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Sample records for anterior hip impingement

  1. Anterior Inferior Iliac Spine (AIIS) and Subspine Hip Impingement.

    PubMed

    Carton, Patrick; Filan, David

    2016-01-01

    Abnormal morphology of the anterior inferior iliac spine (AIIS) and the subspine region of the acetabular rim are increasingly being recognised as a source of symptomatic extra-articular hip impingement. This review article aims to highlight important differences in the pathogenesis, clinical presentation and management of extra-articular hip impingement from both the AIIS and subspine bony regions, and the outcome following surgical intervention. A literature review was undertaken to examine the supporting evidence for AIIS and subspine hip impingement. A narrative account of the Author's professional experience in this area, including operative technique for arthroscopic correction, is also presented. Abnormal morphology of the AIIS and subspine region has been classified using cadaveric, radiological and arthroscopic means; the clinical presentation and operative treatment has been documented in several case series studies. Dual pathology is often present - recognition and treatment of both intra- and extra-articular components are necessary for good postoperative outcome. AIIS and sub-spine hip impingement should be considered as distinct pathological entities, which may also co-exist. Symptom relief can be expected following arthroscopic deformity correction with the treatment of concomitant intra-articular pathology. Failure to recognise and treat the extra-articular component may affect postoperative outcome. V.

  2. Anterior Inferior Iliac Spine (AIIS) and Subspine Hip Impingement

    PubMed Central

    Carton, Patrick; Filan, David

    2016-01-01

    Summary Background Abnormal morphology of the anterior inferior iliac spine (AIIS) and the subspine region of the acetabular rim are increasingly being recognised as a source of symptomatic extra-articular hip impingement. This review article aims to highlight important differences in the pathogenesis, clinical presentation and management of extra-articular hip impingement from both the AIIS and subspine bony regions, and the outcome following surgical intervention. Methods A literature review was undertaken to examine the supporting evidence for AIIS and subspine hip impingement. A narrative account of the Author’s professional experience in this area, including operative technique for arthroscopic correction, is also presented. Results Abnormal morphology of the AIIS and subspine region has been classified using cadaveric, radiological and arthroscopic means; the clinical presentation and operative treatment has been documented in several case series studies. Dual pathology is often present - recognition and treatment of both intra- and extra-articular components are necessary for good postoperative outcome. Conclusions AIIS and sub-spine hip impingement should be considered as distinct pathological entities, which may also co-exist. Symptom relief can be expected following arthroscopic deformity correction with the treatment of concomitant intra-articular pathology. Failure to recognise and treat the extra-articular component may affect postoperative outcome. Level of evidence V. PMID:28066737

  3. Hip impingement: beyond femoroacetabular

    PubMed Central

    Bardakos, Nikolaos V.

    2015-01-01

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

  4. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement: early patient reported outcomes.

    PubMed

    Srinivasan, Sreebala C M; Hosny, Hazem A H; Williams, Mark R

    2013-01-01

    Many surgical techniques have been described for femoroacetabular impingement (FAI) surgery to help with improvement of pain and function in symptomatic patients. The aim of this study was to evaluate early patient reported outcomes and complications using combined hip arthroscopy and limited open osteochondroplasty technique. We retrospectively analysed 27 hips in 26 patients. Outcomes were assessed using the nonarthritic hip score (NAHS), UCLA score and Visual analogue scale (VAS) pain score. The average age of patients was 31.3 years and they were followed up for an average of 22.3 months. Average improvement of NAHS score was 39.55 points (p<.0001), 18 patients (72%) had at least 30 points increase in NAHS. There was 3 points average improvement in UCLA score (p<.0001). 17 patients (68%) had UCLA activity level of 6 and above. The average improvement of VAS pain score was 27.5 points (p<.0001). Minor complications included neuropraxia of the lateral femoral cutaneous nerve in three patients who recovered at three months with no sequelae, while one patient developed asymptomatic heterotopic ossification Brooker grade I. One patient had neuropraxia of the sciatic nerve which recovered completely within six months. One patient had a conversion to THR at 12 months. This is an effective technique to treat FAI for reducing pain and improving function at short term follow-up and has a low complication rate without appearing to have a significant learning curve. The failure rate can be reduced if proper case selection is done.

  5. Arthroscopic Resection of a Large Bony Exostosis Arising from the Anterior Inferior Iliac Spine Causing Extra-articular Hip Impingement: A Case Series

    PubMed Central

    Carton, Patrick; Filan, David

    2016-01-01

    Introduction: Abnormal morphology of the anterior inferior iliac spine (AIIS) is a rarely recognized but important source of extra-articular hip impingement. Chronic progressive symptoms of stiffness and limitation of hip motion with persistent groin pain may place significant restriction on activity. Concomitant femoroacetabular impingement is often present but recognition and effective treatment of the uncommon extra-articular component is important for successful outcome. Case Report: Three cases of symptomatic extra-articular hip impingement secondary to AIIS deformity and in conjunction with mild underlying femoroacetabular impingement (FAI) are presented. They include two athletic Caucasian males aged 27 and 35-years old with a history of prior rectus tendon injury and secondary bony exostosis formation and a 53-year-old Caucasian male with a nontraumatic, developmental AIIS deformity. In all cases, an excellent clinical outcome with a full return to pain free activity was achieved postoperation. Their clinical presentation, diagnosis and post-operative outcome at 1.5-2 years (mean 1.7 years) following arthroscopic AIIS resection are discussed. Conclusion: Arthroscopic management of AIIS extra-articular hip impingement has been rarely reported and the longer-term outcome is unknown. We report the successful clinical outcome in a case series of three patients up to 2 years following arthroscopic AIIS resection. This case series demonstrates the sustainable benefits of arthroscopic correction of AIIS bony exostosis as a cause of extra-articular FAI. PMID:27299135

  6. Psoas impingement syndrome in hip osteoarthritis.

    PubMed

    Di Lorenzo, Luigi; Jennifer, Yanow; Pappagallo, Marco

    2009-01-01

    The degenerative processes underlying osteoarthritis of the hip produce both anatomical and biomechanical changes in and around the involved joint. A good understanding of hip anatomy and the forces crossing the hip joint is essential to understand both hip pathology and current treatment techniques. Total hip arthroplasty (THA) has become a mainstay of treatment for advanced osteoarthritis of the hip. Several factors contribute to post-operative hip pain in THA patients. Iliopsoas impingement on the prosthetic cup after total hip replacement is one of the causes of pain following hip surgery, often due to an anterior overlap of the implant with respect to the acetabulum. The anatomic shape of the anterior acetabular ridge, which may be straight or curved, influences this overlap. In this paper we present a case illustrating a psoas impingement-like syndrome in a patient with severe hip osteoarthritis who has not undergone hip replacement surgery. We discuss the compensatory strategies employed by the patient to reduce pain and prevent falls, and show CT scan images depicting the underlying anatomic pathology.

  7. Femoroacetabular impingement and osteoarthritis of the hip

    PubMed Central

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

    2015-01-01

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

  8. Femoroacetabular impingement and osteoarthritis of the hip.

    PubMed

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

    2015-12-01

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

  9. Effect of soft-tissue impingement on range of motion during posterior approach Total Hip Arthroplasty: an in vivo measurement study.

    PubMed

    Nakamura, Nobuo; Maeda, Yuki; Hamawaki, Makoto; Sakai, Takashi; Sugano, Nobuhiko

    2016-12-01

    While implant impingement and bony impingement have been recognized as causes of poor outcomes in total hip arthroplasty (THA), reports of soft-tissue impingement are rare. To clarify the issue, the effect of anterior capsule resection on hip range of motion (ROM) was quantitatively measured in vivo during posterior approach THA using a CT-based hip navigation system. For 47 patients (51 hips), hip ROM was measured intraoperatively before and after resection of the anterior hip capsule, and the difference was compared. Resection of the anterior hip capsule brought about an average 6° increase of ROM in the direction of flexion with internal rotation and did not markedly change ROM in other directions. During THA through a posterior approach, soft-tissue impingement by the anterior hip capsule can occur. Clinically, we expect that resection of the anterior hip capsule can reduce the risk of posterior instability without increasing the risk of anterior instability.

  10. Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement.

    PubMed

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

    2014-04-01

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

  11. Editorial Commentary: The Hip Bone's Connected to the Knee Bone, but Correlation Does Not Equal Causation-The Association of Hip Motion, Femoroacetabular Impingement, and Anterior Cruciate Ligament Injury.

    PubMed

    Harris, Joshua D

    2017-02-01

    Patients with anterior cruciate ligament (ACL) injury had significantly less hip rotational motion (internal rotation [IR] and sum of IR and external rotation) than control subjects without ACL tears. For each hip IR increase of 10°, the odds of sustaining an ACL rupture decreased by a factor of 0.419. Although this investigation does not prove (causation) that loss of hip rotational motion causes an ACL tear, it does continue to complement the growing and evolving literature base showing an upstream or downstream association (correlation) of decreased hip motion on adjacent structures.

  12. Anterior hip pain.

    PubMed

    O'Kane, J W

    1999-10-15

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

  13. Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

    PubMed

    Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

    2010-06-01

    Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior

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

    PubMed

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

    2013-07-01

    We identified and compared the impingent-free range of motion (ROM) and subluxation potential for native hip, femoral head resurfacing (FHR), and total hip arthroplasty (THA). These constructs were also compared both with and without soft tissue to elucidate the role of the soft tissue. Five fresh-frozen bilateral hip specimens were mounted to a six-degree of freedom robotic manipulator. Under load-control parameters, in vivo mechanics were recreated to evaluate impingement free ROM, and the subluxation potential in two "at risk" positions for native hip, FHR, and THA. Impingement-free ROM of the skeletonized THA was greater than FHR for the anterior subluxation position. For skeletonized posterior subluxations, stability for THA and FHR constructs were similar, while a different pattern was observed for specimens with soft tissues intact. FHR constructs were more stable than THA constructs for both anterior and posterior subluxations. When the femoral neck is intact the joint has an earlier impingement profile placing the hip at risk for subluxation. However, FHR design was shown to be more stable than THA only when soft tissues were intact. Copyright © 2013 Orthopaedic Research Society.

  15. 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

  16. Hip kinematics and kinetics in persons with and without cam femoroacetabular impingement during a deep squat task.

    PubMed

    Bagwell, Jennifer J; Snibbe, Jason; Gerhardt, Michael; Powers, Christopher M

    2016-01-01

    Previous studies have indicated that hip and pelvis kinematics may be altered during functional tasks in persons with femoroacetabular impingement. The purpose of this study was to compare hip and pelvis kinematics and kinetics during a deep squat task between persons with cam femoroacetabular impingement and pain-free controls. Fifteen persons with cam femoroacetabular impingement and 15 persons without cam femoroacetabular impingement performed a deep squat task. Peak hip flexion, abduction, and internal rotation, and mean hip extensor, adductor, and external rotator moments were quantified. Independent t-tests (α<0.05) were used to evaluate between group differences. Compared to the control group, persons with cam femoroacetabular impingement demonstrated decreased peak hip internal rotation (15.2° (SD 9.5°) vs. 9.4° (SD 7.8°); P=0.041) and decreased mean hip extensor moments (0.56 (SD 0.12) Nm/kg vs. 0.45 (SD 0.15) Nm/kg; P=0.018). In addition persons in the cam femoroacetabular impingement group demonstrated decreased posterior pelvis tilt during squat descent compared to the control group, resulting in a more anteriorly tilted pelvis at the time peak hip flexion (12.5° (SD 17.1°) vs. 23.0° (SD 12.4°); P=0.024). The decreased hip internal rotation observed in persons with cam femoroacetabular impingement may be the result of bony impingement. Furthermore, the decrease in posterior pelvis tilt may contribute to impingement by further approximating the femoral head-neck junction with the acetabulum. Additionally, decreased hip extensor moments suggest that diminished hip extensor muscle activity may contribute to decreased posterior pelvis tilt. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  19. Impingement in Total Hip Replacement: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D.; Callaghan, John J.

    2009-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  1. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes.

    PubMed

    Chalmers, Brian P; Sculco, Peter K; Sierra, Rafael J; Trousdale, Robert T; Berry, Daniel J

    2017-04-05

    A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy. Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs. At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07). Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  2. Impaired hip muscle strength in patients with femoroacetabular impingement syndrome.

    PubMed

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

    2017-05-25

    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.

  3. Ischiofemoral impingement of the hip: a novel approach to treatment.

    PubMed

    Safran, Marc; Ryu, Jessica

    2014-04-01

    Ischiofemoral impingement (IFI) is an uncommon source of hip pain recently described in the non-surgical hip, associated with decreased space between the lesser trochanter and the ischium. There are no reports in the English literature of surgical treatment of this problem. We describe a case of IFI in a 19-year-old female who failed conservative management and underwent endoscopic surgical intervention to increase the space between her ischium and proximal femur. More than 2 years later, the patient is doing very well with an improvement of her iHOT score of 53 points to 85.

  4. Advanced hip joint degeneration associated with femoroacetabular impingement in a retired chiropractor

    PubMed Central

    Emary, Peter C.; Taylor, John A.

    2016-01-01

    Femoroacetabular impingement is a relatively new clinical entity only recently described in the orthopedic literature. In this report, we document a severe case of hip joint osteoarthritis associated with cam-type impingement in a retired chiropractor. PMID:27713583

  5. Reliability of hip examination tests for femoroacetabular impingement.

    PubMed

    Ratzlaff, Charles; Simatovic, Jacqueline; Wong, Hubert; Li, Linda; Ezzat, Allison; Langford, Dolores; Esdaile, John M; Kennedy, Carol; Embley, Patrick; Caves, Darryl; Hopkins, Trish; Cibere, Jolanda

    2013-10-01

    To assess the interrater reliability of hip examination tests used to assess femoroacetabular impingement (FAI) among clinicians from different disciplines. Twelve subjects were examined by 9 clinicians using 12 hip tests drawn from a review of the literature and consultation with experts in hip pain and FAI. Examiners assessed both hips of each subject and were blinded to subject history. The order in which subjects were seen, the order of tests, and order of examination of the 2 hips within each subject were all randomized. Interrater reliability (IRR) for the 10 categorical tests was summarized using overall raw agreement (ORA), positive agreement (agreement on abnormal findings), and negative agreement (agreement on normal findings). An ORA of >0.75 was considered to indicate adequate reliability. For the 2 range of motion (ROM) outcomes, IRR was summarized using the median of the absolute difference (MAD) in measurements obtained by any 2 examiners on any patient. MAD reflects the "typical" difference (in degrees) between 2 raters. Adequate reliability (ORA >0.75) was achieved for 6 of the 10 hip examination tests with categorical outcomes. Positive agreement ranged from 0.35 to 0.84, while negative agreement ranged from 0.62 to 0.99. For the ROM outcomes, examiners were, on average, within 5° of each other for flexion and 7° for internal rotation. The results provide evidence that the most common hip examination tests would likely be sufficiently reliable to allow agreement between examiners when discriminating between painful FAI and normal hips in a clinical setting. Copyright © 2013 by the American College of Rheumatology.

  6. Hip Arthroscopy in athletes with Femoroacetabular Impingement: functional outcomes

    PubMed Central

    Magi, Gonzalo; Carucci, Juan Pablo; Berro, Manuel; Bergues, Sebastián

    2017-01-01

    Introduction: Hip pathology is being recognized with more frequency as source of disability and functional limitation in athletes. It has been stated that the overload made with certain positions during some sports activities can develop condral damage. Moreover, the sum of bone deformity and repetitive movements of the hip requiered in sports may increase the risk of causing injuries. These can be treated with hip arthroscopy. Despite of this, there is a lack of evidence about the time taken to return to sports activity and the level reached afterwards by those patients treated with this procedure. Objective: Describe the clinical evolution, the time taken to return to sports activity and the level reached a year after the treatment of femoroacetabular impingement (FAI) with hip arthroscopy in 23 athletes. Method: 23 athletes were included in the study, defined as those patients with a minimum of 6 hours a week of sports practice, who were treated for FAI with hip arthroscopy between 2010 and 2015 by the same surgeon at our institution. The diagnosis was clinical (positive impingement test, hip pain and functional limitation of the hip), radiological (cam and pincer) and with magnetic nuclear resonance (labral tears). Preoperative modified Harris hip score was registered in all cases. Tonnis radiographic score was used. All patients had type 0 or 1 Tonnis hips. After 3 months of ineffective non operative treatment the arthroscopy was performed. Patients were treated in dorsal decubitus with orthopedic table. Labral reconstruction with anchors and femoral and acetabular osteoplasty was made. After surgery, patients were able to walk with support for 4 weeks and began physiotherapy. A year after surgery, all patients were questioned about the time taken to return to sports activity and the level of activity reached at that time compared to the one they had before symptoms appeared. The modified Harris hip score was also registered. Results: Ten patients played

  7. Fifty Most Cited Articles for Femoroacetabular Impingement and Hip Arthroscopy

    PubMed Central

    Lee, Simon; Shin, Jason; Haro, Marc; Khair, Michael; Riboh, Jonathan C.; Kuhns, Benjamin D.; Bush-Joseph, Charles A.; Nho, Shane J.

    2015-01-01

    Growing awareness of femoroacetabular impingement (FAI) and recent innovations in management have resulted in hip arthroscopy becoming one of the fastest-growing orthopedic subspecialties. The purpose of this study was to identify the 50 most cited articles related to the topic of FAI and hip arthroscopy and to analyze their characteristics. The overall number of citations within these articles ranged from 99 to 820. Citation density ranged from 4.41 to 74.55. Seven countries produced these articles with the majority attributed to the United States (n = 26) and Switzerland (n = 18). Clinical studies made up more than half of the top articles (n = 27). The Journal of Bone and Joint Surgery level of evidence most commonly encountered was level IV (n = 24), while the remaining articles were level III (n = 3). No randomized controlled trials or non-randomized controlled trials were encountered in this search. The level of evidence was not significantly correlated with the overall number of citations, publication year, or citation density. The current top 50 list provides orthopedic surgeons interested in hip arthroscopy with an up-to-date core list of the most cited articles in the scientific literature and represents a foundation to use to develop their knowledge regarding hip arthroscopy and FAI. PMID:26347872

  8. 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.

  9. 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

  10. 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

  11. The lesser trochanter as a cause of hip impingement: pathophysiology and treatment options.

    PubMed

    Ganz, Reinhold; Slongo, Theddy; Turchetto, Luigino; Massè, Alessandro; Whitehead, David; Leunig, Michael

    2013-01-01

    Impingement of the lesser trochanter on the ischium or the posterior acetabular rim is not a frequent pathology, but has recently received increased recognition. We have seen 14 cases over a period of 14 years, but concentrate on eight hips showing complex deformities revealing similar characteristics. All eight hips had a residual Perthes or a Perthes-like disease with an elliptically deformed femoral head, but a congurent joint a short or absent femoral neck, a high riding greater trochanter, and a reduced vertical distance between the head and the lesser trochanter. Impingement took place between the lesser trochanter and the ischium or the posteroinferior acetabular border, but was hardly recognisable due to the predominant intraarticular impingement of the nonspherical femoral head and the extraarticular impingement of the greater trochanter. In three cases the impingement showed reproducible subluxation of the hip. While in our hips, excision was the preferred treatment for impingement due to an oversized lesser trochanter, distal advancement was used in the hips with the Perthes morphology; the surgical time was not longer. The overall clinical results in this group however were dominated by a substantial increase in the range of motion (ROM), dependent mainly on the achieved contour of the femoral head and the relative lengthening of the neck. Strength of active hip flexion was normal. Recurrent subluxation disappeared and no complications were recorded.

