy of Physical Medicine and

Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results.

PubMed

Poehling-Monaghan, Kirsten L; Kamath, Atul F; Taunton, Michael J; Pagnano, Mark W

2015-02-01

Although some surgeons strongly advocate for one approach over the other, there are few data directly comparing the direct anterior approach with a miniposterior approach for total hip arthroplasty (THA). Using the same advanced pain and rapid rehabilitation protocols for both groups, we compared the direct anterior and miniposterior approaches with respect to (1) return to activities of daily living at 2 days, 2 weeks, or 2 months; (2) risk of intraoperative or early postoperative complications; and (3) component position. Over a 1-year period we identified all consecutive, primary direct anterior and miniposterior THAs performed by two surgeons at our institution, totaling 242 patients. Of those, 20 did not meet inclusion criteria as a result of prior trauma or surgery about the hip. A total of 222 patients, 126 direct anterior and 96 miniposterior, were retrospectively evaluated. All cases were done by one of two surgeons, one of whom performs THA exclusively through the direct anterior approach and the other who only uses the miniposterior approach. Groups did not differ demographically with mean±SD age 64±12 years, mean body mass index 30±5.7 kg/m2, and 50% female. The same rapid rehabilitation protocols were used with no postoperative hip positioning precautions. No differences were seen between the two groups in mean length of stay (2.2 days; range, 1-9 days), operative or in-hospital complications, intravenous breakthrough analgesia, stairs, maximum feet walked in-hospital, or percent discharged to home (80% [177 of 222]; all p>0.2). The direct anterior patients had longer mean operative times (114 minutes; range, 60-251 minutes) than the miniposterior patients (mean, 60 minutes; range, 41-113 minutes; p<0.001). The direct anterior group had a higher maximum visual analog scale pain score (5.3 direct anterior; ±2, versus 3.8 MP; ±2; p<0.0001). At 2 weeks, more direct anterior patients required gait aids (92% [116 of 126]) than miniposterior (68% [62 of

Radiologic assessment of femoral and tibial tunnel placement based on anatomic landmarks in arthroscopic single bundle anterior cruciate ligament reconstruction.

PubMed

Nema, Sandeep Kumar; Balaji, Gopisankar; Akkilagunta, Sujiv; Menon, Jagdish; Poduval, Murali; Patro, Dilip

2017-01-01

Accurate tibial and femoral tunnel placement has a significant effect on outcomes after anterior cruciate ligament reconstruction (ACLR). Postoperative radiographs provide a reliable and valid way for the assessment of anatomical tunnel placement after ACLR. The aim of this study was to examine the radiographic location of tibial and femoral tunnels in patients who underwent arthroscopic ACLR using anatomic landmarks. Patients who underwent arthroscopic ACLR from January 2014 to March 2016 were included in this retrospective cohort study. 45 patients who underwent arthroscopic ACLR, postoperative radiographs were studied. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation and proportions as applicable. Interobserver agreement was measured using intraclass correlation coefficient. The position of the tibial tunnel was found to be at an average of 35.1% ± 7.4% posterior from the anterior edge of the tibia. The femoral tunnel was found at an average of 30% ± 1% anterior to the posterior femoral cortex along the Blumensaat's line. Radiographic impingement was found in 34% of the patients. The roof angle averaged 34.3° ± 4.3°. The position of the tibial tunnel was found at an average of 44.16% ± 3.98% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 67.5° ± 8.9°. The coronal angle of the femoral tunnel averaged 41.9° ± 8.5°. The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients.

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging.

PubMed

McCarthy, C L; Wilson, D J; Coltman, T P

2008-03-01

The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

Experiments on free and impinging supersonic microjets

NASA Astrophysics Data System (ADS)

Phalnikar, K. A.; Kumar, R.; Alvi, F. S.

2008-05-01

The fluid dynamics of microflows has recently commanded considerable attention because of their potential applications. Until now, with a few exceptions, most of the studies have been limited to low speed flows. This experimental study examines supersonic microjets of 100-1,000 μm in size with exit velocities in the range of 300-500 m/s. Such microjets are presently being used to actively control larger supersonic impinging jets, which occur in STOVL (short takeoff and vertical landing) aircraft, cavity flows, and flow separation. Flow properties of free as well as impinging supersonic microjets have been experimentally investigated over a range of geometric and flow parameters. The flowfield is visualized using a micro-schlieren system with a high magnification. These schlieren images clearly show the characteristic shock cell structure typically observed in larger supersonic jets. Quantitative measurements of the jet decay and spreading rates as well as shock cell spacing are obtained using micro-pitot probe surveys. In general, the mean flow features of free microjets are similar to larger supersonic jets operating at higher Reynolds numbers. However, some differences are also observed, most likely due to pronounced viscous effects associated with jets at these small scales. Limited studies of impinging microjets were also conducted. They reveal that, similar to the behavior of free microjets, the flow structure of impinging microjets strongly resembles that of larger supersonic impinging jets.

How much arthritis is too much for hip arthroscopy: a systematic review.