  12. Are "normal hips" being labeled as femoroacetabular impingement due to EE angle?

    PubMed

    You, Tian; Yang, Bei; Zhang, Xin-Tao; Jiang, Xiao-Cheng; Wang, Shuang; Zhang, Wen-Tao

    2017-03-01

    Gluteal muscle contracture (GMC) is a clinical syndrome characterized by gait abnormality and limb dysfunction, as well as secondary deformities of pelvis and femur. Femoroacetabular impingement (FAI) typically could be diagnosed on the basis of computed tomography (CT) such as the equatorial-edge angle (EE angle), but it did not work well in GMC patients. In this study, we retrospected all image data and found small EE angles in GMCs, which meant retroverted acetabulum; however, none of them showed no symptoms and signs of FAI. Therefore, we had reasons to think that, some normal hips with unbalanced hip myodynamia as same as GMCs, may be incorrectly diagnosed as FAI through measuring EE angle only.In consequence, the paper was designed to assess the use of the EE angle in the assessment of FAI in the diagnosis, as described by Werner.Twenty-three patients (46 hips) were collected and calculated with the "equatorial-edge angle" (EE angle) by CT scans. All of them were excluded from FAI.Review of the hips showed a mean EE angle was 12.93°, with a minimum of -3.42° and a maximum of 24.08°. The mean value for males and females were 13.52° and 12.40°, respectively, without statistical significance, although the mean value of left hips and right sides reached 13.32° and 12.54° individually, not having statistical differences neither. There were not any symptoms or signs of FAI in all patients. Thus, the reduced EE angle could suggest the local excessive coverage of the femoral head by the anterior acetabular edge, but might not be a reasonably good predictor of FAI.GMC patient's acetabular deformity mainly manifests as increased retroversion, which may be the anatomical basis for FAI and lead to high risks of the acetabular impingement. However, all patients in this study showed no symptoms and signs of FAI, suggesting that the measurement of EE angle can only be applied to assessing those people with normal hip myodynamia, and the bone deformity and the

  13. A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement

    PubMed Central

    Tjong, Vehniah K.; Cogan, Charles J.; Riederman, Brett D.; Terry, Michael A.

    2016-01-01

    Background: Hip arthroscopy for femoroacetabular impingement (FAI) is known to produce excellent outcomes, yet some patients do not return to their preinjury level of sport participation. Much literature on return to sport has revolved around anterior cruciate ligament reconstruction and even shoulder instability, but none to date have used qualitative, semistructured patient interviews on patients with hip labral tears. Purpose: To understand the factors influencing the decision to return to sport after arthroscopic hip surgery for FAI. Study Design: Case series; Level of evidence, 4. Methods: An experienced interviewer conducted qualitative, semistructured interviews of patients aged 18 to 60 years who had arthroscopic hip surgery for FAI. All had preinjury participation in sport and a minimum 2-year follow-up with no revision surgery. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sports participation by type, level of competition, and frequency along with patient-reported hip function was also obtained. In addition, current modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), Hip Outcome Score–sports-specific subscale (HOS-SSS), and a coping mechanism evaluation (Brief COPE) were also recorded. Results: A total of 23 patients were interviewed to reveal the overarching themes of internal motivation, external encouragement, and resetting expectations as the predominant factors influencing a patient’s decision to return to preinjury sport. Subjective outcome measurements (mHHS, iHOT-12, patient satisfaction) showed significant differences between patients who did and did not return to sport. Interestingly, the adaptive and maladaptive coping mechanisms matched and supported our themes in those patients who described fear and self-motivation as defining features influencing their cessation of or return to play, respectively. Conclusion: Self-motivation, aging, pain

  14. Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies

    PubMed Central

    Mayne, E.; Memarzadeh, A.; Raut, P.; Arora, A.

    2017-01-01

    Objectives The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. Methods The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only. Results A total of 29 articles were reviewed to obtain information on a number of variables. These comprised the type of device used for measurement, rater standardisation, the type of movements tested, body positioning and comparative studies of muscle strength in FAI versus normal controls. The studies found that hip muscle strength is lower in patients with FAI; this is also true for the asymptomatic hip in patients with FAI. Conclusions Current literature on this subject is limited and examines multiple variables. Our recommendations for achieving reproducible results include stabilising the patient, measuring isometric movements and maximising standardisation by using a single tester and familiarising the participants with the protocol. Further work must be done to demonstrate the reliability of any new testing method. Cite this article: E. Mayne, A. Memarzadeh, P. Raut, A. Arora, V. Khanduja. Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies: A systematic review. Bone Joint Res 2017;6:66–72. DOI: 10.1302/2046-3758.61.BJR-2016-0081. PMID:28108483

  15. 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)

  16. 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)

  17. In-vivo hip arthrokinematics during supine clinical exams: Application to the study of femoroacetabular impingement.

    PubMed

    Kapron, Ashley L; Aoki, Stephen K; Peters, Christopher L; Anderson, Andrew E

    2015-08-20

    Visualization of hip articulation relative to the underlying anatomy (i.e., arthrokinematics) is required to understand hip dysfunction in femoroacetabular (FAI) patients. In this exploratory study, we quantified in-vivo arthrokinematics of a small cohort of asymptomatic volunteers and three symptomatic patients with varying FAI deformities during the passive impingement, FABER, and rotational profile exams using dual fluoroscopy and model-based tracking. Joint angles, joint translations, and relative pelvic angles were calculated. Compared to the 95% confidence interval of the asymptomatic cohort, FAI patients appeared to have decreased adduction and internal rotation during the impingement exam and greater flexion and less abduction/external rotation in the FABER exam. During the rotational profile, only the FAI patient with the most severe deformities demonstrated considerable rotation deficits. In all participants, contact between the labrum and femoral head/neck limited motion during the impingement exam, but not the rotational profile. Substantial pelvic motion was measured during the impingement exam and FABER test in all participants. Femoral translation along any given anatomical direction ranged between 0.69 and 4.1mm. These results suggest that hip articulation during clinical exams is complex in asymptomatic hips and hips with FAI, incorporating pelvic motion and femur translation. Range of motion appears to be governed by femur-labrum contact and other soft tissue constraints, suggesting that current computer simulations that rely on direct bone contact to predict impingement may be unrealistic. Additional research is necessary to confirm these preliminary results. Still, dual fluoroscopy data may serve to validate existing software platforms or create new programs that better-represent hip arthrokinematics. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. [Hip arthroscopy in males younger than 40 with femoroacetabular impingement: short-term outcomes].

    PubMed

    Más Martínez, J; Morales-Santías, M; Bustamante Suarez Suarez de Puga, D; Sanz-Reig, J

    2014-01-01

    Femoroacetabular impingement is probably the most common mechanism that leads to the development of early cartilage and labral damage in the non-dysplastic hip. The objective was to evaluate the outcomes of hip arthroscopy as a treatment for femoroacetabular impingement in patients with high level of function. A prospective study was performed on 41 patients younger than 40 years old undergoing hip arthroscopy for femoroacetabular impingement. Modified Harris Hip Score and HOS and IHOT questionnaires were used for clinical assessment. Radiological evaluation was made for joint space and alpha angle. The mean age of patients was 32.7 years. Labrum injury was detected in 78%, and acetabular cartilage injury in 56% of cases. The average follow-up was 31.3 months. There was a significantly improvement in the mean score in the clinical questionnaires. Radiologically there was no change in the mean joint space, with significantly reduction to normal values of the alpha angle. All patients returned to sports at their pre-injury level of function. Hip arthroscopy resulted in improvement in hip functional outcomes with correction of the underlying osseous deformity and treatment of the associated labral and cartilage pathology, with the return of patients to their pre-injury sports. Further follow-up is essential to confirm the stability of the clinical and radiological outcomes. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  19. Metal neck and liner impingement in ceramic bearing total hip arthroplasty.

    PubMed

    Lee, Young-Kyun; Yoo, Jeong Joon; Koo, Kyung-Hoi; Yoon, Kang Sup; Kim, Hee Joong

    2011-02-01

    Although impingement between the neck of the metallic stem and the ceramic liner has been suspected to be the cause of ceramic liner failure in ceramic-on-ceramic total hip arthroplasty (THA), no report has directly demonstrated microscopic damage on ceramic liner. We performed 18 reoperations on 18 patients who had undergone third generation ceramic-on-ceramic THA. Considering impingement, 16 patients, who were reoperated more than 1 year after previous ceramic bearing THA, were evaluated. Retrieved alumina liners, showing evidence of impingement, were examined by means of visual inspection and scanning electron microscopy (SEM). Four of the 16 hips showed neck notching and black stained liners, evidence of metallic neck to ceramic impingement. Impinged alumina bearings had been implanted for an average of 62.5 months (range: 35-99 months) before reoperation. SEM of the black stained area demonstrated disruptive wear and loss of surface integrity. Furthermore, one liner had multiple microcracks, and its cross-sectional SEM analysis revealed one microcrack propagating into the deep portion of the ceramic liner. Our observations suggest that metal neck-to-ceramic impingement in ceramic-on-ceramic THA can cause microcrack formation in ceramic liner. Copyright © 2010 Orthopaedic Research Society.

  20. MRI Evaluation of Femoroacetabular Impingement After Hip Preservation Surgery.

    PubMed

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

    2016-08-01

    This article reviews the surgical treatment options for femoroacetabular impingement (FAI), including labral repair and osteochondroplasty, and the expected postoperative appearance on MRI. Complications, including residual osseous deformities, chondral injury, adhesions, femoral neck stress fractures, osteonecrosis, instability, malpositioned suture anchors, and infection, will also be discussed. Knowledge of the surgical treatment of FAI can assist in improving our understanding of the expected postoperative MRI appearance and in evaluating surgical complications.

  1. Regional variations in MR relaxation of hip joint cartilage in subjects with and without femoralacetabular impingement.

    PubMed

    Subburaj, Karupppasamy; Valentinitsch, Alexander; Dillon, Alexander B; Joseph, Gabby B; Li, Xiaojuan; Link, Thomas M; Vail, Thomas P; Majumdar, Sharmila

    2013-09-01

    The objective of this study was to analyze regional variations of magnetic resonance (MR) relaxation times (T1ρ and T2) in hip joint cartilage of healthy volunteers and subjects with femoral acetabular impingement (FAI). Morphological and quantitative images of the hip joints of 12 healthy volunteers and 9 FAI patients were obtained using a 3T MR scanner. Both femoral and acetabular cartilage layers in each joint were semi-automatically segmented on sagittal 3D high-resolution spoiled gradient echo (SPGR) images. These segmented regions of interest (ROIs) were automatically divided radially into twelve equal sub-regions (30(0) intervals) based on the fitted center of the femur head. The mean value of T1ρ/T2 was calculated in each sub-region after superimposing the divided cartilage contours on the MR relaxation (T1ρ/T2) maps to quantify the relaxation times. T1ρ and T2 relaxation times of the femoral cartilage were significantly higher in FAI subjects compared to healthy controls (39.9±3.3 msec in FAI vs. 35.4±2.3msec in controls for T1ρ (P=0.0020); 33.9±3.1 msec in FAI vs. 31.1±1.7 msec in controls for T2 (P=0.0160)). Sub-regional analysis showed significantly different T1ρ and T2 relaxation times in the anterior-superior region (R9) of the hip joint cartilage between subjects with FAI and healthy subjects, suggesting possible regional differences in cartilage matrix composition between these two groups. Receiver operating characteristic (ROC) analysis showed that sub-regional analysis in femoral cartilage was more sensitive in discriminating FAI joint cartilage from that of healthy joints than global analysis of the whole region (T1ρ: area under the curve (AUC)=0.981, P=0.0001 for R9 sub-region; AUC=0.901, P=0.002 for whole region; T2: AUC=0.976, P=0.0005 for R9 sub-region; AUC=0.808, P=0.0124 for whole region). The results of this study demonstrated regional variations in hip cartilage composition using MR relaxation times (T1ρ and T2) and suggested

  2. 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.

  3. Femoroacetabular Impingement

    DTIC Science & Technology

    2008-04-01

    or pincer type impingement. On conventional radiographs, prominence of the anterolateral femoral head-neck junction, a “pistol grip deformity,” and...morphologic abnormalities of the hip. There are two types of FAI, termed cam impingement and pincer impingement, which have distinct imaging...to several different morphologic abnormalities of the hip. There are two types of FAI, termed cam impingement and pincer impingement. Though each

  4. The anterior tibio-talar ligament: one reason for anterior ankle impingement.

    PubMed

    Keller, Katharina; Nasrilari, Mehdi; Filler, Tim; Jerosch, Jörg

    2010-02-01

    The purpose of this study was the evaluation of the ankle's anterolateral ligament structures. We documented the anatomic situation of the ankle's anterolateral ligament structures in 33 Thiel-embalmed specimens. The ligaments had been isolated. We performed measurements on both length and orientation and additionally classified the ligaments. We also conducted histologic tissue staining. We were able to document a regular appearance of a so far not well-realized structure between the talus and the tibia, present in 26 (79%) specimens. Average length of this structure was 26 mm (in 20 degrees plantarflexion). The angular orientation in relation to the ant. tibio-fibular lig. was on average 43.7 degrees. This structure could be classified as being either isolated or widespread, with a further four sub-classifications for the orientation. Histologic staining showed parallel orientated dense collagen fibers as well as elastic fibers and hyaline cartilage in different stages of proliferation. In addition, there were neural fibers in the perivascular and the soft tissue. The histologic findings proved that the structure was a ligament. Since the ant. tibio-talar lig. is constantly present in most ankle joints, it could be considered as a regular finding. Its morphology and histology show that this ligament is loaded under tension as well as under compression. This could be one reason for anterior ankle impingement.

  5. Slipped capital femoral epiphysis: a review of management in the hip impingement era

    PubMed Central

    Mahran, Mahmoud A.; Baraka, Mostafa M.; Hefny, Hany M.

    2017-01-01

    Slipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making. PMID:28513428

  6. 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.

  7. Closed Intramedullary Derotational Osteotomy and Hip Arthroscopy for Cam Femoroacetabular Impingement From Femoral Retroversion

    PubMed Central

    Matsuda, Dean K.; Gupta, Nikhil; Martin, Hal D.

    2014-01-01

    Femoral retroversion is an uncommon cause of cam femoroacetabular impingement that may require surgical treatment beyond arthroscopic or open femoroplasty. We present the case of a young adult with bilateral severe femoral retroversion in whom such treatment failed. We discuss the rationale, surgical technique, and outcome of this patient, who underwent bilateral closed intramedullary derotational proximal femoral osteotomies and interlocked nailing with adjunctive pre- and post-osteotomy hip arthroscopies. Clinical improvement with normal foot progression angles, radiographic union, and resolution of bilateral cam femoroacetabular impingement from femoral retroversion was achieved. This surgery permits rapid institution of weight-bearing ambulation and an early rehabilitative program. Femoral retroversion may be an underappreciated and insufficiently treated cause of cam femoroacetabular impingement that may be readily detected and successfully remedied with this less invasive procedure. PMID:24749047

  8. Properties of the cartilage layer from the cam-type hip impingement deformity.

    PubMed

    Speirs, Andrew D; Beaulé, Paul E; Huang, Adrian; Frei, Hanspeter

    2017-04-11

    Femoro-acetabular impingement (FAI) is associated with significant acetabular cartilage damage and degenerative arthritis. To understand the contact stress and thus biomechanical mechanisms that may contribute to degeneration, the material behaviour of the cartilage layer is required. The objective of this study is to determine the fibril-reinforced poroelastic properties and composition of cartilage from cam deformities and to compare to those of normal cartilage. Patients undergoing surgical treatment of a symptomatic cam FAI deformity were recruited from the clinical practice of one of the authors. Osteochondral specimens were retrieved from the deformity during surgery using a trephine. Control specimens were retrieved from the anterior femoral head bearing surface during autopsy procedures. Indentation stress-relaxation tests were performed to determine the modulus (ES), Poisson's ratio (ν) and permeability (k0) of the poroelastic component, and the strain-independent (E0) and -dependent (Eε) moduli of the fibril-reinforcement using finite element analysis and optimization. Safranin-O staining was used to quantify proteoglycan content. ES and ν were 71% and 37% lower, respectively, in Cam specimens compared to controls, and k0 was approximately triple that of Control specimens (p<0.05). No significant differences were seen in the fibrillar components, E0 and Eε. Proteoglycan content was substantially depleted in Cam specimens, and was correlated with ES, ν and k0. This study showed that cartilage from the cam deformity exhibits severe degeneration in terms of the mechanical behaviour and composition changes, and is consistent with osteoarthritis. This further supports the hypothesis that FAI is a cause of hip osteoarthritis.

  9. Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement.

    PubMed

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

    2016-01-01

    Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip/groin pain and impaired function in younger active adults, and may lead to stiffness, muscle weakness, structural damage, and hip osteoarthritis. Understanding the impairments associated with FAI is crucial to guide treatment and rehabilitation strategies. Evidence is limited and conflicting about whether hip biomechanics are impaired during walking in people with symptomatic FAI. The objective of this study was to determine whether kinematics and kinetics during gait differ between people with symptomatic FAI and control participants. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age-, and sex-matched disease-free controls underwent three-dimensional gait analysis. Tri-planar hip kinematics and kinetics were compared between the two groups. There were limited significant between-group differences with respect to spatiotemporal variables. Participants with FAI walked with less range of motion in the sagittal plane during a gait cycle, but did not exhibit any significant kinematic differences in the frontal or transverse planes. There were no systematic differences in kinetics between the groups in any plane. Findings suggest that individuals with symptomatic FAI have minimal impairments in gait biomechanics. Although these individuals demonstrate reduced hip joint motion in the sagittal plane, the size of the difference is small and its significance for symptoms and function is unclear. More pronounced deficits in hip kinetics and kinematics may be evident during functional tasks that challenge the hip towards the position of impingement.

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

    PubMed

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

    2016-01-01

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

  11. 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

  12. Decompression of Posterior Ankle Impingement With Concomitant Anterior Ankle Pathology by Posterior Ankle Arthroscopy in the Supine Position.

    PubMed

    Lui, Tun Hing

    2016-10-01

    Posterior ankle endoscopy is a safe and effective approach for treatment of posterior ankle impingement. This is usually performed with the patient in prone position. The purpose of this technical note is to describe an arthroscopic approach of decompression of posterior ankle impingement with the patient in supine position. This is indicated if there is posterior ankle impingement together with other ankle pathology requiring anterior ankle arthroscopy. This approach allows treatment of both anterior ankle and posterior ankle pathology with the patient in the supine position. Concomitant anterior ankle arthroscopy can be performed with the usual orientation without the need of change of patient's position.

  13. The Distribution of Impingement Region in Cam-Type Femoroacetabular Impingement and Borderline Dysplasia of the Hip With or Without Cam Deformity: A Computer Simulation Study.

    PubMed

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

    2017-02-01

    To identify the distribution of the impingement region in cam-type femoroacetabular impingement (FAI) or patients with borderline developmental dysplasia of the hip (DDH) using computer simulation analysis. A total of 51 painful hip joints from 42 consecutive cases diagnosed as cam-type FAI (center edge [CE] angle ≥ 25°, alpha angle ≥ 55°) or borderline DDH (CE angle ≥ 20° and < 25°) with or without a cam deformity (alpha angle ≥ 55° or < 55°) were enrolled. ZedHip (Lexi, Tokyo, Japan) 3-dimensional computer simulation was used to identify impingement points. Computed tomography data were used for 3-dimensional modeling and impingement simulation. The maximum flexion angle and maximum internal rotation angle at 90° were evaluated. The impingement point was identified at a position of maximum internal rotation and 90° of flexion. Six impingement regions were defined. Differences in the distribution of the impingement region were evaluated between groups. There were significant differences in range of motion at maximum flexion and internal rotation among the 3 groups (P < .0001). There was no significant difference in the distribution of the impingement point in the cam-type FAI group (P = .71); similarly, there was no significant difference in the borderline DDH with a cam deformity group (P = .071). On the other hand, in terms of proximal or distal sites, there was a significant difference between the borderline DDH with and without a cam deformity group (P < .001). The impingement region in cases of cam-type FAI was variable. The coexistence of a cam deformity affected the distribution of the impingement region in cases of borderline DDH; the region tended to be distributed across proximal rather than distal regions. The site of cam osteochondroplasty should be based on the identified impingement point, particularly in cases of cam-type FAI and borderline DDH with a cam deformity. Level IV, case control study. Copyright © 2016 Arthroscopy

  14. Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review.

    PubMed

    Rivière, C; Hardijzer, A; Lazennec, J-Y; Beaulé, P; Muirhead-Allwood, S; Cobb, J

    2017-06-01

    Relationship between hip pathoanatomy and symptomatic FAI has been reported to be weak. This is explained by the reciprocal interaction between proximal femur and acetabular anatomies, but potentially also by the individual spine-hip relations (SHR). The key-answer for a complete understanding of the pathophysiology of FAI might lie in the comprehension of the SHRs, which have not yet been fully addressed. Therefore we conducted a systematic review to answer the subsequent questions: Is there any evidence of a relationship between FAI and (1) sagittal pelvic kinematics, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilizing PubMed and Google search engines was performed in December 2016. Only studies published in peer-reviewed journals over the last ten years in either English or French were reviewed. We identified 90 reports, of which 9 met our eligibility criteria. Review of literature shows Caucasian FAI patients have a pelvis with higher anterior tilt, lesser sagittal mobility, and lower pelvic incidence compared to healthy patients. We found no study having assessed the relationship between SHR and FAI. In order to help further investigations at answering questions 3 and 4, we have developed a classification for SHRs. The classification according spino-pelvic parameters allows identifying patient at risk regarding FAI occurrence. Higher anterior pelvic tilt in standing, sitting and squatting positions and lower pelvic incidence have been found to correlate with symptomatic FAI. Because defining the individual SHR might increase the understanding of the pathophysiology of hip impingement, we have developed a classification for SHRs. Level IV, systematic review of Level III and IV studies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. 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.

  16. The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints.

    PubMed

    Gómez-Hoyos, Juan; Khoury, Anthony; Schröder, Ricardo; Johnson, Eric; Palmer, Ian J; Martin, Hal D

    2017-01-01

    To assess the relation between ischiofemoral impingement (IFI) and lumbar facet joint load during hip extension in cadavers. Twelve hips in 6 fresh T1-to-toes cadaveric specimens were tested. A complete pretesting imaging evaluation was performed using computed tomography scan. Cadavers were positioned in lateral decubitus and fixed to a dissection table. Both legs were placed on a frame in a simulated walking position. Through a posterior lumbar spine approach L3-4 and L4-5 facet joints were dissected bilaterally. In addition, through a posterolateral approach to the hip, the space between the ischium and the lesser trochanter was dissected and measured. Ultrasensitive, and previously validated, piezoresistive force sensors were placed in lumbar facet joints of L3-4 and L4-5. Lumbar facet loads during hip extension were measured in native hip conditions and after simulating IFI by performing lesser trochanter osteotomy and lengthening. Four paired t-tests were performed comparing normal and simulated IFI on the L3-L4 and L4-L5 facet joint loads. After simulating IFI, mean absolute differences of facet joint load were 10.8 N (standard error of the mean [SEM] ±4.53, P = .036) for L3-4 at 10° of hip extension, 13.71 N (SEM ±4.53, P = .012) for L3-4 at 20° of hip extension, 11.49 N (SEM ±4.33, P = .024) for L4-5 at 10° of hip extension, and 6.67 N (SEM ±5.43, P = .245) for L4-5 at 20° of hip extension. A statistically significant increase in L3-4 and L4-5 lumbar facet joint loads of 30.81% was found in the IFI state as compared with the native state during terminal hip extension. Limited terminal hip extension due to simulated IFI significantly increases L3-4 and L4-5 lumbar facet joint load when compared with non-IFI native hips. This biomechanical study directly links IFI to increased lumbar facet loads and supports the clinical findings of IFI causing lumbar pathology. Assessing and treating (open or endoscopic) hip disorders that limit extension

  17. 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.

  18. Open Anterior Dislocation of the Hip in Togo

    PubMed Central

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

    2016-01-01

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

  19. Atypical hip pain: coexistence of femoroacetabular impingement (FAI) and osteoid osteoma.

    PubMed

    Banga, Kamaljeet; Racano, Antonella; Ayeni, Olufemi R; Deheshi, Benjamin

    2015-05-01

    The objective of this article was to emphasize the importance of including less common causes of hip pain in a differential diagnosis, particularly when clinical and radiographic variables are atypical. This article presents the case of a 52-year-old patient with a history of progressive hip pain resulting from the coexistence of both a femoroacetabular impingement (FAI) and an intraarticular osteoid osteoma. The intraarticular osteoid osteoma was initially overlooked due to its unremarkable features on radiographic and resonance imaging. Consequently, the patient was surgically treated for FAI with only partial relief. An osteolytic nidus characteristic of osteoid osteoma was discovered only 1.5 years following surgery. The patient was subsequently treated for osteoid osteoma with anti-inflammatories, after which his pain began to resolve. The patient was completely pain free after 7 months. Level of evidence V.

  20. 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

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

    PubMed

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

    2016-08-01

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

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

    PubMed Central

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

    2016-01-01

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

  3. Prevalence of radiological femoroacetabular impingement in Japanese hip joints: detailed investigation with computed tomography.

    PubMed

    Mimura, Tomohiro; Kawasaki, Taku; Itakura, Shin; Hirata, Tomohiro; Fuzikawa, Hitomi; Mori, Kanji; Imai, Shinji

    2015-07-01

    Femoroacetabular impingement (FAI) has been highlighted as a new etiology for osteoarthritis of the hip, and its prevalence has been reported in the past decade. In the present study, we performed a detailed investigation of the anatomical parameters related to FAI and calculated the prevalence of FAI-related findings in asymptomatic Japanese hip joints using computed tomography. We evaluated high-resolution reconstructed multislice computed tomography images in patients who had undergone computed tomography imaging in our institution for conditions unrelated to hip disorders. The examined parameters were as follows: center-edge (CE) angle; acetabular index; acetabular anteversion (five slices in the axial plane); and asphericity angle of the femoral head (AAFH) (six slices in multiple radial planes). The AAFH in the oblique axial slice through the center of the femoral neck is the so-called α-angle. We then examined the accurate prevalence of FAI-related findings in Japan. We investigated a total of 103 hips. The mean age of the subjects was 59.4 years. The mean CE angle was 31.1° and the mean acetabular index was 7.0°. The mean acetabular anteversion was 20.3° at the level of the hip center, and decreased as the slice level neared the superior margin of the femoral head. The mean AAFH ranged from 40.6° to 49.2° in the radial planes. The AAFH was largest at 60° rotated slice from the oblique axial slice through the center of the femoral neck. The prevalence of FAI-related findings in these Japanese hip joints was assessed as follows. An AAFH of >50° in any slice was detected in 51.5 % of the hips, and acetabular anteversion was negative for all images in 16.5 % of the hips, meaning that a total of 56.3 % of the images met the criteria for radiological FAI. With consideration of our results, we emphasize that "anatomical or radiological FAI" is not uncommon in Japanese hips. Therefore, the diagnosis of FAI should be performed with the clinical findings

  4. Effect of warmed irrigation solution on core body temperature during hip arthroscopy for femoroacetabular impingement.

    PubMed

    Parodi, Dante; Valderrama, Juanjosé; Tobar, Carlos; Besomi, Javier; López, Jaime; Lara, Joaquín; Ilic, Juan Pablo

    2014-01-01

    To determine the effect of warming arthroscopic irrigation solution on core body temperature during hip arthroscopic surgery in patients with femoroacetabular impingement. An analytical, prospective, observational study was performed in a cohort of 166 consecutive patients. All patients underwent hip arthroscopy for treatment of femoroacetabular impingement. Two groups were studied: patients operated on with arthroscopic irrigation solution warmed up to 32°C ± 2°C (89.6°F ± 3.6°F) and a control group comprising patients operated on with irrigation solution used at room temperature. Relevant information was collected regarding the patients (age, sex, body mass index, and blood pressure) and the procedure (volume and temperature of saline solution, pressure of fluid pump, surgery time, and room temperature). Corresponding statistical analysis was performed with STATA 11.0 (StataCorp, College Station, TX), by use of descriptive statistics, parametric and nonparametric tests, and a generalized estimating equation model for repeated measurements. Both groups were comparable in terms of age, sex, systolic and diastolic blood pressure, body mass index, volume of irrigation solution used, and room temperature. The mean age of the cohort was 33 years (range, 14 to 60 years); mean body mass index, 23.7 kg/m(2) (range, 17.2 to 34 kg/m(2)); mean volume of irrigation solution, 26 L (range, 12 to 39 L); mean systolic blood pressure, 97 mm Hg; mean diastolic blood pressure, 51 mm Hg; and mean surgical time, 110 minutes. A decrease in core body temperature by 0.5°C (0.9°F) or greater occurred during the course of surgery in 66% of patients in the control group versus 28% in the warmed-solution group (P < .001). At least 1 core body temperature measurement of less than 36°C (96.8°F) was recorded in 48% of patients in the control group versus 14% in the warmed-solution group (P < .001). The trend toward a decrease in core body temperature was 4 times greater in the control

  5. Effect of prolonged bed rest on the anterior hip muscles.

    PubMed

    Dilani Mendis, M; Hides, Julie A; Wilson, Stephen J; Grimaldi, Alison; Belavý, Daniel L; Stanton, Warren; Felsenberg, Dieter; Rittweger, Joern; Richardson, Carolyn

    2009-11-01

    Prolonged bed rest and inactivity is known to cause muscular atrophy with previous research indicating that muscles involved in joint stabilisation are more susceptible. The anterior hip muscles are important for hip joint function and stability but little is known about the effects of prolonged inactivity on their function. This study investigated the effect of prolonged bed rest on the size of the anterior hip muscles and their pattern of recovery. The effect of resistive vibration exercise (RVE) as a countermeasure to muscle atrophy was also investigated. 12 male participants, randomly assigned to either a control or an exercise group, underwent 8 weeks of bed rest with 6 months follow-up. Changes in muscle cross-sectional area (CSA) of the iliacus, psoas, iliopsoas, sartorius and rectus femoris muscles were measured by magnetic resonance imaging at regular intervals during bed rest and recovery phases. CSAs of iliopsoas and sartorius decreased at the hip joint (p<0.05) during bed rest but iliacus, psoas, and rectus femoris CSAs were unchanged (p>0.05). No significant difference was found between the two groups for all muscles (all p>0.1), suggesting inefficacy of the countermeasure in this sample. These findings suggest that prolonged bed rest can result in the atrophy of specific muscles across the hip joint which may affect its stability and function.

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

    PubMed

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

    2015-02-01

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

  7. 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

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

    PubMed Central

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

    2016-01-01

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

  9. Pose measurement of Anterior Pelvic Plane based on inertial measurement unit in total hip replacement surgeries.

    PubMed

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

    2016-08-01

    In Total Hip Replacement (THR), inaccurate measurement of Anterior Pelvic Plane (APP), which is usually used as a reference plane, will lead to malposition of the acetabular prosthesis. As a result, the risk of impingement, dislocation and wear will increase and the safe range of motion will be limited. In order to acquire the accurate pose of APP, a measurement system is designed in this paper, which includes two parts: one is used to estimate the initial pose of APP and the other is used to trail dynamic motion of APP. Both parts are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. An Extended Kalman Filter (EKF) is adopted to fuse the data from IMU and the magnetometer sensors to estimate the orientation of the pelvis. The test results show that the error angle between calculated axis and true axis of the pelvis in geodetic coordinate frame is less than 1.2 degree, which meets the requirement of the surgery.

  10. Shoulder problems in high level swimmers--impingement, anterior instability, muscular imbalance?

    PubMed

    Rupp, S; Berninger, K; Hopf, T

    1995-11-01

    The objective was to study prevalence and underlying pathology of "swimmer's shoulder". Twenty-two competitive swimmers of national "D-Kader" (elite development swimmers) were evaluated by means of questionnaire, clinical examination and isokinetic testing of external rotation and internal rotation. At the examination current interfering pain necessitating a cessation or reduction of practice was found in 5 (23%) athletes. At isokinetic testing 8 (36%) athletes complained of shoulder pain. Any history of pain was seen in 14 (64%) swimmers. A positive impingement sign was noted in 11 (50%) athletes. Apprehension sign which is indicative of anterior instability was found in 11 (50%) swimmers. Clinical equivalents of dysfunction of scapulothoracic muscles such as scapular winging (5 athletes) and shoulder protraction (12 athletes) were noted. For comparison of results of isokinetic testing a control group of non-swimmers was selected matching the group of swimmers exactly in terms of age, sex and dominant side. External rotation/internal rotation ratio of peak torque and total work at 60 deg/sec and 180 deg/sec was significantly lower in swimmers than in controls. The ratio was independent of sex, dominant side, history of pain and pain at examination. During internal rotation competitive swimmers produced significantly higher peak torques and total work than controls. There was no significant difference in external rotation. In conclusion there are several different abnormalities of function contributing to the pathology of "swimmer's shoulder":--Laxity of anterior-inferior capsuloligamentous structures with atruamatic anterior instability due to repetitive overload.--Impingement with rotator cuff tendinitis.--Muscular imbalance of the rotator cuff muscles and scapulothoracic dysfunction.

  11. Low-energy anterior hip dislocation in a dancer.

    PubMed

    Stein, Drew A; Polatsch, Daniel B; Gidumal, Ramesh; Rose, Donald J

    2002-10-01

    In this article, we report the case of a healthy young woman who sustained an anterior hip dislocation while participating in a noncontact activity (ballet dancing). The patient's atraumatic dislocation failed closed reduction secondary to interposition of anterior capsule and rectus femoris muscle. Open reduction using a Smith-Petersen approach was concentric and stable. Postinjury femoral nerve neuropraxia resolved within 6 weeks. At 2-year follow-up, the patient was without complications of the injury-including avascular necrosis and posttraumatic arthritis. She returned to dancing and is now asymptomatic.

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

    PubMed Central

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

    2015-01-01

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

  13. Gender-Dependent Differences in Hip Range of Motion and Impingement Testing in Asymptomatic College Freshman Athletes.

    PubMed

    Czuppon, Sylvia; Prather, Heidi; Hunt, Devyani M; Steger-May, Karen; Bloom, Nancy J; Clohisy, John C; Larsen, Richard; Harris-Hayes, Marcie

    2017-07-01

    Athletic activity is a proposed factor in the development and progression of intra-articular hip pathology. Early diagnosis and preventive treatments in "at-risk" athletes are needed. Our primary objective was to report hip range of motion (ROM) and prevalence of positive impingement testing in asymptomatic college freshman athletes. Our secondary objective was to determine whether an association exists between hip ROM and a positive flexion-adduction-internal rotation (FADIR) test. Cross-sectional study. Collegiate athletic campus. Four hundred thirty (299 male, 131 female) freshman athletes reporting no current or previous hip pain. During the athletes' preseason medical screening, trained examiners performed a hip-specific exam to obtain data for hip ROM and impingement testing. Bilateral passive ROM measures included hip flexion, and hip internal and external rotation with the hip flexed 0° and 90°. Mean age of male participants was 18.5 ± 0.8 and female participants was 18.3 ± 0.6 years (P = .003). Male participants demonstrated less hip ROM than female participants in flexion (115.8 ± 11.2° versus 122.0 ± 10.5°, P < .001), internal rotation in 90° flexion (26.9 ± 9.8° versus 34.7 ± 10.7°, P < .001) and 0° flexion (29.0 ± 9.8° versus 38.9 ± 10.1°, P < .001), and external rotation in 90° flexion (44.7 ± 10.9° versus 49.7 ± 10.4°, P < .001) but not for external rotation in 0° flexion (39.8 ± 11.1° versus 37.6 ± 11.5°, P = .06). Pain with FADIR test on the right and left hip were reported in 11.9% and 14.5% of athletes, respectively. Gender and a positive FADIR were not related (male 12.2%, female 15.3%, P = .36). In asymptomatic college freshman athletes, male athletes generally demonstrated less hip ROM than female athletes. In addition, a positive FADIR was more prevalent than previously reported in healthy young adults. Preseason screenings that use these baseline data in conjunction with other examination findings may allow

  14. Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High

    DTIC Science & Technology

    2010-01-27

    impingement (abnormal alpha angle or pistol grip deformity only), whereas 16 patients (18%) had signs of pure pincer -type impingement (abnormal center-edge or...care and orthopaedic clinics. Radiographs were analyzed for signs of FAI (herniation pits, pistol grip deformity, center-edge angle, alpha angle, and...11, 12]. Two types of FAI have been described: cam and pincer . In cam-type impingement, the abnormally shaped femoral head-neck junction abuts the

  15. 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

  16. Femoroacetabular impingement and labral tears in the adolescent hip: diagnosis and surgical advances.

    PubMed

    Friend, L; Kelly, Bryan T

    2009-02-01

    To identify several of the major trends and advancements in the diagnosis and care of the adolescent hip that have recently been responsible for reshaping the standard of care for this group of patients. Recent research has provided an expanded understanding of hip mechanics and anatomy, improved imaging techniques and, in particular, produced a better appreciation of factors that predispose the hip to degenerative changes. It has led to the development and expansion of several treatment options, including hip arthroscopy, safe surgical dislocation of the hip and periacetabular rotational osteotomy. An appreciation of emerging trends in the diagnosis and treatment of adolescent hip problems is important, as prompt recognition of and intervention for certain hip disorders may prevent ongoing injury and avoid or ameliorate chronic conditions associated with the development of degenerative joint changes and osteoarthritis.

  17. 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

  18. Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology: a systematic review of the clinimetric evidence.

    PubMed

    Lodhia, Parth; Slobogean, Gerard P; Noonan, Vanessa K; Gilbart, Michael K

    2011-02-01

    The purpose of this study is to systematically review the content and clinimetric evidence (rigor of rating scales and indexes for the description of clinical phenomena) of published patient-reported outcome (PRO) instruments used to assess femoroacetabular impingement (FAI) and labral hip pathology. We used Medical Subject Heading terms related to FAI and labrum/labral tears to search the Medline, Embase, and Cochrane databases for studies of FAI and labral hip pathology. Studies with hip-related PRO instruments, with any operative intervention except total hip arthroplasty, were included. We excluded studies with a skeletally immature population, revision surgeries in more than 10% of cases, or a primary diagnosis of hip osteoarthritis. We conducted a second review using the same databases for studies reporting clinimetric properties of at least 1 of the PRO instruments identified previously. Articles were selected in an independent, stepwise manner by 2 reviewers. Selected articles were evaluated to determine the presence and quality of measurement properties of the outcome instruments. We found 5 articles assessing 3 PRO instruments: the Hip Outcome Score (HOS), the Non-Arthritic Hip Score, and the 12-item modified Western Ontario and McMaster Universities Osteoarthritis Index. The HOS had the highest positive rating for internal consistency, construct validity, agreement, responsiveness, lack of floor/ceiling effect, and interpretability. The Non-Arthritic Hip Score showed evidence for validity and lack of floor/ceiling effect. The modified Western Ontario and McMaster Universities Osteoarthritis Index was only strong for internal consistency and was indeterminate for construct validity. Only 3 PRO instruments have shown clinimetric evidence to support their use to measure outcomes in FAI and labral pathology patients. The HOS has the greatest amount of clinimetric evidence and is the most proven instrument for use in this population. This review shows that

  19. Femoroacetabular Impingement (FAI)

    MedlinePlus

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

  20. [Minimally invasive total hip arthroplasty via direct anterior approach].