PubMed

Domb, Benjamin G; Gui, Chengcheng; Lodhia, Parth

2015-03-01

The purpose of this study was to determine the extent of preoperative osteoarthritis (OA) that precludes benefit from hip arthroscopy by systematically reviewing the literature on hip arthroscopy in the setting of OA. We searched the Medline and PubMed databases using the following Medical Subject Heading terms: arthritis, osteoarthritis, chondral damage, chondral injury, chondral delamination, and hip arthroscopy. Two authors independently reviewed the literature and included articles if they were in the English language; commented on preoperative factors, parameters, physical examination, or diagnostic testing that may be evidence of cartilage damage and/or arthritis; contained outcome data on patients undergoing hip arthroscopy; and had a sample size of at least 10 patients with arthritic changes in the hip. We excluded review articles, technique articles, articles with overlapping patient populations, articles with hip arthroscopy used as an adjunct to an open procedure, articles with inflammatory and septic arthritis, and articles with a mean age younger than 18 years. Our search identified 518 articles, of which 15 met the inclusion and exclusion criteria. Two thousand fifty-one hips underwent arthroscopy at a mean patient age of 40.2 years. Of these, 1,195 hips had signs of OA. There were 345 conversions to total hip arthroplasty/surface replacement arthroplasty. Of these patients, 274 had OA. Eight patient-reported outcome instruments were used. Factors influencing outcomes were preoperative OA, age, chondral damage, femoroacetabular impingement, and duration of symptoms. Current evidence is insufficient to define a cutoff for how much arthritis is too much for hip arthroscopy. However, this analysis shows that patients with a Tönnis grade of 1 or greater or a joint space of 2 mm or less are less likely to benefit from hip arthroscopy and more likely to require conversion to total hip arthroplasty/surface replacement arthroplasty. Postoperative scores on

Drop Impingement on Highly Wetting Micro/Nano Porous Surfaces

NASA Astrophysics Data System (ADS)

Buie, Cullen; Joung, Youngsoo

2011-11-01

Recently, we developed a novel fabrication method using a combination of electrophoretic deposition (EPD) and break down anodization (BDA) to achieve highly wetting nanoporous surfaces with microscale features. In this study we investigate droplet impingement behavior on these surfaces as a function of impact velocity, droplet size, and liquid properties. We observe impingement modes we denote as ``necking'' (droplet breaks before full penetration in the porous surface), ``spreading'' (continuous wicking into the porous surface), and ``jetting'' (jets of liquid emanate from the edges of the wicking liquid). To predict the droplet impingement modes, we've developed a non-dimensional parameter that is a function of droplet velocity, dynamic viscosity, effective pore radius and contact angle. The novel dimensionless parameter successfully predicts drop impingement modes across multiple fluids. Results of this study will inform the design of spray impingement cooling systems for electronics applications where the ``spreading'' mode is preferred.

Is the T1ρ MRI profile of hyaline cartilage in the normal hip uniform?

PubMed

Rakhra, Kawan S; Cárdenas-Blanco, Arturo; Melkus, Gerd; Schweitzer, Mark E; Cameron, Ian G; Beaulé, Paul E

2015-04-01

T1ρ MRI is an imaging technique sensitive to proteoglycan (PG) content of hyaline cartilage. However, normative T1ρ values have not been established for the weightbearing cartilage of the hip, and it is not known whether it is uniform or whether there is topographic variation. Knowledge of the T1ρ profile of hyaline cartilage in the normal hip is important for establishing a baseline against which comparisons can be made to experimental and clinical arthritic subjects. In this diagnostic study, we determined (1) the T1ρ MRI values of hyaline cartilage of the normal hip; and (2) whether the T1ρ MRI profile of the normal hip hyaline cartilage is uniform. Fourteen asymptomatic volunteers (11 men, three women; mean age, 35 years) prospectively underwent 1.5-T T1ρ MRI of a single hip. The weightbearing hyaline cartilage bilayer of the acetabulum and femoral head was evaluated on sagittal images and segmented into four zones: (1) anterior; (2) anterosuperior; (3) posterosuperior; and (4) and posterior. For the full region of interest and within each zone and each sagittal slice, we calculated the mean T1ρ relaxation value, a parameter that indirectly quantifies PG content, where T1ρ is inversely related to PG concentration. There was variation in the T1ρ relaxation values depending on zone (anterior to posterior) and slice (medial to lateral). When combining the most anterior quadrants (Zones 1 and 2), the T1ρ relaxation values were lower than those in the combined posterior quadrants (Zones 3 and 4) (30.4 msec versus 32.2 msec, respectively; p = 0.002), reflecting higher PG concentration. There was a difference between the T1ρ relaxation values of the sagittal slices (p = 0.038), most pronounced anteriorly in Zone 1 (26.6 msec, p = 0.001). With a selective combination of zones and slices, there were lower mean T1ρ values in the anterolateral-most region compared with the remainder of the weightbearing portion of the hip (28.6 msec versus 32.2 msec

Statistics of fully turbulent impinging jets

NASA Astrophysics Data System (ADS)

Wilke, Robert; Sesterhenn, Jörn

2017-08-01

Direct numerical simulations of sub- and supersonic impinging jets with Reynolds numbers of 3300 and 8000 are carried out to analyse their statistical properties. The influence of the parameters Mach number, Reynolds number and ambient temperature on the mean velocity and temperature fields are studied. For the compressible subsonic cold impinging jets into a heated environment, different Reynolds analogies are assesses. It is shown, that the (original) Reynolds analogy as well as the Chilton Colburn analogy are in good agreement with the DNS data outside the impinging area. The generalised Reynolds analogy (GRA) and the Crocco-Busemann relation are not suited for the estimation of the mean temperature field based on the mean velocity field of impinging jets. Furthermore, the prediction of fluctuating temperatures according to the GRA fails. On the contrary, the linear relation between thermodynamic fluctuations of entropy, density and temperature as suggested by Lechner et al. (2001) can be confirmed for the entire wall jet. The turbulent heat flux and Reynolds stress tensor are analysed and brought into coherence with the primary and secondary ring vortices of the wall jet. Budget terms of the Reynolds stress tensor are given as data base for the improvement of turbulence models.