    PubMed

    Rachbauer, Franz; Krismer, Martin

    2008-09-01

    Minimally invasive total hip arthroplasty via direct anterior approach aims at reducing soft-tissue damage, diminishing blood loss and postoperative pain, shortening stay in hospital, accelerating rehabilitation, and keeping scars small. The technique is suitable for primary and secondary osteoarthritis as well as fractures of the femoral neck. Complex distortions of the proximal femur should be exempted. Complex malalignment of the proximal femur. The femoral neck is exposed in the interval between tensor fasciae latae, glutei medius and minimus muscles laterally, and sartorius and rectus femoris muscles medially. After osteotomy of the neck and extraction of the head the acetabulum is reamed to prepare for cup prosthesis. Following peritrochanteric capsulotomy the externally rotated, adducted and elevated femor is broached. Cemented and cementless implants may be used. The patients are allowed to walk full weight bearing beginning on the 1st postoperative day. As soon as they are able to safely master the transfers and stairs, they are discharged. The method is a safe procedure that allows correct placement of acetabular and femoral components. It may be performed in a reasonable time, the blood loss is little. The procedure preserves the muscles and leads to small, cosmetically pleasing scars. Patients usually do not suffer from pronounced pain, rehabilitation is accelerated. They therefore agree in an short postoperative stay in hospital.

  1. The John Charnley Award: Redefining the Natural History of Osteoarthritis in Patients With Hip Dysplasia and Impingement.

    PubMed

    Wyles, Cody C; Heidenreich, Mark J; Jeng, Jack; Larson, Dirk R; Trousdale, Robert T; Sierra, Rafael J

    2017-02-01

    Structural hip deformities including developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are thought to predispose patients to degenerative joint changes. However, the natural history of these malformations is not clearly delineated. (1) Among patients undergoing unilateral THA who have a contralateral hip without any radiographic evidence of hip disease, what is the natural history and progression of osteoarthritis in the native hip based on morphological characteristics? (2) Among patients undergoing unilateral THA who have a contralateral hip without any radiographic evidence of hip disease, what are the radiographic parameters that predict differential rates of degenerative change? We identified every patient 55 years of age or younger at our institution who received unilateral primary THA from 1980 to 1989 (n = 722 patients). Preoperative radiographs were reviewed on the contralateral hip and only hips with Tönnis Grade 0 degenerative change that had minimum 10-year radiographic followup were included. A total of 172 patients met all eligibility criteria with the following structural diagnoses: 48 DDH, 74 FAI, and 40 normal morphology, and an additional 6% (10 of the 172 patients) met all eligibility criteria but were lost to followup before the 10-year minimum. Mean age at the time of study inclusion was 47 years (range, 18-55 years), and 56% (91 of 162) of the patients in this study were female. Mean followup was 20 years (range, 10-35 years). Radiographic metrics, in conjunction with the review of two experienced arthroplasty surgeons, determined the structural hip diagnosis as DDH, FAI, or normal morphology. Every available followup AP radiograph was reviewed to determine progression from Tönnis Grade 0 to 3 until the time of last followup or operative intervention with THA. Survivorship was analyzed by Kaplan-Meier methodology, hazard ratios, and multistate modeling. Thirty-five patients eventually underwent THA: 16 (33%) DDH

  2. 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.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  5. Prevalence of pincer, cam, and combined deformities in Japanese hip joints evaluated with the Japanese Hip Society diagnostic guideline for femoroacetabular impingement: A CT-based study.

    PubMed

    Mimura, Tomohiro; Mori, Kanji; Itakura, Shin; Furuya, Yuki; Kawasaki, Taku; Imai, Shinji

    2017-01-01

    Femoroacetabular impingement (FAI) is thought to be associated with hip osteoarthritis. We investigated the prevalences of radiologic deformities of the pincer, cam, and their combinations in Japanese hip joints using computed tomography (CT) according to the Japanese Hip Society diagnostic guideline for FAI. Multi-slice CT images were evaluated. Pincer deformities were defined as: type 1: center-edge angle (CE) ≥40°; type 2: CE ≥ 30° and acetabular roof obliquity ≤0°; type 3: CE ≥ 25° and retroverted acetabulum. Cam deformities were defined as: type 1: CE ≥ 25°, α-angle ≥55°, and head-neck offset ratio <0.14; type 2: CE ≥ 25°, α-angle ≥55°, and herniation pit positive; type 3: CE ≥ 25°, α-angle ≥55°, and pistol grip deformity positive. We studied 128 hips. Pincer was detected in 35.9% (type 1, 12.5%; type 2, 18.0%; type 3, 13.3%). Cam was detected in 24.2% (type 1, 23.4%; type 2, 7.8%; type 3, 10.9%). Combined deformities were detected in 10.2%. Type 3 pincer/type 1 cam was the most frequent combined deformity compared with all combined deformities. All of the cam deformities, total combined deformities, and all radiological FAIs appeared significantly more often in men. When we used this guideline to diagnose FAI in a Japanese population, radiological FAI was common, and pincer deformities were more common than cam deformities. The most frequent seen pincer, cam, and combined deformities was type 2 pincer, type 1 cam, and the combination of type 3 pincer/type 1 cam, respectively. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  6. US in ankle impingement syndrome.

    PubMed

    Pesquer, Lionel; Guillo, Stephane; Meyer, Philippe; Hauger, Olivier

    2014-06-01

    Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Clinical symptoms are chronic pain located in the affected region and limited range of ankle motion. There are three types of ankle impingement syndrome: anterior impingement, which can be subdivided into anterolateral, anteromedial and purely anterior impingement; posterior impingement, which can be subdivided into posterior and posteromedial impingement; and calcaneal peroneal impingement which is secondary to planovalgus foot deformity. This paper evaluates physiological and clinical elements of these three types of ankle impingement syndrome as well as the role of ultrasound (US) imaging and US-guided treatment.

  7. The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement.

    PubMed

    Chahal, Jaskarndip; Van Thiel, Geoffrey S; Mather, Richard C; Lee, Simon; Song, Sang Hoon; Davis, Aileen M; Salata, Michael; Nho, Shane J

    2015-08-01

    There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Cohort study (diagnosis); Level of evidence, 2. A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values-at which patients considered their status to be satisfactory-at 1 year after surgery were 74 (mHHS), 87 (HOS-activities of daily living subscale), and 75 (HOS-sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS-activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to

  8. Radiographic signs for detection of femoroacetabular impingement and hip dysplasia should be carefully used in patients with osteoarthritis of the hip.

    PubMed

    Ipach, Ingmar; Rondak, Ina-Christine; Sachsenmaier, Saskia; Buck, Elisabeth; Syha, Roland; Mittag, Falk

    2014-05-08

    During the last years, terms like acetabular retroversion, excessive overcoverage, and abnormal head-neck-junction with the so called "pistol-grip-deformity" has been added to the classical description of hip dysplasia. These anatomical changes could lead to a femoroacetabular impingement (FAI). Both kinds of FAI has been indentified as a main reason for hip pain and progressive degenerative changes leading to early osteoarthritis of the hip. A lot of radiographic criteria on pelvic views have been established to detect classical dysplasia and FAI. The present study was initiated to assess the hypothesis that age and severity of osteoarthritis affect measurements of different radiographic parameters. The pelvic radiographs of 1614 patients were measured for head-ratio, CE-angle, roof obliquity, extrusion-index, depth-to-width ratio, CCD-angle, sharp's angle. To evaluate the severity of osteoarthritis of the hip the classification by Kellgren and Lawrence was used. Associations between age and radiographic parameters or severity of osteoarthritis were assessed by Spearman's (ρ) or Kendall's (r) rank correlation coefficient, respectively. 366 (22.7%) patients presented no sign of osteoarthritis, 367 (22.7%) patients presented I° osteoarthritis, 460 (28.5%) patients presented II° osteoarthritis, 307 (19%) III° osteoarthritis and 114 (7.1%) IV° osteoarthritis of the hip. The mean head-ratio of all patients was 1.13 ± 0.26 (0.76 - 2.40), the mean CE-angle 40.05° ± 10.13° (0° - 70°), the mean roof obliquity was 35.27° ± 4.96° (10° - 55°), the mean extrusion-index was 12.99 ± 9.21 (6.20 - 95.2), the mean depth-to-width ratio was 59.30 ± 8.90 (6.30 - 100), the mean CCD-angle was 127.68° ± 7.22° (123° - 162°) and the mean sharp's angle was 9.75° ± 5.40° (1° - 34°) There was a weak association between age and the severity of osteoarthritis of the hips (left: r= 0.291; right: r=0.275; both P<0.001) with higher osteoarthritis levels observable for

  9. 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

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

    PubMed

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

    2016-07-01

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

  11. Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction.

    PubMed

    Jagodzinski, M; Richter, G M; Pässler, H H

    2000-01-01

    This study analyzed the interaction between the anterior cruciate ligament (ACL) and the intercondylar notch roof (INR) in hyperextension of the knee using magnetic resonance cinematography. Cinematographic image series of 15 knees were investigated. Two independent observers identified the image that displayed the beginning of contact between the ACL and the INR. They determined knee extension on this image and on the image that displayed maximum hyperextension of the knee. Correlations between a variable representing impingement and the inclination angle of the INR, the anterior laxity of the knee, and full hyperextension were examined. Theoretical, impingement-free tibial tunnel positions for the knees were calculated as a percentage of the anteroposterior tibial width. All ACLs of the knees in this study made contact with the INR. The average extension angle at the beginning of impingement was -6.3 +/- 3.8 degrees. There were significant correlations between impingement and maximum manual displacement as measured with the arthrometer (r = 0.77; P < 0.001), maximum hyperextension (r = 0. 67; P = 0.007), and notch roof angle (r = -0.73; P = 0.002). There were biomechanically acceptable tunnel positions for all knees but one. Hyperextension is physiologically associated with impingement of the ACL. In uninjured knees there was a correlation between ACL impingement and hyperextension, inclination of the INR, and maximum manual displacement of the tibia. Impingement free tibial tunnel positioning is possible in most knees without notchplasty.

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

    PubMed Central

    2017-01-01

    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. PMID:28244282

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

    PubMed Central

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

    2014-01-01

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

  14. Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction.

    PubMed

    Gribbin, Timothy C; Slater, Lindsay V; Herb, C Collin; Hart, Joseph M; Chapman, Ryan M; Hertel, Jay; Kuenze, Christopher M

    2016-02-01

    After anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging. Thirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal-knee frontal planes, hip frontal-knee sagittal, hip frontal-knee transverse, hip sagittal-knee frontal, hip sagittal-knee transverse, and hip transverse-knee frontal planes. The hip sagittal-knee frontal and hip sagittal-knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal-knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal-knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking. The increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Amateur and Recreational Athletes Return to Sport at a High Rate Following Hip Arthroscopy for Femoroacetabular Impingement.

    PubMed

    Weber, Alexander E; Kuhns, Benjamin D; Cvetanovich, Greg L; Grzybowski, Jeffrey S; Salata, Michael J; Nho, Shane J

    2017-04-01

    To compare the return-to-play rates, patient-reported outcome (PRO) scores, and satisfaction between high-level amateur athletes and recreational athletes and to evaluate for differences in ability to return to sport in these groups based on patient-related and sport-related characteristics. Clinical data were retrieved for 66 (26 male/40 female) consecutive athletes undergoing hip arthroscopy for femoroacetabular impingement. Athletes were classified as high-level amateur or recreational. Athletes were also divided into 6 distinct sporting categories based on the physical demands on the hip. Preoperative and 2-year PROs including a sport-specific questionnaire, modified Harris Hip Score (MHHS), and Hip Outcome Scores with Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales were collected. Of the 66 patients, 49 were recreational and 17 were high-level amateur athletes (10 high school and 7 collegiate). High-level athletes were significantly younger than recreational athletes (18.4 ± 2.3 years vs 29.7 ± 6.8 years; P < .001). After 2 years, all PROs had improved significantly, with no differences between the 2 athletic groups. There was a high overall rate of return for both recreational and high-level amateur athletes (94% vs 88%; P = .60). Increasing preoperative withdrawal time from sport prior to surgery was associated with decreased HOS-SS (r = 0.33; P = .04) and MHHS scores (r = 0.02; P = .02). Overall, athletes who had withdrawn from sport for greater than 8 months before surgery returned to sport significantly more slowly (P = .01). Increasing body mass index (BMI) was associated with lower improvements in HOS (r = 0.26; P = .04) and MHHS scores (r = 0.38; P < .01). Recreational athletes, despite being significantly older than their high-level counterparts, return to play at a similar high rate and with comparable PROs. Increasing preoperative cessation time from sport significantly prolongs return to sport

  16. Persistent bilateral anterior hip pain in a young adult due to meralgia paresthetica: a case report

    PubMed Central

    Shetty, Vijay D; Shetty, Gautam M

    2008-01-01

    Background We describe a case report where a young woman presented with persistent bilateral anterior hip pain whose diagnosis was obscure for many months. Case presentation The symptoms started three months after she underwent laparoscopic surgery, with entry portals on both iliac regions of her abdomen. After a thorough clinical examination, a working diagnosis of "Meralgia paresthetica" was made. She responded well to diagnostic block supplemented with local steroids. Conclusion To our knowledge, this is the first ever case report of a bilateral meralgia paresthetica presenting as bilateral persistent anterior hip pain following a laparoscopic procedure. PMID:19077310

  17. Persistent bilateral anterior hip pain in a young adult due to meralgia paresthetica: a case report.

    PubMed

    Shetty, Vijay D; Shetty, Gautam M

    2008-12-15

    We describe a case report where a young woman presented with persistent bilateral anterior hip pain whose diagnosis was obscure for many months. The symptoms started three months after she underwent laparoscopic surgery, with entry portals on both iliac regions of her abdomen. After a thorough clinical examination, a working diagnosis of "Meralgia paresthetica" was made. She responded well to diagnostic block supplemented with local steroids. To our knowledge, this is the first ever case report of a bilateral meralgia paresthetica presenting as bilateral persistent anterior hip pain following a laparoscopic procedure.

  18. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

    PubMed

    Matta, Joel M; Shahrdar, Cambize; Ferguson, Tania

    2005-12-01

    Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. Therapeutic study, Level IV-1 (case series). See the Guidelines for

  19. 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.

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

    PubMed

    de Oliveira, Anderson Luiz; Machado, Eduardo Gomes

    2014-01-01

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

  1. 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.

  2. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty.

    PubMed

    Goulding, Krista; Beaulé, Paul E; Kim, Paul R; Fazekas, Anna

    2010-09-01

    Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its' incidence in anterior arthroplasty procedures. We therefore defined the incidence, functional impact, and natural history of LFCN neuropraxia after an anterior approach for both hip resurfacing (HR) and primary total hip arthroplasty (THA). We followed 132 patients who underwent an anterior hip approach (55 THA; 77 HR). We administered self-reported questionnaires for sensory deficits of LFCN, neuropathic pain score (DN4), visual analog scale, as well as SF-12, UCLA, and WOMAC scores at one year postoperatively. A subset of 60 patients (30 THA; 30 HR) was evaluated at two time intervals. One hundred seven patients (81%) reported LFCN neuropraxia with a mean severity score of 2.32/10 and a mean DN4 score of 2.42/10. Hip resurfacing had a higher incidence of neuropraxia as compared with THA: 91% versus 67%, respectively. No functional limitations were reported on SF-12, WOMAC, or UCLA scores. Of the subset of 60 patients followed over an average of 12 months, 53 (88%) reported neuropraxia at the first followup interval with only three (6%) having complete resolution at second followup. Improvement in DN4 scores was observed over time: 3.6 versus 2.5, respectively. Although LFCN neuropraxia was a frequent complication after anterior approach THA, it did not lead to functional limitations in our patients. A decrease in symptoms occurred over time but only a small number of patients reported complete resolution. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  3. Complications Following Direct Anterior Hip Procedures: Costs to Both Patients and Surgeons.

    PubMed

    Lee, Gwo-Chin; Marconi, Dante

    2015-09-01

    A systematic review of the literature on clinical outcomes following direct anterior approach (DAA) hip arthroplasty was performed. An aggregated 11,810 hip procedures were analyzed for intraoperative and early postoperative complications. The most common complication following DAA hip arthroplasty was nerve dysfunction (2.8%) followed by intraoperative fractures (2.3%). Postoperative dislocation, wound complications, and revision THA within the first 12 months were reported in 1.2% of cases. Thus, while DAA hip arthroplasty can be successfully performed, it is not without complications. Without definitive evidence of clinical superiority, surgeons considering switching to DAA should benchmark their personal complication rates against published reports. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Closed Suction Drainage Has No Benefits in Anterior Hip Arthroplasty: A Prospective, Randomized Trial.

    PubMed

    Suarez, Juan C; McNamara, Colin A; Barksdale, Leticia C; Calvo, Cecilia; Szubski, Caleb R; Patel, Preetesh D

    2016-09-01

    Many studies have challenged routine drain placement in patients undergoing total hip arthroplasty. Some studies suggest increased transfusion rate with the use of closed suction drains. The use of tranexamic acid to control surgical bleeding and aspirin for venous thromboembolism prophylaxis has gained popularity. No study has evaluated the use of drains in patients undergoing direct anterior total hip arthroplasty under these conditions. We performed a prospective, randomized study in patients undergoing direct anterior total hip arthroplasty to evaluate whether closed suction drain placement provides any clinical benefit. Patients randomly assigned to the control group had closed suctions drains placed; patients randomly assigned to the treatment group had no drains placed. The primary outcome measures were hematoma formation, wound complications, and transfusion rates. The secondary outcome measures were estimated blood loss, decrease in hemoglobin and hematocrit levels, total hemoglobin loss, calculated blood loss, hidden blood loss, and total length of hospital stay. Differences in outcomes between groups were considered to be significant at P ≤ .05. There were no significant differences between groups in transfusion rate (P = .49), postoperative decrease in hemoglobin levels (P = .95), average calculated blood loss (P = .65), complications (P = .49), or length of hospital stay (P = .14). There was no hematoma formation observed in either group. Our study showed no clinical benefit or disadvantage to closed suction drainage in anterior hip arthroplasty with the concomitant use of tranexamic acid for surgical hemostasis and aspirin for venous thromboembolism prophylaxis. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Ceramic acetabular cups for hip endoprostheses. 7: How do position of the center of rotation and the CCD angle of the shaft modify range of motion and impingement?].