Pre-operative Thresholds for Achieving Meaningful Clinical Improvement after Arthroscopic Treatment of Femoroacetabular Impingement

PubMed Central

Nwachukwu, Benedict U.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2016-01-01

Objectives: Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) treatment is evolving. The primary purpose of this study was to define pre-operative outcome score thresholds that can be used to predict patients most likely to achieve meaningful clinically important difference (MCID) after arthroscopic FAI treatment. Secondarily determinants of achieving MCID were evaluated. Methods: A prospective institutional hip arthroscopy registry was reviewed to identify patients with FAI treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) tools were administered at baseline and at one year post-operatively. MCID was calculated using a distribution-based method. A receiver operating characteristic (ROC) analysis was used to calculate cohort-based threshold values predictive of achieving MCID. Area under the curve (AUC) was used to define predictive ability (strength of association) with AUC >0.7 considered acceptably predictive. Univariate and multivariable analyses were used to analyze demographic, radiographic and intra-operative factors associated with achieving MCID. Results: There were 374 patients (mean + SD age, 32.9 + 10.5) and 56.4% were female. The MCID for mHHS, HOS activities of daily living (HOS-ADL), HOS Sports, and iHOT-33 was 8.2, 8.4,14.5, and 12.0 respectively. ROC analysis (threshold, % achieving MCID, strength of association) for these tools in our population was: mHHS (61.6, 78%, 0.68), HOS-ADL (83.8, 68%, 0.84), HOS-Sports (63.9, 64%, 0.74), and iHOT-33 (54.3, 82%, 0.65). Likelihood for achieving MCID declined above and increased below these thresholds. In univariate analysis female sex, femoral version, lower acetabular outerbridge score and increasing CT sagittal center edge angle (CEA) were predictive of achieving MCID. In multivariable analysis

Outerbridge Grade IV Cartilage Lesions in the Hip Identified at Arthroscopy.

PubMed

Bhatia, Sanjeev; Nowak, Douglas D; Briggs, Karen K; Patterson, Diana C; Philippon, Marc J

2016-05-01

To determine factors associated with grade IV cartilage defects in the hip in patients undergoing hip arthroscopy with joint pain. Data from consecutive patients who underwent hip arthroscopy performed by a single surgeon over a period of 4 years were included in this study. The study group included 1,097 patients (491 women and 606 men; mean age, 37 years) who underwent hip arthroscopy for pain, had no prior hip surgery, and were aged 18 years or older. Preoperative radiographs, patient demographic characteristics, and operative details were used to identify risk factors for cartilage defects. Grade IV chondral defects were present in 308 of 1,097 hips (28%). Isolated chondral lesions were more frequently observed on the acetabulum (76%) than on the femoral head (24%). Defects of the acetabulum were more commonly anterosuperior (94.7%) and less commonly posterolateral (5.3%). Patients with less than 2 mm of joint space on preoperative radiographs were 8 times more likely to have a grade IV lesion than those with more than 2 mm. Men were more likely than women to have grade IV lesions (35% v 19%, P = .0001); patients with grade IV lesions were older than those without (42 years v 34 years, P = .0001). Hips with grade IV lesions had significantly higher alpha angles than those without (74° v 70°, P = .0001). Patients with grade IV defects reported a longer duration of symptoms than those without (37 months v 27 months, P = .007). Independent risk factors for the presence of grade IV chondral defects were less than 2 mm of joint space, male gender, increasing age, larger alpha angle, and longer duration of symptoms. Grade IV chondral defects in patients undergoing hip arthroscopy were associated with decreased joint space, increased time from symptom onset to arthroscopy, male gender, and larger alpha angles associated with femoroacetabular impingement. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by

Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

PubMed Central

Mishima, Hajime; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

2016-01-01

The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips) were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips) of those occurring within 3 months after surgery. First- (n = 12 hips), second- (n = 32), and third- (n = 1) degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100%) and posteromedial distal portions (85%). Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree. PMID:26881087

Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series.

PubMed

Larson, Christopher M; Pierce, Bradley R; Giveans, M Russell

2011-06-01

The purpose of the study was to evaluate the results of surgical treatment in athletes with associated intra-articular hip pathology and extra-articular sports pubalgia. Between December 2003 and September 2009, 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology. There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes. Outcomes included an evaluation regarding return to sports and modified Harris Hip Score, Short Form 12 score, and visual analog scale score. We evaluated 37 hips at a mean of 29 months (range, 12 to 78 months) after the index surgery. Thirty-one hips underwent thirty-five athletic pubalgia surgeries. Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia). Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery. Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy. Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P < .05) and an unrestricted return to sporting activity in 89% of hips (24 of 27). When surgery only addressed either the athletic pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy

Sonographic prevalence of groin hernias and adductor tendinopathy in patients with femoroacetabular impingement.

PubMed

Naal, Florian D; Dalla Riva, Francesco; Wuerz, Thomas H; Dubs, Beat; Leunig, Michael

2015-09-01

Femoroacetabular impingement (FAI) is a common debilitating condition that is associated with groin pain and limitation in young and active patients. Besides FAI, various disorders such as hernias, adductor tendinopathy, athletic pubalgia, lumbar spine affections, and others can cause similar symptoms. To determine the prevalence of inguinal and/or femoral herniation and adductor insertion tendinopathy using dynamic ultrasound in a cohort of patients with radiographic evidence of FAI. Case series; Level of evidence, 4. This retrospective study consisted of 74 patients (36 female and 38 male; mean age, 29 years; 83 symptomatic hips) with groin pain and radiographic evidence of FAI. In addition to the usual diagnostic algorithm, all patients underwent a dynamic ultrasound examination for signs of groin herniation and tendinopathy of the proximal insertion of the adductors. Evidence of groin herniation was found in 34 hips (41%). There were 27 inguinal (6 female, 21 male) and 10 femoral (9 female, 1 male) hernias. In 3 cases, inguinal and femoral herniation was coexistent. Overall, 5 patients underwent subsequent hernia repair. Patients with groin herniation were significantly older than those without (33 vs 27 years, respectively; P = .01). There were no significant differences for any of the radiographic or clinical parameters. Tendinopathy of the proximal adductor insertion was detected in 19 cases (23%; 11 female, 8 male). Tendinopathy was coexistent with groin herniation in 8 of the 19 cases. There were no significant differences for any of the radiographic or clinical parameters between patients with or without tendinopathy. Patients with a negative diagnostic hip injection result were more likely to have a concomitant groin hernia than those with a positive injection result (80% vs 27%, respectively). Overall, 38 hips underwent FAI surgery with satisfactory outcomes in terms of score values and subjective improvement. The results demonstrate that groin

Atomization of Impinging Droplets on Superheated Superhydrophobic Surfaces

NASA Astrophysics Data System (ADS)

Emerson, Preston; Crockett, Julie; Maynes, Daniel

2017-11-01

Water droplets impinging smooth superheated surfaces may be characterized by dynamic vapor bubbles rising to the surface, popping, and causing a spray of tiny droplets to erupt from the droplet. This spray is called secondary atomization. Here, atomization is quantified experimentally for water droplets impinging superheated superhydrophobic surfaces. Smooth hydrophobic and superhydrophobic surfaces with varying rib and post microstructuring were explored. Each surface was placed on an aluminum heating block, and impingement events were captured with a high speed camera at 3000 fps. For consistency among tests, all events were normalized by the maximum atomization found over a range of temperatures on a smooth hydrophobic surface. An estimate of the level of atomization during an impingement event was created by quantifying the volume of fluid present in the atomization spray. Droplet diameter and Weber number were held constant, and atomization was found for a range of temperatures through the lifetime of the impinging droplet. The Leidenfrost temperature was also determined and defined to be the lowest temperature at which atomization ceases to occur. Both atomization and Leidenfrost temperature increase with decreasing pitch (distance between microstructures).

Femoroacetabular Impingement

DTIC Science & Technology

2008-04-01

the abnormal morphology of the femoral head indicative of FAI. Prominent osteophyte formation can be seen bilaterally at the femoral head-neck...marked joint space loss of the left hip which predominantly involves the superolateral aspect of the joint (Figs. 1B and 2). Subchondral sclerosis...B). Close up view of the left hip from Fig. 1A. Superolateral joint space loss, subchondral sclerosis, cystic changes of the anterolateral femoral

[Arthroscopic therapy of ankle joint impingement syndrome after operation of ankle joint fracture dislocation].

PubMed

Feng, Zhibin; Mi, Kun; Wei, Renzhi; Liu, Wu; Wang, Bin

2011-07-01

To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, there were 28 males and 10 females with an average age of 28 years (range, 18 to 42 years). The time from internal fixation to admission was 12-16 months (mean, 13.8 months). There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from -20 to -5 degrees (mean, -10.6 degrees), and the palmar flexion was 30-40 degrees (mean, 35.5 degrees). The total score was 48.32 +/- 9.24 and the pain score was 7.26 +/- 1.22 before operation according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. All incisions healed primarily. Thirty-eight cases were followed up 10-26 months (mean, 16 months). At last follow-up, 26 patients had normal range of motion (ROM); the dorsal extension was 15-25 degrees (mean, 19.6 degrees) and the palmar flexion was 35-45 degrees (mean, 40.7 degrees). Eight patients had mild limited ROM; the dorsal extension was 5-15 degrees (mean, 7.2 degrees) and the palmar flexion was 35-45 degrees (mean, 39.5 degrees). Four patients had mild limited ROM and pain in posterior portion of the ankle after a long walking (3-4 hours); the dorsal extension was 0-5 degrees (mean, 2.6 degrees) and the palmar flexion was 35-40 degrees (mean, 37.5 degrees). The total score was 89.45 +/- 9.55 and the pain score was 1.42 +/- 1.26 after

Regeneratively cooled transition duct with transversely buffered impingement nozzles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morrison, Jay A; Lee, Ching-Pang; Crawford, Michael E

2015-04-21

A cooling arrangement (56) having: a duct (30) configured to receive hot gases (16) from a combustor; and a flow sleeve (50) surrounding the duct and defining a cooling plenum (52) there between, wherein the flow sleeve is configured to form impingement cooling jets (70) emanating from dimples (82) in the flow sleeve effective to predominately cool the duct in an impingement cooling zone (60), and wherein the flow sleeve defines a convection cooling zone (64) effective to cool the duct solely via a cross-flow (76), the cross-flow comprising cooling fluid (72) exhausting from the impingement cooling zone. In themore » impingement cooling zone an undimpled portion (84) of the flow sleeve tapers away from the duct as the undimpled portion nears the convection cooling zone. The flow sleeve is configured to effect a greater velocity of the cross-flow in the convection cooling zone than in the impingement cooling zone.« less

Magnetic Resonance Velocimetry analysis of an angled impinging jet

NASA Astrophysics Data System (ADS)

Irhoud, Alexandre; Benson, Michael; Verhulst, Claire; van Poppel, Bret; Elkins, Chris; Helmer, David