    PubMed

    Bader, R; Willmann, G

    1999-12-01

    The range of motion (ROM) of total hip prostheses is influenced by a number of parameters. An insufficient ROM may cause impingement, which may result in subluxation, dislocation or material failure of the prostheses. In a three-dimensional CAD simulation, the position of the centre of rotation and the CCD angle of the stem were investigated. Displacement of the centre of rotation of the femoral head may be due to wear (PE cups) or to the design of the prosthesis (ceramic cups). Stems of widely differing design have been developed and implanted. The results of the present study demonstrate that the ROM is clearly reduced by increasing penetration of the femoral head. At an inclination angle of 45 degrees, a depth of penetration of 2 mm restricts flexion by about 15 degrees, and a depth of penetration of 3 mm by about 30 degrees. At smaller angles of inclination the ROM is reduced and flexion and abduction are associated with an increased risk of impingement. With steeper acetabular cup inclinations, the risk of impingement decreases, but dislocation, the risk of rim fractures (ceramic cups), and wear and penetration rates (PE cups) increase. The CCD angle of the stem should be oriented to the anatomical situation. At high CCD angles (> 135 degrees), flexion is clearly limited, in particular when there is penetration of the femoral head. For modern total hip arthroplasty, prosthetic systems characterised by precise positioning of components, minimum wear, slightly recessed inserts, and appropriate CCD angles should be used.

  6. 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

  7. Limited hip rotation and non-contact anterior cruciate ligament injury: a case-control study.

    PubMed

    Tainaka, Koji; Takizawa, Tsuyoshi; Kobayashi, Hiroyuki; Umimura, Masakazu

    2014-01-01

    Insufficient hip flexibility, a limiting factor for lower extremity rotation, can cause great rotational stress and consequent injury to the knees and ankles. A limited range of motion (ROM) of the hip might be associated with increased risk of non-contact anterior cruciate ligament (ACL) injury. We investigated the association between the risk of non-contact ACL injured student athletes and limitations of hip ROM. A case-control study was conducted at an orthopaedic clinic in Japan. Cases included all patients with non-contact ACL injury and without known marked alignment abnormalities who visited the orthopaedic clinic during 2000-2008. Controls included all patients with non-ACL sports-related injuries who visited the same clinic in 2000. The adjusted odds ratio of ROM of the hip was evaluated for non-contact ACL injury risk. These cases were 44 ACL cases and 123 controls aged 13-17 years. The odds ratios (ORs) of internal and external rotations of hip ROMs were adjusted for age, sex, BMI, type of sports and hip ROM (flexion, extension, adduction, abduction). The adjusted ORs for a 10° increase of the sum of the right and left internal hip rotations were 0.18 (95% confidence interval [CI], 0.10-0.34, p<0.0001), and 0.23 (95% CI, 0.14-0.39, p<0.0001) for external rotations, and the observed ORs were small. Data obtained from this small sample indicate that limited hip rotation ROMs in young athletes have the possibility of association with increased risk of non-contact ACL injury. III - case-control study. © 2013.

  8. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult.

    PubMed

    Kumar, Sunil; Rathi, Akhilesh; Sehrawat, Sunil; Gupta, Vikas; Talwar, Jatin; Arora, Sumit

    2014-01-01

    Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  9. 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/.

  10. The effect of abductor muscle and anterior-posterior hip contact load simulation on the in-vitro primary stability of a cementless hip stem

    PubMed Central

    2010-01-01

    Background In-vitro mechanical tests are commonly performed to assess pre-clinically the effect of implant design on the stability of hip endoprostheses. There is no standard protocol for these tests, and the forces applied vary between studies. This study examines the effect of the abductor force with and without application of the anterior-posterior hip contact force in the in-vitro assessment of cementless hip implant stability. Methods Cementless stems (VerSys Fiber Metal) were implanted in twelve composite femurs which were divided into two groups: group 1 (N = 6) was loaded with the hip contact force only, whereas group 2 (N = 6) was additionally subjected to an abductor force. Both groups were subjected to the same cranial-caudal hip contact force component, 2.3 times body weight (BW) and each specimen was subjected to three levels of anterior-posterior hip contact load: 0, -0.1 to 0.3 BW (walking), and -0.1 to 0.6 BW (stair climbing). The implant migration and micromotion relative to the femur was measured using a custom-built system comprised of 6 LVDT sensors. Results Substantially higher implant motion was observed when the anterior-posterior force was 0.6BW compared to the lower anterior-posterior load levels, particularly distally and in retroversion. The abductor load had little effect on implant motion when simulating walking, but resulted in significantly less motion than the hip contact force alone when simulating stair climbing. Conclusions The anterior-posterior component of the hip contact load has a significant effect on the axial motion of the stem relative to the bone. Inclusion of the abductor force had a stabilizing effect on the implant motion when simulating stair climbing. PMID:20576151

  11. 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

  12. [Experience of using anterior windowing of the femur in revision total hip arthroplasty].

    PubMed

    Li, Hu; Lin, Jian-hao

    2012-05-01

    To discuss the clinical results of anterior windowing of the femur to remove the femoral component and cement in revision total hip arthroplasty. From September 1999 to May 2011, 31 revision cases received anterior windowing of the femur in operation. There were 12 male and 19 female, with the average age in operation was 61.8 years (from 40 to 83 years). The reason for revision included aseptic loosening in 12 cases, infection in 4 cases, breakage of femoral stem in 11 cases and acetabular liner wear in 4 hemi-arthroplasties. Nine cases were cemented and 22 were non-cemented for the primary stem. The position of the window located in the anterior femur with 6 cases of complete windowing from the proximal to the end of the stem. Another 25 cases received regional windowing just around the tip of the stem. In revisions, non-cemented rectangular revision stem were used for 27 cases and two-stage surgery were used for 4 infection cases. In all revisions, femoral stems and cement fragments were removed successfully and safely without any complications of fracture and perforation of new stems. All femur windows showed successfully union for average 14 weeks (12-18 weeks). There were some postoperative complications. One recurrent dislocation was treated using plaster external fixation for 8 weeks. One case with dislocation and fracture along with the window was revised by cerclage fixation. One periprosthetic fracture due to trauma was treated by cerclage fixation. The average Harris score of the hip improved to 83 points (75 to 90 points) at an average 5.5 years follow-up (0.5 to 12.0 years). Twenty six cases were completely followed up. Revision femoral stems were well-fixed without any subsidence or loosening. Anterior windowing of the femur is a proven technique which can be used to remove femoral stem and cement conveniently and safely without any fractures in revision total hip arthroplasty.

  13. Three-dimensional morphology and bony range of movement in hip joints in patients with hip dysplasia.

    PubMed

    Nakahara, I; Takao, M; Sakai, T; Miki, H; Nishii, T; Sugano, N

    2014-05-01

    To confirm whether developmental dysplasia of the hip has a risk of hip impingement, we analysed maximum ranges of movement to the point of bony impingement, and impingement location using three-dimensional (3D) surface models of the pelvis and femur in combination with 3D morphology of the hip joint using computer-assisted methods. Results of computed tomography were examined for 52 hip joints with DDH and 73 normal healthy hip joints. DDH shows larger maximum extension (p = 0.001) and internal rotation at 90° flexion (p < 0.001). Similar maximum flexion (p = 0.835) and external rotation (p = 0.713) were observed between groups, while high rates of extra-articular impingement were noticed in these directions in DDH (p < 0.001). Smaller cranial acetabular anteversion (p = 0.048), centre-edge angles (p < 0.001), a circumferentially shallower acetabulum, larger femoral neck anteversion (p < 0.001), and larger alpha angle were identified in DDH. Risk of anterior impingement in retroverted DDH hips is similar to that in retroverted normal hips in excessive adduction but minimal in less adduction. These findings might be borne in mind when considering the possibility of extra-articular posterior impingement in DDH being a source of pain, particularly for patients with a highly anteverted femoral neck.

  14. Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population

    PubMed Central

    Bennett, A N; Nixon, J; Roberts, A; Barker-Davies, R; Villar, R; Houghton, J M

    2016-01-01

    Background Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10–15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis. Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations. Aim To evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population. Methods All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability. Results 101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative. Conclusions These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments. PMID:27900190

  15. Femoroacetabular impingement.

    PubMed

    Volpon, José Batista

    2016-01-01

    The femoroacetabular impingement (FAI) is as condition recently characterized that results from the abnormal anatomic and functional relation between the proximal femur and the acetabular border, associated with repetitive movements, which lead labrum and acetabular cartilage injuries. Such alterations result from anatomical variations such as acetabular retroversion or decrease of the femoroacetabular offset. In addition, FAI may result from acquired conditions as malunited femoral neck fractures, or retroverted acetabulum after pelvic osteotomies. These anomalies lead to pathological femoroacetabular contact, which in turn create impact and shear forces during hip movements. As a result, there is early labrum injury and acetabulum cartilage degeneration. The diagnosis is based on the typical clinical findings and images. Treatment is based on the correction of the anatomic anomalies, labrum debridement or repair, and degenerate articular cartilage removal. However, the natural evolution of the condition, as well as the outcome from long-term treatment, demand a better understanding, mainly in the asymptomatic individuals.

  16. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach

    PubMed Central

    2012-01-01

    Background and purpose There is growing interest in minimally invasive surgery techniques in total hip arthroplasty (THA). In this study, we investigated the learning curve and the early complications of the direct anterior approach in hip replacement. Methods In the period January through December 2010, THA was performed in 46 patients for primary osteoarthritis, using the direct anterior approach. These cases were compared to a matched cohort of 46 patients who were operated on with a conventional posterolateral approach. All patients were followed for at least 1 year. Results Operating time was almost twice as long and mean blood loss was almost twice as much in the group with anterior approach. No learning effect was observed in this group regarding operating time or blood loss. Radiographic evaluation showed adequate placement of the implants in both groups. The early complication rate was higher in the anterior approach group. Mean time of hospital stay and functional outcome (with Harris hip score and Oxford hip score) were similar in both groups at the 1-year follow-up. Interpretation The direct anterior approach is a difficult technique, but adequate hip placement was achieved radiographically. Early results showed no improvement in functional outcome compared to the posterolateral approach, but there was a higher early complication rate. We did not observe any learning effect after 46 patients. PMID:22880711

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

    PubMed Central

    Gómez Pellico, L; Fernández Camacho, F J

    1992-01-01

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

  18. Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females.

    PubMed

    Delahunt, Eamonn; Prendiville, Anna; Sweeney, Lauren; Chawke, Mark; Kelleher, Judy; Patterson, Matt; Murphy, Katie

    2012-08-01

    Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P<0.05) and transverse plane (P<0.05) kinematic profiles, as well as knee joint frontal plane (P<0.05) and sagittal plane (P<0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

  19. 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

  20. 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

  1. Assessment of the alpha angle and mobility of the hip in patients with noncontact anterior cruciate ligament injury.

    PubMed

    Lopes, Osmar Valadao; Tragnago, Gustavo; Gatelli, Cristiano; Costa, Rogério Nascimento; de Freitas Spinelli, Leandro; Saggin, Paulo Renato Fernandes; Kuhn, André

    2017-08-01

    To evaluate the alpha angle of the hip in patients with noncontact anterior cruciate ligament (ACL) injury and compare it with patients without injury. In addition, external and internal rotation of the hip was assessed and correlated with the alpha angle. The alpha angle of the ipsilateral hip was assessed in 41 subjects with non-contact ACL tear and compared with 39 subjects with no tear. The external and internal rotation of the ipsilateral hip was also evaluated. The alpha angle was larger in subjects with noncontact ACL injury. The mean was 70.31° (±13.92°) compared with 58.55° (±13.95°) in the control group (p < 0.001). The groups were similar when considering the external, internal, and sum of rotation of the ipsilateral hip. There was no correlation between the alpha angle and decreased rotational range of motion of the hip in either group (p > 0.05). Patients with noncontact ACL injury presented a greater alpha angle when compared with the group without tear. There was no difference in the rotational mobility of the hip between groups, nor was there a correlation between the increase in the alpha angle and the decrease in the rotational mobility of the hip.

  2. Nerve injuries in total hip arthroplasty with a mini invasive anterior approach.

    PubMed

    Macheras, George A; Christofilopoulos, Panayiotis; Lepetsos, Panagiotis; Leonidou, Andreas O; Anastasopoulos, Panagiotis P; Galanakos, Spyridon P

    2016-07-25

    Minimal invasive techniques in total hip arthroplasty (THA) have become increasingly popular during recent years. Despite much debate over the outcome of several minimal invasive techniques, complications arising from the use of anterior minimally invasive surgery (AMIS) for THA on a traction table are not well documented. Our study aims to focus on nerve damage during the AMIS procedure and the possible explanations of these injuries. We reviewed all primary THAs performed with the AMIS technique using a traction table, over 5 years and recorded all intraoperative and postoperative complications up to the latest follow-up. We focused on nerve injuries and nerve function impairment following the aforementioned technique. Our study included 1,512 THAs performed with the AMIS technique in 2 major hip reconstruction centres (KAT General Hospital, Athens, Greece and University Hospital of Geneva, Switzerland), on 1,238 patients (985 women, 253 men; mean age 65.24 years). Mean follow-up was 29.4 months. We observed 51 cases of transient lateral femoral cutaneous nerve neuropraxia (3.37%), 4 cases of femoral nerve paralysis (3 permanent, 1 transient [0.26%]) and 1 case of permanent sciatic nerve paralysis (0.06%). No case of obturator or pudendal nerve injury was noticed. Mean age of these cases was 68.97 years. Sciatic and femoral nerve injuries were confirmed by electromyography, showing axonotmesis of the damaged nerve. Neurological injuries are a rare but distinct complication of THAs using the AMIS technique. Possible explanations for such referred nerve injuries are direct nerve injury, extreme traction, hyperextension, extreme external rotation of the leg, use of retractors and coexisting spinal deformities. Controlled use of traction in hip extension, cautious use of retractors and potential use of dynamometers may be useful, so that neurological damage can be avoided. Further studies are needed to fully elucidate the role of the above factors in AMIS

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

    PubMed Central

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

    2015-01-01

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

  4. 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.

  5. 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

  6. IMPROVEMENTS IN KNEE EXTENSION STRENGTH ARE ASSOCIATED WITH IMPROVEMENTS IN SELF-REPORTED HIP FUNCTION FOLLOWING ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT SYNDROME

    PubMed Central

    Ellis, Thomas J.; Amesur, Ajit K.; Hewett, Timothy E.; Di Stasi, Stephanie

    2016-01-01

    Background Recovery of strength is critical for return to sport, and is a known predictor of functional outcomes in post-surgical orthopedic populations. Muscle weakness is a known impairment in patients with femoroacetabular impingement syndrome (FAIS) but whether improvements in muscle strength after arthroscopy are associated with improved hip function is unknown. Hypothesis/Purpose To examine the relationships between changes in hip and thigh muscle strength and self-reported function in athletes undergoing arthroscopy for FAIS. Study Design Single cohort descriptive and correlational study Methods Twenty-eight athletes underwent strength testing and completed the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports (HOS-S) subscales prior to and six months after surgery. Isokinetic knee extension and flexion strength were measured using a Biodex dynamometer at 60 °/s and 300 °/s. Isometric hip abduction strength was measured using a custom dynamometer. Changes in strength, limb symmetry, and HOS scores were assessed using paired t-tests. Spearman's rank correlations were used to examine relationships between change in involved limb strength and change in HOS scores. Results Subjects were tested an average of 32 days before and 178 days after surgery. HOS-ADL and HOS-S subscales improved by a mean of 19.0 ± 21.1 and 23.8 ± 31.9, respectively, over time (p < 0.001). Hip abduction strength did not increase over time in either limb (p ≥ 0.27). Involved limb knee flexion and extension strength did not increase significantly over time (p-values: 0.10-0.48) with the exception of knee extension at 300 °/s (p = 0.04). Uninvolved limb knee extension strength at both velocities and knee flexion strength at 60 °/s improved significantly over time (p < 0.012). Increases in knee extension strength (60 °/s) of the involved limb were significantly correlated with improvements on the HOS-ADL (r = 0.431; 0 = 0

  7. 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

  8. 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/

  9. Problems With Large Joints: Hip Conditions.

    PubMed

    Goerl, Kyle

    2016-07-01

    Common overuse injuries of the hip include greater trochanteric pain syndrome (GTPS) and coxa saltans (ie, snapping hip). GTPS, previously called trochanteric bursitis, is a regional chronic pain syndrome. Etiologies include gluteal tendinitis or tendinosis, gluteal muscle or tendon tears, bursitis, meralgia paresthetica, iliotibial band disorders, and referred osteoarthritis pain. Treatment typically consists of activity modification and physical therapy (PT). Snapping hip can have multiple etiologies. Extra-articular etiologies include iliotibial band syndrome and iliopsoas snapping. Patients typically are treated with activity modification and PT. Intra-articular snapping usually is the result of chondral or acetabular labral injuries, and may require surgical intervention. Femoroacetabular impingement is an emerging etiology of hip pain. Patients commonly report anterior hip or groin pain with insidious onset. It results from cam-type impingement from an irregular shape of the femoral head-neck junction, pincer-type impingement from the acetabulum, or mixed-type impingement resulting from a combination of abnormalities. This atypical morphology can lead to labral tears or chondral injuries, which may manifest as painful clicking or popping. Treatments range from conservative, including activity modification, anti-inflammatory drugs, and PT, to surgical correction of the atypical morphology and addressing labral or chondral damage when present.

  10. 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

    2017-04-04

    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

  11. Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation.

    PubMed

    Batailler, Cécile; Fary, Camdon; Batailler, Pierre; Servien, Elvire; Neyret, Philippe; Lustig, Sébastien

    2017-03-01

    We hypothesize that a dual mobility cup can be safely used via the direct anterior approach, without increasing the risk of complications or incorrect positioning. This retrospective study compared 201 primary total hip arthroplasties using a dual mobility cup performed via direct anterior approach without a traction table, to 101 arthroplasties performed via posterolateral approach. Implant positioning, function scores, and early complications were recorded. Implant positioning was appropriate in both groups, with a higher cup anteversion in direct anterior approach. The complications rates were similar in both groups, with no dislocation or infection. The direct anterior approach without traction table associated with a dual mobility cup does not increase the risk of complications or non-optimal positioning of implants. This strategy is interesting for patients with high risk of post-operative dislocation.

  12. Short-term comparison of postural effects of three minimally invasive hip approaches in primary total hip arthroplasty: Direct anterior, posterolateral and Röttinger.

    PubMed

    Van Driessche, S; Billuart, F; Martinez, L; Brunel, H; Guiffault, P; Beldame, J; Matsoukis, J

    2016-10-01

    There is renewed interest in total hip arthroplasty (THA) with the development of minimally invasive approaches. The anterior and Röttinger approaches are attractive for their anatomical and minimally invasive character, but with no comparative studies in the literature definitely suggesting superiority in terms of quality of functional recovery. We therefore performed a case-control study, assessing: 1) whether the postural parameters of patients operated on with the anterior, Röttinger and posterior minimally invasive approaches were similar to those of asymptomatic subjects, and 2) whether there were any differences in postural parameters between the three approaches at short-term follow-up. We hypothesized that the anterior and Röttinger approaches are less disruptive of postural parameters than the posterior approach. Seventy subjects (44 primary THA patients and 26 asymptomatic control subjects) were enrolled. Operated subjects were divided into 3 experimental groups corresponding to the 3 minimally invasive approaches: posterior (n=14), anterior (n=15) and Röttinger (n=15). Two single-leg stance tests (left followed by right leg stance; 10s per test) were carried out on a stabilometric platform, within 2months after surgery for all THA patients, and for controls. Six significant parameters were selected for statistical analysis: test performance, mediolateral and anteroposterior displacements of the center of pressure (CP), path length, average CP displacement speed, and the ellipse containing 95% of CP projections. Non-parametric statistical tests were used to compare groups. There was no difference between the 3 study groups and the control group according to age, gender, BMI, or side (or between study groups regarding WOMAC score). No significant differences between approaches were found for success on postural tests (P=0.14). Subjects operated on with the anterior or Röttinger approach showed significant differences from asymptomatic subjects for 2

  13. Pilot evaluation of anterior dynamic ultrasound screening for developmental dysplasia of the hip in an Australian regional hospital.