2016-11-01

Impinging jets are used to achieve high heat transfer rates in applications ranging from gas turbine engines to electronics. Despite the importance and relative simplicity of the geometry, simulations historically fail to accurately predict the flow behavior in the vicinity of the flow impingement. In this work, we present results from a novel experimental technique, Magnetic Resonance Velocimetry (MRV), which measures three-dimensional time-averaged velocity without the need for optical access. The geometry considered in this study is a circular jet angled at 45 degrees and impinging on a flat plate, with a separation of approximately seven jet diameters between the jet exit and the impingement location. Two flow conditions are considered, with Reynolds numbers of roughly 800 and 14,000. Measurements from the MRV experiment are compared to predictions from Reynolds Averaged Navier Stokes (RANS) simulations, thus demonstrating the utility of MRV for validation of numerical analyses of impinging jet flow.

Functional performance testing of the hip in athletes: a systematic review for reliability and validity.

PubMed

Kivlan, Benjamin R; Martin, Robroy L

2012-08-01

The purpose of this study was to systematically review the literature for functional performance tests with evidence of reliability and validity that could be used for a young, athletic population with hip dysfunction. A search of PubMed and SPORTDiscus databases were performed to identify movement, balance, hop/jump, or agility functional performance tests from the current peer-reviewed literature used to assess function of the hip in young, athletic subjects. The single-leg stance, deep squat, single-leg squat, and star excursion balance tests (SEBT) demonstrated evidence of validity and normative data for score interpretation. The single-leg stance test and SEBT have evidence of validity with association to hip abductor function. The deep squat test demonstrated evidence as a functional performance test for evaluating femoroacetabular impingement. Hop/Jump tests and agility tests have no reported evidence of reliability or validity in a population of subjects with hip pathology. Use of functional performance tests in the assessment of hip dysfunction has not been well established in the current literature. Diminished squat depth and provocation of pain during the single-leg balance test have been associated with patients diagnosed with FAI and gluteal tendinopathy, respectively. The SEBT and single-leg squat tests provided evidence of convergent validity through an analysis of kinematics and muscle function in normal subjects. Reliability of functional performance tests have not been established on patients with hip dysfunction. Further study is needed to establish reliability and validity of functional performance tests that can be used in a young, athletic population with hip dysfunction. 2b (Systematic Review of Literature).

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

PubMed

Griffin, D R; Dickenson, E J; O'Donnell, J; Agricola, R; Awan, T; Beck, M; Clohisy, J C; Dijkstra, H P; Falvey, E; Gimpel, M; Hinman, R S; Hölmich, P; Kassarjian, A; Martin, H D; Martin, R; Mather, R C; Philippon, M J; Reiman, M P; Takla, A; Thorborg, K; Walker, S; Weir, A; Bennell, K L

2016-10-01

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise

Surface pressure fluctuations due to an impinging underexpanded supersonic jet

NASA Astrophysics Data System (ADS)

Pundir, Binu

The impingement of supersonic jets on surfaces is of interest because of its important application to jet blast deflectors (JBD), and short takeoff and vertical landing aircraft (STOVL) during hover. Typically, on an aircraft carrier deck, the impingement of the jet blast on the deflector generates impingement tones, and structural vibrations, not only on the JBD but also on the ship deck. Therefore, apart from direct transmission of jet noise to the gallery level, there is a component of noise transmitted due to the impingement of the jet on the JBD. The objectives of this work are to study the pressure spectra (i) on a flat plate, and separately on a cone due to axisymmetric impingement of a supersonic underexpanded cold jet issuing from a convergent-divergent nozzle and (ii) on a plane jet impinging on a finite plate and an adjoining ground plane due to the impingement of a planar jet on the plate. The characteristics of the surface pressure fluctuations are numerically investigated using WIND-US 2.0. The time-dependent, compressible Euler equations for perfect gas are employed for the present computations. The impingement distance between the jet nozzle and the deflector plate, and the plate inclination with respect to the incident jet are varied. The impingement zone stagnation bubble and a high-speed radial jet with several embedded structures (shocklets) were identified on the perpendicular plate. Flows involving cones reveal the presence of detached cone shocks, enclosing a recirculation zone. The location and magnitude of the peak pressure on the cone surface are a strong function of the cone apex angle. For the two-dimensional jet impingement on angled plate the peak value of pressure occurs at normal jet impingement. The pressure at the intersection point of the plate and the ground plane is sometimes higher than the peak pressure on the plate. Beyond this point there is a sharp decrease in pressure. As the flow accelerates, an oblique shock is sometimes

Biomechanical study of pelvic discontinuity in failed total hip arthroplasty. Lessons learnt from the treatment of pelvic fractures.

PubMed

Ribes-Iborra, Julio; Atienza, Carlos; Sevil-De la Torre, Jorge; Gómez Pérez, Amelia

2017-11-01

Pelvic discontinuity is a rare but serious problem in orthopedic surgery. Acetabular reconstruction in case of severe bone loss after failed total hip arthroplasty is technically difficult, especially in segmental loss type III (anterior or posterior) or pelvic discontinuity (type IV). Acetabular reinforcement devices are frequently used as load-sharing devices to allow allograft incorporation and in order to serve as support of acetabular implants. This study tries to show, by means of biomechanic work, the efficiency of reinforced plate in anterior column in a segmental pelvic loss, illustrated with a clinical case, which shows the socket stability of hip prosthesis. © 2017 Elsevier Ltd. All rights reserved.

Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket.

PubMed

Robin, Brett N; Lubowitz, James H

2014-10-01

Anterior cruciate ligament (ACL) femoral socket techniques have distinct advantages and disadvantages when considering the following techniques: transtibial, anteromedial portal, outside-in, and outside-in retroconstruction. There is no one perfect technique and we have an incomplete understanding of anatomical, biomechanical, isometry, stability, and clinical outcomes. Our primary focus is transtibial technique for creating the ACL femoral socket. Advantages include less invasive, isometric graft placement, stable Lachman exam, and minimal graft impingement with the tunnel and notch. Disadvantages include nonanatomic vertical graft placement that can cause rotational instability and positive pivot shift, interference screw divergence, graft-tunnel length mismatch, femoral socket constraint, posterior cruciate ligament impingement, and a short, oblique tibial tunnel that may undermine the medial plateau in an attempt to achieve anatomic ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship between the alpha and beta angles in diagnosing CAM-type femoroacetabular impingement on frog-leg lateral radiographs.

PubMed

Khan, Moin; Ranawat, Anil; Williams, Dale; Gandhi, Rajiv; Choudur, Hema; Parasu, Naveen; Simunovic, Nicole; Ayeni, Olufemi R

2015-09-01

Alpha and beta angles are commonly used radiographic measures to assess the sphericity of the proximal femur and distance between the pathologic head-neck junction and the acetabular rim, respectively. The aim of this study was to explore the relationship between these two measurements on frog-leg lateral hip radiographs. Fifty frog-leg lateral hip radiographs were evaluated by two orthopaedic surgeons and two radiologists. Each reviewer measured the alpha and beta angles on two separate occasions to determine the relationship between positive alpha and beta angles and the inter- and intra-observer reliability of these measurements. There was no significant association between positive alpha and beta angles, [kappa range -0.043 (95 % CI -0.17 to 0.086) to 0.54 (95 % CI 0.33-0.75)]. Intra-observer reliability was high [alpha angle intra-class correlation coefficient (ICC) range 0.74 (95 % CI 0.58-0.84) to 0.99 (95 % CI 0.98-0.99) and beta angle ICC range 0.86 (95 % CI 0.76-0.92) to 0.97 (95 % CI 0.95-0.98)]. There is no statistical or functional relationship between readings of positive alpha and beta angles. The radiographic measurements resulted in high intra-observer and fair-to-moderate inter-observer reliability. Results of this study suggest that the presence of a CAM lesion on lateral radiographs as suggested by a positive alpha angle does not necessitate a decrease in clearance between the femoral head and acetabular rim as measured by the beta angle and thus may not be the best measure of functional impingement. Understanding the relationship between these two aspects of femoroacetabular impingement improves a surgeon's ability to anticipate potential operative management.

Two stage serial impingement cooling for isogrid structures

DOEpatents

Lee, Ching-Pang; Morrison, Jay A.

2014-09-09

A system for cooling a wall (24) of a component having an outer surface with raised ribs (12) defining a structural pocket (10), including: an inner wall (26) within the structural pocket and separating the wall outer surface within the pocket into a first region (28) outside of the inner wall and a second region (40) enclosed by the inner wall; a plate (14) disposed atop the raised ribs and enclosing the structural pocket, the plate having a plate impingement hole (16) to direct cooling air onto an impingement cooled area (38) of the first region; a cap having a skirt (50) in contact with the inner wall, the cap having a cap impingement hole (20) configured to direct the cooling air onto an impingement cooled area (44) of the second region, and; a film cooling hole (22) formed through the wall in the second region.

Active Control of Supersonic Impinging Jets Using Supersonic Microjets

DTIC Science & Technology

2005-01-01

Impinging Jets using Supersonic Microjets 5b. GRANT NUMBER F49620-03-1-0017 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Farrukh Alvi 5e. TASK...investigation on the use of microjets for the control of supersonic impinging jets was conducted under this research program. Supersonic impinging...aircraft structures and the landing surfaces. Prior research has shown that microjets , placed around the main jet periphery, are very effective in

Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing.

PubMed

Partridge, Susan; Tipper, Joanne L; Al-Hajjar, Mazen; Isaac, Graham H; Fisher, John; Williams, Sophie

2018-05-01

Wear and fatigue of polyethylene acetabular cups have been reported to play a role in the failure of total hip replacements. Hip simulator testing under a wide range of clinically relevant loading conditions is important. Edge loading of hip replacements can occur following impingement under extreme activities and can also occur during normal gait, where there is an offset deficiency and/or joint laxity. This study evaluated a hip simulator method that assessed wear and damage in polyethylene acetabular liners that were subjected to edge loading. The liners tested to evaluate the method were a currently manufactured crosslinked polyethylene acetabular liner and an aged conventional polyethylene acetabular liner. The acetabular liners were tested for 5 million standard walking cycles and following this 5 million walking cycles with edge loading. Edge loading conditions represented a separation of the centers of rotation of the femoral head and the acetabular liner during the swing phase, leading to loading of the liner rim on heel strike. Rim damage and cracking was observed in the aged conventional polyethylene liner. Steady-state wear rates assessed gravimetrically were lower under edge loading compared to standard loading. This study supports previous clinical findings that edge loading may cause rim cracking in liners, where component positioning is suboptimal or where material degradation is present. The simulation method developed has the potential to be used in the future to test the effect of aging and different levels of severity of edge loading on a range of cross-linked polyethylene materials. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1456-1462, 2018. © 2017 Wiley Periodicals, Inc.

Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes.