    PubMed

    Charlton, S; Muir, L; Skinner, T C; Walters, L

    2012-01-01

    Developmental Dysplasia of the Hip (DDH) is the most common notifiable musculoskeletal birth defect in South Australia (SA). Despite routine screening by physical examination of the hips in the neonatal period and at 6 weeks of age, the risk of late diagnosis is increased in rural areas. It is assumed this is due to the examining doctors' reduced clinical expertise. Introducing Anterior Dynamic Ultrasound (ADUS) has reduced the late detection rates in Sweden to almost zero, and may benefit Australian infants in rural areas if routine screening was introduced. This study reports on a small implementation pilot in a SA regional hospital where volunteer postnatal mothers consented to their babies having ADUS examinations. The pilot was evaluated by collecting results of physical examination, ADUS, and surveying parental impressions of the screening test. Hips of 86 infants underwent ADUS during the implementation pilot. Parents' perceptions were mainly very positive and indicated ADUS was an accessible and acceptable screening test. Of the hips scanned, three were found to have maximum movement of the femoral head of >3 mm and were deemed to demonstrate increased laxity. Four hips described as loose or mobile on clinical examination were found to be within normal limits of maximum mobility on ADUS. This study has demonstrated that a larger scale implementation project would be feasible in regional Australia, and would enable researchers to better understand how to reduce the late diagnosis rate of DDH in rural areas.

  14. 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.

  15. Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study.

    PubMed

    Khayambashi, Khalil; Ghoddosi, Navid; Straub, Rachel K; Powers, Christopher M

    2016-02-01

    Prospective studies have reported that abnormal movement patterns at the trunk, hip, and knee are associated with noncontact anterior cruciate ligament (ACL) injuries. Impaired hip strength may underlie these abnormal movement patterns, suggesting that diminished hip strength may increase the risk of noncontact ACL injury. To determine whether baseline hip strength predicts future noncontact ACL injury in athletes. Case-control study; Level of evidence, 3. Before the start of the competitive season, isometric hip strength (external rotation and abduction) was measured bilaterally by use of a handheld dynamometer in 501 competitive athletes (138 female and 363 male athletes) participating in various sports. During the sport season, ACL injury status was recorded, and injured athletes were further classified based on the mechanism of injury (noncontact vs contact). After the season, logistic regression was used to determine whether baseline hip strength predicted future noncontact ACL injury. Receiver operating characteristic (ROC) curves were constructed independently for each strength measure to determine the clinical cutoff value between a high-risk and low-risk outcome. A total of 15 noncontact ACL injuries were confirmed (6 females, 9 males), for an overall annual incidence of 3.0% (2.5% for males, 4.3% for females). Baseline hip strength measures (external rotation and abduction) were significantly lower in injured athletes compared with noninjured athletes (P = .003 and P < .001, respectively). Separate logistic regression models indicated that impaired hip strength increased future injury risk (external rotation: odds ratio [OR] = 1.23 [95% CI, 1.08-1.39], P = .001; abduction: OR = 1.12 [95% CI, 1.05-1.20], P = .001). Clinical cutoffs to define high risk were established as external rotation strength ≤20.3% BW (percentage of body weight) or abduction strength ≤35.4% BW. Measures of preseason isometric hip abduction and external rotation strength

  16. The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table.

    PubMed

    Molenaers, Ben; Driesen, Ronald; Molenaers, Guy; Corten, Kristoff

    2017-05-01

    The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures. We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17). The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97). Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Rehabilitation following anterior approach total hip arthroplasty in a 49-year-old female: a case report.

    PubMed

    Lesch, Dennis C; Yerasimides, Jonathan G; Brosky, Joseph A

    2010-07-01

    Over 230,000 total hip arthroplasties (THA) are performed annually, and many of these patients will seek or be referred to a physical therapist to assist them in their recovery. Improvements in understanding of joint replacement technology have allowed earlier weight bearing and return to function. With the anterior surgical approach, patients are permitted weight bearing as tolerated immediately after surgery and can resume nearly all prior activities upon returning home. This case report describes the home-based physical therapy management of a 49-year-old female following a left THA using an anterior surgical approach. This report also includes a description of the functional based protocol and hip assessment scale used. The rehabilitation program was initiated 4 days postoperatively and consisted of a patient-oriented and functional approach. Seventeen days after surgery and seven home visits, the patient exhibited a normal gait pattern, was walking 20 minutes continuously, safely negotiating stairs, and had resumed normal household activities. The subject of this case report was relatively young, highly motivated, and the outcomes presented may not be generalized or expected of other patients following anterior approach THA. Additional studies are needed to determine long-term effects of this surgical approach and postoperative home-based rehabilitation program.

  18. Is the hip capsule thicker in diseased hips?

    PubMed Central

    Bonura, A. A.; Nairn, R.; Schweitzer, M. E.; Kolanko, N. M.; Beaule, P. E.

    2016-01-01

    Objectives The purpose of this study was to compare the thickness of the hip capsule in patients with surgical hip disease, either with cam-femoroacetabular impingement (FAI) or non-FAI hip pathology, with that of asymptomatic control hips. Methods A total of 56 hips in 55 patients underwent a 3Tesla MRI of the hip. These included 40 patients with 41 hips with arthroscopically proven hip disease (16 with cam-FAI; nine men, seven women; mean age 39 years, 22 to 58) and 25 with non-FAI chondrolabral pathology (four men, 21 women; mean age 40 years, 18 to 63) as well as 15 asymptomatic volunteers, whose hips served as controls (ten men, five women; mean age 62 years, 33 to 77). The maximal capsule thickness was measured anteriorly and superiorly, and compared within and between the three groups with a gender subanalysis using student’s t-test. The correlation between alpha angle and capsule thickness was determined using Pearson’s correlation coefficient. Results Superiorly, the hip capsule was significantly greater in cam- (p = 0.028) and non-FAI (p = 0.048) surgical groups compared with the asymptomatic group. Within groups, the superior capsule thickness was significantly greater than the anterior in cam- (p < 0.001) and non-FAI (p < 0.001) surgical groups, but not in the control group. There was no significant correlation between the alpha angle and capsule thickness. There were no gender differences identified in the thickness of the hip capsule. Conclusion The thickness of the capsule does not differ between cam- and non-FAI diseased hips, and thus may not be specific for a particular aetiology of hip disease. The capsule is, however, thicker in diseased surgical hips compared with asymptomatic control hips. Cite this article: K. S. Rakhra, A. A. Bonura, R. Nairn, M. E. Schweitzer, N. M. Kolanko, P. E. Beaule. Is the hip capsule thicker in diseased hips? Bone Joint Res 2016;5:586–593. DOI: 10.1302/2046-3758.511.2000495. PMID:27903506

  19. Evaluation of wound healing after direct anterior total hip arthroplasty with use of a novel retraction device.

    PubMed

    Alvarez-Pinzon, Andres M; Mutnal, Amar; Suarez, Juan C; Jack, Megan; Friedman, David; Barsoum, Wael K; Patel, Preetesh D

    2015-01-01

    Use of shorter incisions in minimally invasive surgery total hip arthroplasty (THA) may come at the cost of poorer cosmesis, possibly a result of the excessive retraction needed for visualization. This may be particularly relevant in the direct anterior approach, in which wound-healing issues are common. We prospectively investigated whether a specialized ring retractor was effective in minimizing wound-edge trauma, as evidenced by improved scar cosmesis. Fifty patients having direct anterior THA were randomized to surgery with or without ring retractor. Incisional photographs 2, 6, and 12 weeks after surgery were graded by 2 blinded plastic surgeons. Wound scores and patient satisfaction with scar appearance were similar between groups. Our results suggest no improvement in wound cosmesis with use of this retraction device.

  20. Direct anterior approach for total hip arthroplasty with a novel mobile traction table -a prospective cohort study.

    PubMed

    Nakamura, Junichi; Hagiwara, Shigeo; Orita, Sumihisa; Akagi, Ryuichiro; Suzuki, Takane; Suzuki, Masahiko; Takahashi, Kazuhisa; Ohtori, Seiji

    2017-01-31

    The purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table. The first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients. The implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group. The direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.

  1. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis (PRISMA).

    PubMed

    Yue, Chen; Kang, Pengde; Pei, Fuxing

    2015-12-01

    The direct anterior approach (DAA) to total hip arthroplasty has been promoted as a minimally invasive alternative to the lateral approach, which we sought to verify by systematically reviewing and meta-analyzing the literature comparing clinical, radiographic, and surgical outcomes. Two reviewers independently searched PubMed, OVID, and Web of Science databases for randomized controlled trials (RCTs) and cohort studies comparing the DAA and lateral approach for total hip arthroplasty. Quality of RCTs was assessed using the Jadad scoring system, quality of cohort studies, using the Minors system. Data were extracted and meta-analyzed or qualitatively synthesized for primary outcomes (function, complications, and hospitalization time) and several secondary outcomes. Data were extracted from 12 trials involving 4901 arthroplasty procedures. Meta-analysis showed that DAA was associated with significantly shorter hospitalization than the lateral approach, as well as greater functional rehabilitation and lower perceived pain during the early postoperative period. On the other hand, DAA was associated with longer surgery time. The 2 approaches were associated with similar rates of perioperative surgical complications and transfusions, as well as similar radiographic analysis results. Although DAA may provide shorter hospitalization and faster recovery during the early postoperative period, the available evidence is still insufficient to conclude whether the DAA or lateral approach is superior for total hip arthroplasty. More high-quality studies and subsequent meta-analyses are needed.

  2. Kerboull-type plate in a direct anterior approach for severe bone defects at primary total hip arthroplasty: technical note

    PubMed Central

    Matsumoto, Mikio; Baba, Tomonori; Ochi, Hironori; Ozaki, Yu; Watari, Taiji; Homma, Yasuhiro; Kaneko, Kazuo

    2017-01-01

    Introduction: For cases with extensive acetabular bone defects, we perform surgery combining the Kerboull-type (KT) plate and bone graft through direct anterior approach (DAA) in primary total hip arthroplasty (THA) requiring acetabular reconstruction as minimally invasive surgery. This paper provides the details of the surgical procedure. Methods: The basic structure of the Kerboull-type plate is a cruciform plate. Since the hook of the Kerboull-type plate has to be applied to the tear drop, a space for it was exposed. The tear drop is located in the anterior lower region in surgery through DAA in supine position. It was also confirmed by fluoroscopy as needed. The bone grafting was performed using an auto- or allogeneic femoral head for bone defects in the weight-bearing region of the hip joint. Results: Of 563 patients who underwent primary THA between 2012 and 2014, THA using the KT plate through DAA was performed in 21 patients (3.7%). The mean duration of postoperative follow-up was 31.8 months. The mean operative time was 188.4 min, and the mean blood loss was 770 g. The patients became able to walk independently after 2.4 days on average (1–4 days). On clinical evaluation, the modified Harris Hip Score was 45.6 ± 12.4 before surgery, and it was significantly improved to 85.3 ± 8.97 on the final follow-up. Discussion: DAA is a true intermuscular approach capable of conserving soft tissue. Since it is applied in a supine position, fluoroscopy can be readily used, and it was very useful to accurately place the plate. PMID:28287388

  3. BRAZILIAN ORTHOPEDISTS' OPINIONS AND PERCEPTIONS ON FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Ejnisman, Leandro; Khan, Moin; Ayeni, Olufemi Rolland; Bhandari, Mohit; Miyahara, Helder de Souza; Vicente, Jose Ricardo Negreiros

    2016-01-01

    ABSTRACT Objective: To assess the opinion of Brazilian orthopedists surgeons on the diagnosis and treatment of femoroacetabular impingement (FAI). Methods: A questionnaire was sent to several orthopedic societies around the world, including the Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). This questionnaire was sent electronically and included questions on many topics related to FAI. Results: 253 Brazilian orthopedists responded the questionnaire. Sixty-eight point nine percent worked in private practice and 23.1% in academic institutions. Pain during hip rotation was the most important finding in the clinical history according to 81.8% of the respondents and the anterior impingement sign was the most important finding in the physical examination according to 88.2%. Initial treatment was physiotherapy according to 86.2%. Surgical treatment was hip arthroscopy according to 38.8%, and via surgical hip dislocation for 14.7%. Conclusion: Brazilian orthopedists' opinions on FAI are similar to their international colleagues. There is considerable discrepancy in the answers provided, demonstrating a need for future investigation on FAI, in order to institute proper treatment and diagnosis protocols. Level of Evidence V. Expert Opinion. PMID:28924359

  4. BRAZILIAN ORTHOPEDISTS' OPINIONS AND PERCEPTIONS ON FEMOROACETABULAR IMPINGEMENT.

    PubMed

    Ejnisman, Leandro; Khan, Moin; Ayeni, Olufemi Rolland; Bhandari, Mohit; Miyahara, Helder de Souza; Vicente, Jose Ricardo Negreiros

    2016-01-01

    To assess the opinion of Brazilian orthopedists surgeons on the diagnosis and treatment of femoroacetabular impingement (FAI). A questionnaire was sent to several orthopedic societies around the world, including the Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). This questionnaire was sent electronically and included questions on many topics related to FAI. 253 Brazilian orthopedists responded the questionnaire. Sixty-eight point nine percent worked in private practice and 23.1% in academic institutions. Pain during hip rotation was the most important finding in the clinical history according to 81.8% of the respondents and the anterior impingement sign was the most important finding in the physical examination according to 88.2%. Initial treatment was physiotherapy according to 86.2%. Surgical treatment was hip arthroscopy according to 38.8%, and via surgical hip dislocation for 14.7%. Brazilian orthopedists' opinions on FAI are similar to their international colleagues. There is considerable discrepancy in the answers provided, demonstrating a need for future investigation on FAI, in order to institute proper treatment and diagnosis protocols. Level of Evidence V. Expert Opinion.

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

    PubMed Central

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

    2015-01-01

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

  6. The Direct Anterior Approach for Hip Revision: Accessing the Entire Femoral Diaphysis Without Endangering the Nerve Supply.

    PubMed

    Nogler, Michael M; Thaler, Martin R

    2017-02-01

    The direct anterior approach (DAA) to the hip has been criticized as an approach that is limited to primary arthroplasty only. Our study objective was to demonstrate, in a cadaveric setting, that an alternate extension of the DAA can be used to reach the femur at the posterior border of the lateral vastus muscle without endangering the nerve supply. The iliotibial tract is split anteriorly and pulled laterally, thereby opening the interval to the lateral-posterior aspect of the vastus muscle. The muscle fascia is incised at the posterior border to access the femoral diaphysis. The vastus mobilization is started distally and laterally to the greater trochanter, leaving a muscular bridge between the vastus and the medial gluteal muscle intact. If it is necessary to open the femoral cavity for implant retrieval, we perform an anterior wall osteotomy instead of an extended trochanteric osteotomy. It was possible to split the iliotibial band and pull it laterally, thereby exposing the entire vastus lateralis muscle. The junction of the vastus lateralis and vastus intermedius was not encountered in all cases, nor was the nerve supply with all nerve fibers in that interval. The alternate technique described here for accessing the femoral diaphysis allows for easy access to the lateral aspect of the vastus lateralis and the femoral diaphysis. Using this technique, it should also be possible to access the femur and perform all necessary reconstructive procedures on it without damaging the surrounding nerve structures. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Hip arthroscopy.

    PubMed

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

    2015-01-01

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

  8. 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

  9. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty.

    PubMed

    Martin, Christopher T; Pugely, Andrew J; Gao, Yubo; Clark, Charles R

    2013-05-01

    The efficacy of the anterior, relative to other operative approaches, in promoting earlier return to function after hip arthroplasty has not been well established. We retrospectively compared 41 anterior and 47 posterior approach cases. Mean hospital stay (2.9 vs. 4 days, p=0.001) and days to mobilization (2.4 vs. 3.2 days, p=0.006) were shorter with the anterior approach. After multivariate regression, the anterior approach remained a significant predictor of early discharge (p=0.009). Lateral femoral cutaneous nerve neuropraxia (17%) and fracture (2%), were more common in the anterior cohort, but all patients recovered without sequela. Overall, the anterior approach patients had earlier discharge and mobilization as compared to patients who received the posterior approach. Neuropraxia and fracture remain a concern, but the clinical significance was low in our cohort. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip.

    PubMed

    Tatu, L; Parratte, B; Vuillier, F; Diop, M; Monnier, G

    2001-01-01

    Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments: a medial compartment for the main tendon and a lateral compartment for the accessory tendon.

  11. ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT

    PubMed Central

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

    2015-01-01

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

  12. Safe suture anchor insertion for anterior and posterior hip labral repair

    PubMed Central

    Foster, Andrew D.; Ryan, John; Ellis, Thomas; Flom, James

    2015-01-01

    We sought to define bone thickness in relation to the chondral surface at various depths along the anterior and posterior acetabular rim and safe portals for anchor insertion in these regions. Six cadaveric pelvises were mounted on a custom jig. A custom guide was attached to simulate anterolateral (AL), mid-anterior (MA), distal anterolateral (DALA) and posterolateral (PL) arthroscopy portals. Anterior 3 o’clock and 4 o’clock positions were drilled using MA and DALA portals. Posterior 8 o’clock to 11 o’clock positions were drilled using a 1.4-mm drill bit from the PL portal. At depths of 5, 10 and 15 mm, the distance from the drill to the intra and extra-articular surfaces was measured using a custom caliper. Mean distance between drill hole and articular surface for anterior and posterior positions ranged from 1.61 to 2.75 mm at 5 mm. The smallest distance between the drill hole and articular surface and the largest width between drill hole and the extra-articular surface were at the 4 o’clock position. No difference between the MA and DALA portals were noted for the anterior positions. For the posterior rim positions, the distance on the articular side remained consistent throughout. For the posterior positions, only the PL portal was utilized. Both the MA or DALA portals can be utilized for safe drilling of the anterior rim positions. The posterior positions can all be safely drilled with a relatively good bone margin using the PL portal, but use of the MA or DALA portals resulted in extra-articular cortical perforation in all cases. PMID:27011835

  13. Safe suture anchor insertion for anterior and posterior hip labral repair.

    PubMed

    Foster, Andrew D; Ryan, John; Ellis, Thomas; Flom, James

    2015-07-01

    We sought to define bone thickness in relation to the chondral surface at various depths along the anterior and posterior acetabular rim and safe portals for anchor insertion in these regions. Six cadaveric pelvises were mounted on a custom jig. A custom guide was attached to simulate anterolateral (AL), mid-anterior (MA), distal anterolateral (DALA) and posterolateral (PL) arthroscopy portals. Anterior 3 o'clock and 4 o'clock positions were drilled using MA and DALA portals. Posterior 8 o'clock to 11 o'clock positions were drilled using a 1.4-mm drill bit from the PL portal. At depths of 5, 10 and 15 mm, the distance from the drill to the intra and extra-articular surfaces was measured using a custom caliper. Mean distance between drill hole and articular surface for anterior and posterior positions ranged from 1.61 to 2.75 mm at 5 mm. The smallest distance between the drill hole and articular surface and the largest width between drill hole and the extra-articular surface were at the 4 o'clock position. No difference between the MA and DALA portals were noted for the anterior positions. For the posterior rim positions, the distance on the articular side remained consistent throughout. For the posterior positions, only the PL portal was utilized. Both the MA or DALA portals can be utilized for safe drilling of the anterior rim positions. The posterior positions can all be safely drilled with a relatively good bone margin using the PL portal, but use of the MA or DALA portals resulted in extra-articular cortical perforation in all cases.