PubMed

Knapik, Derrick M; Sheehan, Joe; Nho, Shane J; Voos, James E; Salata, Michael J

2018-02-01

Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Cohort study; Level of evidence, 3. Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes during their first season in the NFL.

Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes

PubMed Central

Knapik, Derrick M.; Sheehan, Joe; Nho, Shane J.; Voos, James E.; Salata, Michael J.

2018-01-01

Background: Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. Purpose: To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Results: Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). Conclusion: American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes

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

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

PubMed

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

2015-09-16

To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. 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. 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. The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

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.

Radiologic assessment of femoral and tibial tunnel placement based on anatomic landmarks in arthroscopic single bundle anterior cruciate ligament reconstruction

PubMed Central

Nema, Sandeep Kumar; Balaji, Gopisankar; Akkilagunta, Sujiv; Menon, Jagdish; Poduval, Murali; Patro, Dilip

2017-01-01

Background: Accurate tibial and femoral tunnel placement has a significant effect on outcomes after anterior cruciate ligament reconstruction (ACLR). Postoperative radiographs provide a reliable and valid way for the assessment of anatomical tunnel placement after ACLR. The aim of this study was to examine the radiographic location of tibial and femoral tunnels in patients who underwent arthroscopic ACLR using anatomic landmarks. Patients who underwent arthroscopic ACLR from January 2014 to March 2016 were included in this retrospective cohort study. Materials and Methods: 45 patients who underwent arthroscopic ACLR, postoperative radiographs were studied. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation and proportions as applicable. Interobserver agreement was measured using intraclass correlation coefficient. Results: The position of the tibial tunnel was found to be at an average of 35.1% ± 7.4% posterior from the anterior edge of the tibia. The femoral tunnel was found at an average of 30% ± 1% anterior to the posterior femoral cortex along the Blumensaat's line. Radiographic impingement was found in 34% of the patients. The roof angle averaged 34.3° ± 4.3°. The position of the tibial tunnel was found at an average of 44.16% ± 3.98% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 67.5° ± 8.9°. The coronal angle of the femoral tunnel averaged 41.9° ± 8.5°. Conclusions: The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients. PMID:28566780

Posterior hip dislocation in a non-professional football player: a case report and review of the literature.

PubMed

Bakalakos, Matthaios; Benetos, Ioannis S; Rozis, Meletios; Vlamis, John; Pneumaticos, Spiros

2018-06-02

The majority of injuries during a football game are contusions, sprains and/or strains in the thigh, knee and ankle. Hip dislocations account for 2-5% of total hip dislocations, and they can be posterior or anterior. Major complications of traumatic hip dislocation include avascular necrosis of femoral head, secondary osteoarthritis, sciatic nerve injury and heterotopic ossification. On the occasion of a case of a 33-year-old football player, who suffered a posterior hip dislocation, associated with a posterior wall fracture of the acetabulum, while playing football, we review the literature and analyze the various mechanisms of injury, the possible complications and the management including surgery and rehabilitation.

Rocket exhaust plume impingement on the Voyager spacecraft

NASA Technical Reports Server (NTRS)

Baerwald, R. K.

1978-01-01

In connection with the conduction of the long-duration Voyager missions to the outer planets and the sophisticated propulsion systems required, it was necessary to carry out an investigation to avoid exhaust plume impingement problems. The rarefied gas dynamics literature indicates that, for most engineering surfaces, the assumption of diffuse reemission and complete thermal accommodation is warranted in the free molecular flow regime. This assumption was applied to an analysis of a spacecraft plume impingement problem in the near-free molecular flow regime and yielded results to within a few percent of flight data. The importance of a correct treatment of the surface temperature was also demonstrated. Specular reflection, on the other hand, was shown to yield results which may be unconservative by a factor of 2 or 3. It is pointed out that one of the most difficult portions of an exhaust plume impingement analysis is the simulation of the impinged hardware. The geometry involved must be described as accurately and completely as possible.

Increasing alpha angle is predictive of athletic-related "hip" and "groin" pain in collegiate National Football League prospects.

PubMed

Larson, Christopher M; Sikka, Robby S; Sardelli, Matthew C; Byrd, J W Thomas; Kelly, Bryan T; Jain, Rahul K; Giveans, M Russell

2013-03-01

The first purpose was to evaluate radiographic pathomorphology/abnormalities in a cohort of high-level collegiate football players screened with hip radiographs. The second purpose was to define the radiographic predictors of athletic-related "hip" and "groin" symptoms in this cohort of high-level athletes. The study population included all male collegiate football players undergoing evaluation and hip radiography at the National Football League (NFL) Scouting Combine in 2009 and 2010. All radiographs were evaluated with a detailed evaluation for hip pathomorphology. Symptoms were recorded as symptomatic or asymptomatic with respect to athletic-related groin/hip pain for comparative purposes. There were 125 players (239 hips) who had hip radiographs and were included in the final cohort. Ninety percent of players (87% of hips) in this cohort had at least 1 finding consistent with cam-type and/or pincer-type femoroacetabular impingement (FAI). There were 75 hips in the symptomatic group and 164 hips in the asymptomatic group. Although the symptomatic group had a greater prevalence of cam-type FAI (P = .009), combined-type FAI (P < .001), and osteitis pubis (P = .014), increasing alpha angle (larger cam deformities) was the only independent predictor of athletic-related groin pain (P = .01). There was no correlation, however, between FAI and body mass index (P = .659), player position (P = .166), or whether a player was drafted by an NFL team (P = .430). Radiographic signs of FAI were frequently seen in collegiate NFL prospects who were screened with hip radiographs. Although patients with radiographic evidence of osteitis pubis, cam- and combined-type FAI, and larger cam deformities showed a statistically higher prevalence of symptoms, increasing alpha angle (larger cam deformity) was the only independent predictor of athletic-related hip/groin pain. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by