  14. Intraoperative Femur Fracture Risk During Primary Direct Anterior Approach Cementless Total Hip Arthroplasty With and Without a Fracture Table.

    PubMed

    Cohen, Eric M; Vaughn, Joshua J; Ritterman, Scott A; Eisenson, Daniel L; Rubin, Lee E

    2017-09-01

    There is no study to date comparing intraoperative femur fractures (IFFs) in the direct anterior approach (DAA) with and without a fracture table. We hypothesize that there is no significant difference in the IFF with and without a fracture table when performed by experienced DAA hip surgeons. This study is a 1-year retrospective review of patients who underwent DAA total hip arthroplasty by 2 surgeons: one surgeon uses a flat table and manually elevates the femur with a large bone hook, while the other surgeon uses a fracture table and a mechanical femoral elevator. Exclusion criteria included cemented femoral implants, femoral neck fractures, and lack of 6-month follow-up. We identified 487 patients for analysis (220 male and 267 female, average age 66.55 years). There were 12 total IFFs (2.46%): 8 female and 4 male patients. The average age of IFF patients was 70.67 years and in nonfracture patients was 66.00 years. There was no difference in gender (P = .2981) or age (P = .2099) between IFF and nonfracture patients. In the fracture table group, there were 6 IFFs (2.22%) in 271 patients; in the nonfracture table group, there were 6 IFFs (2.76%) in 216 patients. There was no statistical difference in IFF between the 2 groups (P = .6973). We observed just 2 patients (0.4%) in this series where the IFFs changed management requiring a revision femoral stem. There was no statistical difference in IFF with or without the use of fracture table. Both DAA surgical technique variations are felt to be equivalent regarding the risk for IFF during DAA cementless total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Break dance hip: chronic avulsion of the anterior superior iliac spine.

    PubMed

    Winkler, A R; Barnes, J C; Ogden, J A

    1987-01-01

    A case of chronic, progressive avulsion of the anterior superior iliac spine leading to the formation of a long, attenuated spur of bone in an 18-year-old black male break dancer is described. The mechanism of formation appeared to be repetitive avulsion from break dancing.

  16. Distal Extension of the Anterior Approach to the Hip Using the Femoral Interbundle Technique: Surgical Technique and Case Series.

    PubMed

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

    2017-07-01

    The direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, it has been associated with an increased incidence of intraoperative femoral fractures in particular during the learning curve. Distal extension of the approach may be needed in case of intraoperative complications. The aim of the present study is to describe the distal extension of the DAA using the femoral interbundle technique. A stepwise approach based on a cadaveric study to extend the DAA distally is presented. The interval between the neurovascular bundles running to the vastus lateralis is used to gain access to the femur. Clinical and electromyography results of 5 patients undergoing a revision of the femoral component through an extended anterior approach are reported. In 2 cases, the proximal bundle was exposed whereas in 3 cases the interval between the proximal and distal bundle was developed and cerclage wires were applied around the isthmus of the femur. All fractures had healed at 6 months of follow-up. Four cases had a normal electromyography, and 1 case demonstrated a neuropraxia of a branch to the vastus lateralis. All cases had a 5/5 extension power of the quadriceps muscle clinically. The interbundle technique is an alternative way to gain additional exposure of the femur during the DAA and is based on precise knowledge of the periarticular neurovascular structures. This approach can be helpful to safely deal with intraoperative complications such as fractures requiring proximal femoral cerclage wiring during the anterior approach. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2015-01-01

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

  18. 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

  19. High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table

    PubMed Central

    Collis, Dennis K.

    2010-01-01

    Background Recent attention in THA has focused on minimally invasive techniques and their short-term outcomes. Despite much debate over the outcomes and complications of the two-incision and the mini-lateral and mini-posterior approaches, complications arising from use of the anterior THA on a fracture table are not well documented. Questions/purposes We determined the intraoperative and postoperative complications with the anterior approach to THA through an extended single-surgeon patient series. Methods We reviewed 800 primary THAs performed anteriorly with the aid of a fracture table over 5 years and recorded all intraoperative and postoperative complications up to latest followup (average, 1.8 years; range, 0–5 years). Patients with severe acetabular deformity or severe flexion contractures were excluded and those surgeries were performed with a lateral approach during the time period of this study. Results Intraoperative complications included 19 trochanteric fractures, three femoral perforations, one femoral fracture, one acetabular fracture, one bleeding complication, and one case of cardiovascular collapse. There were no ankle fractures. Postoperative complications included seven patients with dislocations; seven with deep infections; one with delayed femur fracture; 37 with wound complications, among which 13 had reoperation for local débridement; 14 with deep venous thrombosis; and two with pulmonary embolism; and 31 other nonfatal medical complications. Conclusions The main intraoperative complications of trochanteric fractures and perforations occurred mostly early in the series, while the main postoperative complications related to wound healing were prevalent throughout the entire series. Despite potential advantages of use of a fracture table, surgeons should be aware of the potential complications of trochanteric fractures, perforations, and wound-healing problems associated with this technique. Level of Evidence Level IV, therapeutic study

  20. Range of motion and radiographic analysis of the hip in patients with contact and non-contact anterior cruciate ligament injury.

    PubMed

    Lopes, Osmar Valadão; Gomes, João Luiz Ellera; de Freitas Spinelli, Leandro

    2016-09-01

    To compare the range of motion (ROM) and radiography of the hip joints in male patients with contact anterior cruciate ligament (ACL) injury and non-contact ACL injury. ROM of the ipsilateral hip was evaluated in 35 male patients with contact ACL injury (contact group) and compared to that of 45 male patients with a non-contact ACL injury (non-contact group). Radiographic evaluation of hip joints was also performed to assess the presence of cam and pincer-type deformity . ROM of the hip joint was statistically higher in patients with contact ACL injury. The average sum of hip rotation in the non-contact group was 66.1 ± 8.4° compared to 79.4 ± 10.6° for the contact group (p < 0.001). Seventy-seven per cent of patients in the non-contact group had a sum of hip rotation <70° and 93 % had <80°, compared to17.1 and 42.9 % in the contact group (p < 0.001). Prevalence of cam or pincer deformity was similar in the groups. Cam or pincer deformity was not more frequent in patients with limited ROM of the hip. Individuals with contact ACL injury had greater ROM of the hip joints than those with non-contact ACL injury. The presence of cam or pincer deformity was similar in both groups and was not related to decreased ROM of the hip joints. These findings may assist the surgeons to identify new risk factors for non-contact ACL injury and, additionally, develop prevention program of injury. III.

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

    PubMed Central

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

    2015-01-01

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

  2. [Surgical treatment of hip osteoarthritis: hpdete on hip arthroscopy].

    PubMed

    Ilizaliturri Sánchez, Víctor M; Camacho Galindo, Javier

    2007-10-01

    Arthroscopic surgery of the hip is a routine procedure in an increasing number of institutions around the world. Indications for this procedure increase as more experience is developed. Thanks to hip arthroscopy some intraarticular lesions like labral or ligamentum teres tears and cartilage lesions have been recognized. All of these have the potential to develop hip osteoarthritis. Open techniques for the treatment of femoroacetabular impingement have been transformed to arthroscopic techniques. Femoroacetabular impingement has the potential to cause hip osteoarthritis. The role of hip arthroscopy in the treatment of formally established hip osteoarthritis is limited and has better results in young patients with early degenerative changes.

  3. Femoral Vessel Blood Flow Is Preserved Throughout Direct Anterior Total Hip Arthroplasty.

    PubMed

    Stryker, Louis S; Gilliland, Jeremy M; Odum, Susan M; Mason, J Bohannon

    2015-06-01

    Posterolateral and anterolateral approach THA disrupts femoral vessel blood flow, however, this has not been established for the direct anterior (DA) approach. Ten patients undergoing primary DA THA had peak vascular flow rates for the femoral artery and vein calculated via Doppler ultrasound at specified points: incision, acetabular preparation, femoral preparation and final reduction. Peak femoral arterial and venous flow decreased over baseline, but not significantly, during acetabular preparation (P=0.88, P=0.98) and femoral preparation (P=0.97, P=0.97). At final reduction, arterial peak flow was restored (P=1) with an increase in venous flow (P=0.55). Although there were alterations to peak flow, no vessel occlusion occurred at any point during DA THA.

  4. 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

  5. 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.

  6. Prefemoral fat pad impingement syndrome: identification and diagnosis.

    PubMed

    Borja, Maria J; Jose, Jean; Vecchione, David; Clifford, Paul D; Lesniak, Bryson P

    2013-01-01

    Fat pad impingement syndrome refers to anterior knee pain caused by hemorrhage, inflammation, fibrosis and/or degeneration of the anterior knee fat pads. Symptomatic impingement of the prefemoral fat pad can be clinically significant but easily overlooked on magnetic resonance imaging, unless looked for. It should be evaluated in patients with persistent anterior knee pain, particulary if accompanied with mechanical symptoms and lack of intra-articular pathology.

  7. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach.

    PubMed

    Cheng, Tze E; Wallis, Jason A; Taylor, Nicholas F; Holden, Chris T; Marks, Paul; Smith, Catherine L; Armstrong, Michael S; Singh, Parminder J

    2017-03-01

    We report a prospective randomized study comparing early clinical results between the direct anterior approach (DAA) and posterior approach (PA) in primary hip arthroplasty. Surgeries were performed by 2 senior hip arthroplasty surgeons. Seventy-two patients with complete data were assessed preoperatively 2, 6, and 12 weeks postoperatively. The primary outcomes were the Western Ontario McMasters Arthritis Index and Oxford Hip Scores. Secondary outcome measures included the EuroQoL, 10-meter walk test, and clinical and radiographic parameters. Data analyses showed no difference between DAA (n = 35) and PA (n = 37) groups when comparing total scores for primary outcomes. No significant differences were observed for 10-meter walk test, EuroQoL, and radiographic analyses. Subgroup analysis for surgeon 1 identified that the DAA group had shorter acute hospital stay, less postoperative opiate requirements, and smaller wounds. However, this was offset by increased operative time, higher intraoperative blood loss, and weaker hip flexion at 2 and 6 weeks. Subgroup analysis of items on the Western Ontario McMasters Arthritis Index and Oxford Hip Score identified that hip flexion activity favored the DAA group up to 6 weeks postoperatively. There was an 83% incidence of lateral cutaneous nerve of thigh neuropraxia at the 12-week mark in the DAA group. No neuropraxias occurred in the PA group. One dislocation occurred in each group. A single patient from the DAA group required reoperation for leg-length discrepancy. DAA total hip arthroplasty (THA) has comparable results with PA THA. Choice of surgical approach for THA should be based on patient factors, surgeon preference, and experience. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2015-01-01

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

  9. Do Muscle Strength Deficits of the Uninvolved Hip and Knee Exist in Young Athletes Before Anterior Cruciate Ligament Reconstruction?

    PubMed Central

    Hannon, Joseph; Wang-Price, Sharon; Goto, Shiho; Garrison, J. Craig; Bothwell, James M.

    2017-01-01

    Background: Muscle strength of the involved limb is known to be decreased after injury. Comparison with the uninvolved limb has become standard of practice to measure progress and for calculation of limb symmetry indices (LSIs) to determine readiness to return to sport. However, some literature suggests strength changes in the uninvolved limb also are present after lower extremity injury. Purpose: To examine the uninvolved limb strength in a population of adolescent athletes after an anterior cruciate ligament (ACL) injury and compare strength values with those of the dominant limb in a healthy control group. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 64 athletes were enrolled in this study, including 31with injured ACLs (mean age, 15.6 ± 1.4 years) and 33 healthy controls (mean age, 14.9 ± 1.9 years). The median time from injury to testing was 23 days for the ACL-injured group. Participants underwent Biodex isokinetic strength testing at 60 deg/s to assess quadriceps and hamstring strength. Isometric hip strength (abduction, extension, external rotation) was measured using a handheld dynamometer. The muscle strength of the uninvolved limb of the ACL-injured group was compared with that of the dominant limb of the healthy control group. Results: The results showed a significant difference in quadriceps muscle strength between the 2 study groups (P < .001). Isokinetic quadriceps strength of the uninvolved limb in the ACL group was significantly decreased by 25.5% (P < .001) when compared with the dominant limb of the control group. Conclusion: The results of this study demonstrate a decreased isokinetic strength of the quadriceps muscle in the uninvolved limb after ACL injury as compared with healthy controls. Consideration should be taken when using the uninvolved limb for comparison when assessing quadriceps strength in a population with an ACL injury. PMID:28203600

  10. Ankle impingement syndromes: a review of etiology and related implications.

    PubMed

    Hess, Gregory William

    2011-10-01

    Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10,000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.

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

    PubMed

    Larson, Christopher M

    2016-07-01

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

  12. Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity.

    PubMed

    Dienst, M; Gödde, S; Seil, R; Hammer, D; Kohn, D

    2001-01-01

    To describe the in vivo anatomy of the peripheral compartment of the hip joint using a systematic sequence of examination without traction. Case series. We performed 35 hip arthroscopies without traction from an anterolateral portal in the supine position. Free draping and a good range of movement of the hip joint were used to relax parts of the capsule and increase the intra-articular volume of the area that was inspected. Each procedure was documented on a standard protocol including detailed information on technical features and normal and pathologic intra-articular findings. A comprehensive inspection of the peripheral compartment was obtained from the anterolateral portal. A systematic sequence of examination was developed separating the periphery of the hip joint into 7 areas: anterior neck area, medial neck area, medial head area, anterior head area, lateral head area, lateral neck area, and posterior area. The arthroscopic in vivo anatomy of each area is described. In 3 patients, 1 to 3 loose bodies were removed. In 1 patient with a synovial chondromatosis, 40 chondromas were retrieved. In osteoarthritis, impinging osteophytes were trimmed in 3 cases and partial synovectomy was performed in 10 patients. The following complications were observed: a temporary sensory deficit of the lateral femoral cutaneus nerve in 1 patient, scuffing of the anterior surface of the femoral head in 3 patients, detaching of an osteophyte in 1 patient, and partial tears of the anterior synovial fold in 10 patients. Arthroscopy without traction allows for a complete evaluation of hip anatomy without the loaded articular surfaces, the acetabular fossa, and the ligamentum teres. For a complete overview of both the central and peripheral part of the hip, traction is necessary for the central part.

  13. The Natural History of Femoroacetabular Impingement

    PubMed Central

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

    2015-01-01

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

  14. Open surgical dislocation for the treatment of femoroacetabular impingement: past, present, and future.

    PubMed

    Peters, Christopher L; Stronach, Benjamin M; Pelt, Christopher E; Erickson, Jill A

    2012-01-01

    Femoroacetabular impingement results from a lack of clearance between the femoral neck and the acetabulum. This condition is most commonly seen in the young adult presenting with hip pain after activity. There have been rapid advancements in the understanding of femoroacetabular impingement to include diagnostic, imaging, and treatment options. An open surgical dislocation approach has been developed that offers a safe and effective method to dislocate the hip and allow direct visualization and full access to treat the often complex intra-articular pathologies of femoroacetabular impingement. The ultimate goal of treatment in carefully selected patients is relief of hip pain and preservation of the hip joint.

  15. Ankle impingement: a review of multimodality imaging approach.

    PubMed

    Russo, A; Zappia, M; Reginelli, A; Carfora, M; D'Agosto, G F; La Porta, M; Genovese, E A; Fonio, P

    2013-08-01

    Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55-59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564-574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465-471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft

  16. Posterior ankle impingement.

    PubMed

    Giannini, Sandro; Buda, Roberto; Mosca, Massimiliano; Parma, Alessandro; Di Caprio, Francesco

    2013-03-01

    Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement.

  17. Molecular Characterization of Articular Cartilage from Young Adults with Femoroacetabular Impingement

    PubMed Central

    Hashimoto, Shingo; Rai, Muhammad Farooq; Gill, Corey S.; Zhang, Zhiqi; Sandell, Linda J.; Clohisy, John C.

    2013-01-01

    Background: Femoroacetabular impingement is a frequent cause of hip pain and may lead to secondary osteoarthritis, yet little is known about the molecular events linking mechanical hip impingement and articular cartilage degeneration. The first goal of this study was to quantify the expression of inflammatory cytokine and chemokine, matrix-degrading, and extracellular matrix genes in articular cartilage harvested from control hips and hips with femoroacetabular impingement and end-stage osteoarthritis. The second goal was to analyze the relative expression of these genes in articular cartilage harvested at various stages of osteoarthritis. Methods: Cartilage samples were obtained from thirty-two hips undergoing hip preservation surgery for femoroacetabular impingement or hip arthroplasty. Three control cartilage samples were also analyzed. Specimens were graded intraoperatively with regard to the severity of cartilage damage, the radiographic osteoarthritis grade was recorded, and quantitative RT-PCR (real-time polymerase chain reaction) was performed to determine relative gene expression. Results: Except for interleukin-1β (IL-1β) and CXCL2, the mRNA (messenger RNA) expression of all other chemokine (IL-8, CXCL1, CXCL3, CXCL6, CCL3, and CCL3L1), matrix-degrading (matrix metalloproteinase [MMP]-13 and ADAMTS-4), and structural matrix (COL2A1 [collagen, type II, alpha] and ACAN [aggregan]) genes was higher overall in cartilage from hips with femoroacetabular impingement compared with hips with osteoarthritis and normal controls. The differences reached significance (p ≤ 0.05) for seven of these ten quantified genes, with CXCL3, CXCL6, and COL2A1 being elevated in the femoroacetabular impingement group compared with only the control group and IL-8, CCL3L1, ADAMTS-4, and ACAN being elevated compared with both the osteoarthritis and control groups. When samples were grouped according to the stage of the degenerative cascade, mRNA expression was relatively higher in

  18. Arthroscopic treatment of femoroacetabular impingement: early outcomes.

    PubMed

    Polat, Gökhan; Dikmen, Göksel; Erdil, Mehmet; Aşık, Mehmet

    2013-01-01

    The aim of the study was to assess the early outcomes of the arthroscopic treatment of femoroacetabular impingement. Forty-two femoroacetabular impingement (FAI) patients (mean age: 35.1 years, range: 16 to 52 years) treated arthroscopically between 2006 and 2011 in our clinic were retrospectively analyzed. Twenty-five patients had Cam, 6 Pincer and 11 combined femoroacetabular impingement. Mean follow-up time was 28.2 (range: 10 to 72) months. Patients were assessed clinically and functionally using the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Oxford Hip Score, WOMAC score, and Visual Analogue Scale (VAS) pain scores preoperatively and at the final follow-up. In clinical and functional assessments, there were increases of 24.8 points in mean NAHS, 23.3 in mHHS, 20.6 in WOMAC score and 9.6 in Oxford Hip Score. VAS pain score decreased by 4.9 points in comparison to the preoperative scores. There were no major complications. However, transient pudendal nerve neuropraxia was present in two patients, transient lateral femoral cutaneous nerve neuropraxia in one and asymptomatic heterotopic ossification in one patient. Short-term clinical results of the arthroscopic treatment of the FAI appear to be satisfactory.