Hip range of motion and provocative physical examination tests reliability and agreement in asymptomatic volunteers

PubMed Central

Prather, H; Harris-Hayes, M; Hunt, D; Steger-May, K; Mathew, V; Clohisy, JC

2012-01-01

Objective The objectives of this study are the following: 1) report passive hip ROM in asymptomatic young adults, 2) report the intra-tester and inter-tester reliability of hip ROM measurements among testers of multiple disciplines, 3) report the results of provocative hip tests and tester agreement. Design descriptive epidemiology study Setting tertiary university Participants Twenty-eight young adult volunteers without musculoskeletal symptoms, history of disorder or surgery involving the lumbar spine or lower extremities were enrolled and completed the study. Methods Asymptomatic young adult volunteers completed questionnaires and were examined by two blinded examiners during a single session. The testers were physical therapists and physicians. Hip range of motion and provocative tests were completed by both examiners on each hip. Main Outcome Measurements Inter and intra-rater reliability for ROM and agreement for provocative tests was determined. Results Twenty-eight asymptomatic adults with mean age 31 years old (range 18–51 years) and mean modified Harris Hip Score of 99.5 ± 1.5 and UCLA Activity score of 8.8 ± 1.2 completed the study. Intra-rater agreement was excellent for all hip range of motion measurements, with intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.97 with similar agreement if the examiner was a physical therapist or a physician. Excellent inter-rater reliability was found for hip flexion ICC 0.87 (95% CI 0.78 to 0.92), supine internal rotation ICC 0.75 (95% CI 0.60 to 0.84) and prone internal rotation ICC 0.79 (95% CI 0.66 to 0.87). The least reliable measurements were supine hip abduction (ICC 0.34) and supine external rotation (ICC 0.18). Agreement between examiners ranged from 96–100% for provocative hip tests which included the hip impingement, resisted straight leg raise, FABER/Patrick’s and log roll tests. Conclusions Specific hip ROM measures show excellent inter-rater reliability and provocative hip tests

Experimental Study of Impinging Jets Flow-Fields

DTIC Science & Technology

2016-07-27

1 Grant # N000141410830 Experimental Study of Impinging Jet Flow-Fields Final Report for Period: Jun 15, 2014 – Jun 14, 2016 PI: Dennis K...impinging jet model in the absence of any jet heating. The results of the computations had been compared with the experimental data produced in the...of the validity of the computations, and also of the experimental approach. Figure 12a. Initial single

Origin of the direct and reflected head of the rectus femoris: an anatomic study.

PubMed

Ryan, John M; Harris, Joshua D; Graham, William C; Virk, Sohrab S; Ellis, Thomas J

2014-07-01

This study aimed to define the footprint of the direct and reflected heads of the rectus femoris and the relation of the anterior inferior iliac spine (AIIS) to adjacent neurovascular (lateral circumflex femoral artery and femoral nerve), bony (anterior superior iliac spine [ASIS]), and tendinous structures (iliopsoas). Twelve fresh-frozen cadaveric hip joints from 6 cadavers, average age of 44.5 (±9.9) years, were carefully dissected of skin and fascia to expose the muscular, capsular, and bony structures of the anterior hip and pelvis. Using digital calipers, measurements were taken of the footprint of the rectus femoris on the AIIS, superior-lateral acetabulum and hip capsule, and adjacent anatomic structures. The average dimensions of the footprint of the direct head of the rectus femoris were 13.4 mm (±1.7) × 26.0 mm (±4.1), whereas the dimensions of the reflected head footprint were 47.7 mm (±4.4) × 16.8 mm (±2.2). Important anatomic structures, including the femoral nerve, psoas tendon, and lateral circumflex femoral artery, were noted in proximity to the AIIS. The neurovascular structure closest to the AIIS was the femoral nerve (20.8 ± 3.4 mm). The rectus femoris direct and reflected heads originate over a broad area of the anterolateral pelvis and are in close proximity to critical neurovascular structures, and care must be taken to avoid them during hip arthroscopy. A thorough knowledge of the anatomy of the proximal rectus femoris is valuable for any surgical exposure of the anterior hip joint, particularly arthroscopic subspine decompression and open femoroacetabular impingement (FAI) surgery. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Supersonic impinging jet noise reduction using a hybrid control technique

NASA Astrophysics Data System (ADS)

Wiley, Alex; Kumar, Rajan

2015-07-01

Control of the highly resonant flowfield associated with supersonic impinging jet has been experimentally investigated. Measurements were made in the supersonic impinging jet facility at the Florida State University for a Mach 1.5 ideally expanded jet. Measurements included unsteady pressures on a surface plate near the nozzle exit, acoustics in the nearfield and beneath the impingement plane, and velocity field using particle image velocimetry. Both passive control using porous surface and active control with high momentum microjet injection are effective in reducing nearfield noise and flow unsteadiness over a range of geometrical parameters; however, the type of noise reduction achieved by the two techniques is different. The passive control reduces broadband noise whereas microjet injection attenuates high amplitude impinging tones. The hybrid control, a combination of two control methods, reduces both broadband and high amplitude impinging tones and surprisingly its effectiveness is more that the additive effect of the two control techniques. The flow field measurements show that with hybrid control the impinging jet is stabilized and the turbulence quantities such as streamwise turbulence intensity, transverse turbulence intensity and turbulent shear stress are significantly reduced.