  19. 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

  20. Sonographic Findings in Subcoracoid Impingement Syndrome: A Case Report and Literature Review.

    PubMed

    Lappin, Maura; Gallo, Andrew; Krzyzek, Monika; Evans, Korboi; Chen, Yin-Ting

    2017-02-01

    Subcoracoid impingement syndrome is a rare and underrecognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. Comparison of gait in patients following a computer-navigated minimally invasive anterior approach and a conventional posterolateral approach for total hip arthroplasty: a randomized controlled trial.

    PubMed

    Reininga, Inge H F; Stevens, Martin; Wagenmakers, Robert; Boerboom, Alexander L; Groothoff, Johan W; Bulstra, Sjoerd K; Zijlstra, Wiebren

    2013-02-01

    Minimally invasive total hip arthroplasty (MIS THA) aims at minimizing damage to muscles and tendons to accelerate postoperative recovery. Computer navigation allows a precise prosthesis alignment without complete visualization of the bony landmarks during MIS THA. A randomized controlled trial (RCT) was conducted to determine the effectiveness of a computer-navigated MIS anterior approach for THA compared to a conventional posterolateral THA technique on the restoration of physical functioning during recovery following surgery. Thirty-five patients underwent computer-navigated MIS THA via the anterior approach, and 40 patients underwent conventional THA using the conventional posterolateral approach. Gait analysis was performed preoperatively, 6 weeks, and 3 and 6 months postoperatively using a body-fixed-sensor based gait analysis system. Walking speed, step length, cadence, and frontal plane angular movements of the pelvis and thorax were assessed. The same data were obtained from 30 healthy subjects. No differences were found in the recovery of spatiotemporal parameters or in angular movements of the pelvis and thorax following the computer-navigated MIS anterior approach or the conventional posterolateral approach. Although gait improved after surgery, small differences in several spatiotemporal parameters and angular movements of the trunk remained at 6 months postoperatively between both patient groups and healthy subjects. Copyright © 2012 Orthopaedic Research Society.

  2. 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

  3. Hip Microfracture

    PubMed Central

    McGill, Kevin C.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Microfracture is a marrow-stimulating technique used in the hip to treat cartilage defects associated with femoro-acetabular impingement, instability, or traumatic hip injury. These defects have a low probability of healing spontaneously and therefore often require surgical intervention. Originally adapted from the knee, microfracture is part of a spectrum of cartilage repair options that include palliative procedures such as debridement and lavage, reparative procedures such as marrow-stimulating techniques (abrasion arthroplasty and microfracture), and restorative procedures such as autologous chondrocyte implantation and osteochondral allograft/autografts. The basic indications for microfracture of the hip include focal and contained lesions typically less than 4 cm in diameter, full-thickness (Outerbridge grade IV) defects in weightbearing areas, unstable lesions with intact subchondral bone, and focal lesions without evidence of surrounding chondromalacia. Although not extensively studied in the hip, there are some small clinical series with promising early outcomes. Although the widespread use of microfracture in the hip is hindered by difficulties in identifying lesions on preoperative imaging and instrumentation to circumvent the femoral head, this technique continues to gain acceptance as an initial treatment for small, focal cartilage defects. PMID:26069544

  4. Arthroscopic treatment of unstable total hip replacement.

    PubMed

    Cuéllar, Ricardo; Aguinaga, Iñaki; Corcuera, Irene; Ponte, Juan; Usabiaga, Jaime

    2010-06-01

    Hip arthroscopy may be useful in the diagnosis and treatment of apparently well-implanted but unstable total hip replacement prostheses. We present 2 cases of arthroscopically assisted capsular tightening in unstable total hip replacements. Both cases had significant capsular laxity. Case 2 had impingement of the lower part of the acetabulum with the lesser trochanter that caused hip dislocation. Early revision surgery can be avoided with the use of this technique in selected cases of unstable total hip replacements.

  5. [Femoroacetabular impingement: frequently missed in patients with chronic groin pain].

    PubMed

    Röling, Maarten A; Pilot, Peter; Krekel, Peter R; Bloem, Rolf M

    2012-01-01

    Femoroacetabular impingement is a diagnosis that is often missed in patients with chronic groin pain. The condition often appears in young athletes. An anatomic deformity of the femoral head and the acetabular ridge causes an impingement that damages the subchondral tissue. This damage can result in sharp pain in the groin during specific hip movements and the acetabular labrum may also be ruptured. Diagnosing femoroacetabular impingement and a labral tear can be a challenge. We present the case of a 19-year-old male who twisted his right hip joint during a game of football. Physiotherapy only aggravated the pain. Further diagnostics showed femoroacetabular impingement and a labral tear. Arthroscopic intervention in the hip joint by an orthopedic surgeon lead to immediate pain relief, and two years after surgery the patient is still free of pain and has returned playing sport at his previous level. Femoroacetabular impingement can be a cause of chronic groin pain in young athletes. Hip arthroscopy is a safe and effective treatment, enabling the patient to return to playing sport at their previous level.

  6. 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 Central

    2014-01-01

    Background 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. Methods 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). Results 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. Conclusion 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. PMID:24621189

  7. 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

  8. Impingement syndrome (image)

    MedlinePlus

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

  9. A pre-operative approach of range of motion simulation and verification for femoroacetabular impingement.

    PubMed

    Chang, Ta-Cheng; Kang, Hyosig; Arata, Louis; Zhao, Weizhao

    2011-09-01

    Femoroacetabular impingement (FAI) is increasingly recognized as a potential cause of hip osteoarthritis. A system capable of pre-operatively simulating hip range of motion (ROM) by given surface models from either healthy or FAI diseased bone is desirable. An impingement detection system using bounding sphere hierarchies was first developed. Both precision and accuracy of the impingement detection system were verified by a custom-designed phantom to imitate ball-and-socket hip movement. The impingement detection system was then implemented into the hip ROM simulation system to simulate the ROM of (1) healthy pelvis and femur, and (2) healthy pelvis and pathologic femur. The ROM simulation system was also verified by manipulating sawbones under the navigation of an optical tracking system. The impingement detection system achieved a distance error of 0.53 ± 0.06 mm and an angular error of 0.28 ± 0.03°. The impingement detection accuracies were 100%, 100%, and 96% in three different phantom orientations, respectively. The mean errors between simulated and verified ROM were 0.10 ± 1.39° for the 'healthy pelvis and femur' group, and - 2.38 ± 3.49° for the 'healthy pelvis and pathologic femur' group. The present study demonstrates a pre-operative approach to virtually simulate and predict the functional hip ROM based on the given bone models. The impingement detection and ROM simulation systems developed may also be used for other orthopedic applications. Copyright © 2011 John Wiley & Sons, Ltd.

  10. Are “normal hips” being labeled as femoroacetabular impingement due to EE angle?

    PubMed Central

    You, Tian; Yang, Bei; Zhang, Xin-tao; Jiang, Xiao-cheng; Wang, Shuang; Zhang, Wen-tao

    2017-01-01

    Abstract Gluteal muscle contracture (GMC) is a clinical syndrome characterized by gait abnormality and limb dysfunction, as well as secondary deformities of pelvis and femur. Femoroacetabular impingement (FAI) typically could be diagnosed on the basis of computed tomography (CT) such as the equatorial-edge angle (EE angle), but it did not work well in GMC patients. In this study, we retrospected all image data and found small EE angles in GMCs, which meant retroverted acetabulum; however, none of them showed no symptoms and signs of FAI. Therefore, we had reasons to think that, some normal hips with unbalanced hip myodynamia as same as GMCs, may be incorrectly diagnosed as FAI through measuring EE angle only. In consequence, the paper was designed to assess the use of the EE angle in the assessment of FAI in the diagnosis, as described by Werner. Twenty-three patients (46 hips) were collected and calculated with the “equatorial-edge angle” (EE angle) by CT scans. All of them were excluded from FAI. Review of the hips showed a mean EE angle was 12.93°, with a minimum of -3.42° and a maximum of 24.08°. The mean value for males and females were 13.52° and 12.40°, respectively, without statistical significance, although the mean value of left hips and right sides reached 13.32° and 12.54° individually, not having statistical differences neither. There were not any symptoms or signs of FAI in all patients. Thus, the reduced EE angle could suggest the local excessive coverage of the femoral head by the anterior acetabular edge, but might not be a reasonably good predictor of FAI. GMC patient's acetabular deformity mainly manifests as increased retroversion, which may be the anatomical basis for FAI and lead to high risks of the acetabular impingement. However, all patients in this study showed no symptoms and signs of FAI, suggesting that the measurement of EE angle can only be applied to assessing those people with normal hip myodynamia, and the bone

  11. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics.

    PubMed

    Ross, James R; Nepple, Jeffrey J; Philippon, Marc J; Kelly, Bryan T; Larson, Christopher M; Bedi, Asheesh

    2014-10-01

    The current understanding of the effect of dynamic changes in pelvic tilt on the functional acetabular orientation and occurrence of femoroacetabular impingement (FAI) is limited. To determine the effect of changes in pelvic tilt on (1) terminal hip range of motion and (2) measurements of acetabular version as assessed on 2- and 3-dimensional imaging. Controlled laboratory study. Preoperative pelvic computed tomographic scans of 48 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI were analyzed. The mean age of the study population was 25.7 years (range, 14-56 years), and 56% were male. Three-dimensional models of the hips were created, allowing manipulation of the pelvic tilt and simulation of hip range of motion to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign was recorded on simulated plain radiographs. Measurements of range of motion to bony impingement during (1) hip flexion, (2) internal rotation in 90° of flexion, and (3) internal rotation in 90° of flexion and 15° adduction were performed, and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for -10° (posterior), 0° (native), and +10° (anterior) pelvic orientations. In native tilt, mean cranial acetabular version was 3.3°, while central version averaged 16.2°. Anterior pelvic tilt (10° change) resulted in significant retroversion, with mean decreases in cranial and central version of 5.9° and 5.8°, respectively (P < .0001 for both). Additionally, this resulted in a significantly increased proportion of positive crossover, posterior wall, and prominent ischial spine signs (P < .001 for all). Anterior pelvic tilt (10° change) resulted in a decrease in internal rotation in 90° of flexion of 5.9° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 8.5° (P < .0001), with a shift

  12. Magnetic resonance imaging of hip joint cartilage and labrum

    PubMed Central

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

    2011-01-01

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

  13. Differences in Athletic Performance Between Sportsmen With Symptomatic Femoroacetabular Impingement and Healthy Controls.

    PubMed

    Mullins, Karen; Hanlon, Michael; Carton, Patrick

    2017-06-22

    Femoroacetabular impingement (FAI) is a commonly recognized condition in athletes characterized by activity-related hip pain and stiffness, which if left untreated can progress to hip osteoarthritis. The aim of the study was to determine the effect of symptomatic FAI on performance in young athletes based on the hypothesis that athletes with FAI would show deficits in performance compared with healthy controls. The functional performance of a cohort of preoperative, competitive sportsmen with symptomatic FAI (FAI group, n = 54), was compared with that of a group of age, sex and activity-level matched controls (n = 66). Participants performed functional tests including a 10-m sprint, a modified agility T-test, a maximal deep squat test and a single-leg drop jump (reactive strength index). Hip range of motion was assessed by measuring maximal hip flexion, abduction, and internal rotation (at 90 degree hip flexion). The FAI group was significantly slower during the 10-m sprint (3%, P = 0.002) and agility T-test (8%, P < 0.001); flexion, abduction, and internal rotation values for the FAI group were reduced compared with controls (P < 0.001). No significant differences between groups were identified for squat depth or reactive strength index. The FAI group also reported higher levels of anterior groin pain during the 10-m sprint, modified agility T-test, and while squatting. Many sportsmen with confirmed FAI continue sports participation up to and after diagnosis, despite issues with activity-related pain and stiffness. This study highlights the functional limitations in speed, agility, and flexibility that are likely to be present in this group of FAI patients.

  14. Anterior knee pain in the young athlete: diagnosis and treatment.

    PubMed

    Kodali, Pradeep; Islam, Andrew; Andrish, Jack

    2011-03-01

    The underlying etiology of anterior knee pain has been extensively studied. Despite many possible causes, often times the diagnosis is elusive. The most common causes in the young athlete are osteosynchondroses, patellar peritendinitis and tendinosis, synovial impingement, malalignment, and patellar instability. Less common causes are osteochondritis dissecans and tumors. It is always important to rule out underlying hip pathology and infections. When a diagnosis cannot be established, the patient is usually labeled as having idiopathic anterior knee pain. A careful history and physical examination can point to the correct diagnosis in the majority of cases. For most of these conditions, treatment is typically nonoperative with surgery reserved for refractory pain for an established diagnosis.

  15. Rehabilitation after arthroscopic decompression for femoroacetabular impingement.

    PubMed

    Enseki, Keelan R; Martin, Robroy; Kelly, Bryan T

    2010-04-01

    The use of arthroscopic technology to address pathologic conditions of the hip joint has become a topic of growing interest in the orthopedic community. Addressing femoroacetabular impingement through this method has generated additional attention. As surgical options evolve, rehabilitation protocols must meet the challenge of providing a safe avenue of recovery, yet meeting the goal of returning to high levels of functioning. Current rehabilitation concepts should be based on the growing body of evidence, knowledge of tissue healing properties, and clinical experience. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Assessment of range of motion and contact zones with commonly performed physical exam manoeuvers for femoroacetabular impingement (FAI): what do these tests mean?

    PubMed

    Bedi, Asheesh; Thompson, Matthew; Uliana, Christiano; Magennis, Erin; Kelly, Bryan T

    2013-01-01

    Recognition of the magnitude and location of mechanical conflicts is critical to reliably and reproducibly improve functional range of motion and outcomes after surgical treatment of femoroacetabular impingement (FAI). The purpose of this study was to assess the ROM and location of intra-articular and extra-articular mechanical conflict with seven commonly performed physical exam manoeuvers in a cohort of hips with symptomatic FAI. Internal rotation in flexion results in mechanical contact between the anterolateral and anterior femoral head-neck junction with the acetabulum, most commonly at a 1:15 o'clock position. Associated adduction, however, significantly reduces the available internal rotation secondary to contact in the same locations. Straight abduction results in mechanical conflict between the superior femoral head-neck junction and the 12:00 o'clock position of the acetabulum. With external rotation of the hip in various degrees of hip flexion, the potential mechanical impingement is extra-articular between the greater trochanter and ischium or pubic ramus. The zones of proximal femoral and acetabular contact are not intuitive, and may extend significantly more laterally and distally on the femoral head-neck junction than previously appreciated.

  17. Standing radiological analysis with a low-dose biplanar imaging system (EOS system) of the position of the components in total hip arthroplasty using an anterior approach: a cohort study of 102 patients.

    PubMed

    Morvan, A; Moreau, S; Combourieu, B; Pansard, E; Marmorat, J L; Carlier, R; Judet, T; Lonjon, G

    2016-03-01

    The primary aim of this study was to analyse the position of the acetabular and femoral components in total hip arthroplasty undertaken using an anterior surgical approach. In a prospective, single centre study, we used the EOS imaging system to analyse the position of components following THA performed via the anterior approach in 102 patients (103 hips) with a mean age of 64.7 years (sd 12.6). Images were taken with patients in the standing position, allowing measurement of both anatomical and functional anteversion of the acetabular component. The mean inclination of the acetabular component was 39° (standard deviation (sd) 6), the mean anatomical anteversion was 30° (sd 10), and the mean functional anteversion was 31° (sd 8) five days after surgery. The mean anteversion of the femoral component was 20° (sd 11). Anatomical and functional anteversion of the acetabular component differed by > 10° in 23 (22%) cases. Pelvic tilt was the only pre-operative predictive factor of this difference. Our study showed that anteversion of the acetabular component following THA using the anterior approach was greater than the recommended target value, and that substantial differences were observed in some patients when measured using two different measurement planes. If these results are confirmed by further studies, and considering that the anterior approach is intended to limit the incidence of dislocation, a new correlation study for each reference plane (anatomical and functional) will be necessary to define a 'safe zone' for use with the anterior approach. EOS imaging system is helpful in the pre-operative and post-operative radiological analysis of total hip arthroplasty. ©2016 The British Editorial Society of Bone & Joint Surgery.

  18. Hip pain

    MedlinePlus

    ... pain involves any pain in or around the hip joint. You may not feel pain from your hip ... 2012:chap 48. Read More Hip fracture surgery Hip joint replacement Patient Instructions Hip fracture - discharge Hip or ...

  19. Direct Flame Impingement

    SciTech Connect

    2005-09-01

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

  20. Effects of Push-up Exercise with Hip Adduction on the COP Deviation and the Serratus Anterior and L1 Paraspinal Muscles.

    PubMed

    Kim, Min-Hee; Yoo, Won-Gyu

    2013-07-01

    [Purpose] This study investigated the effect of push-up exercise with hip adduction on the COP deviation and SA and L1 spinal muscle activation. [Subjects] Twelve males aged 20-30 years were recruited. [Methods] We measured the COP deviation and SA and L1 spinal muscle activities during push-up exercise with and without hip adduction [Results] The COP deviation significantly decreased and the SA and L1 spinal muscles were significantly increased during push-ups with hip adduction when compared with push-ups without hip adduction. [Conclusion] We thought that the push-up exercise with hip adduction might help to selectively strengthen the SA.

  1. Treatment of cam-type femoroacetabular impingement

    PubMed Central

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

    2015-01-01

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

  2. Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement.

    PubMed

    Morgan, Patrick M; Anderson, Anthony W; Swiontkowski, Marc F

    2013-01-01

    Symptomatic sacroiliac (SI) joint disease is poorly understood. The literature provides no clear aetiology for SI joint pathology, making evaluation and diagnosis challenging. We hypothesised that patients with documented sacroiliac pain might provide insight into the aetiology of these symptoms. Specifically, we questioned whether SI joint symptoms might be associated with abnormal hip radiographs. We reviewed the pelvic and hip radiographs of a prospectively collected cohort of 30 consecutive patients with SI joint pathology. This database included 33 hips from 30 patients. Radiographic analysis included measurements of the lateral centre edge angle, Tönnis angle, and the triangular index, of the ipsilateral hip. Evidence for retrotorsion of the hemipelvis was recorded. Hips were graded on the Tönnis grading system for hip arthrosis. In this cohort 14/33 (42%) of hips had evidence of significant osteoarthrosis indicated by Tönnis grade 2 or greater and 15/33 (45%) displayed subchondral cyst formation around the hip or head neck junction. In assessing acetabular anatomy, 21% (7/33) had retroversion, 12% (4/33) had a lateral centre edge angle >40° with 3% (1/33) >45°. Tönnis angle was <0° in 27% (9/33). Coxa profunda and acetabuli protrusio were present in 47% (17/33) and 3% (1/33), respectively. When femoral head morphology was assessed, 33% (11/33) showed evidence of cam impingement. Overall, 76% (25/33) had at least one abnormality on their hip radiograph. A significant number of patients meeting strict diagnostic criteria for SI joint pain had radiographic evidence of femoroacetabular impingement (FAI) and hip arthrosis. The clinician should maintain FAI in the differential diagnosis when investigating patients with buttock pain.

  3. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

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

  4. [Atraumatic hip pain in young adults].

    PubMed

    González Murillo, M; Turcu, V; De Nicolás Navas, M B; Yeguas Bermejo, A

    2016-01-01

    Hip pain in the young adult is a disabling pathophysiological process may be related to multiple etiologies. The process must be determined in order to make a diagnosis and follow-up treatment. The case is presented of a 29 year old woman with anemia, atraumatic hip pain on the right side, and a limp of one month onset. The differential diagnosis includes infectious, rheumatological, tumor, avascular necrosis of hip, hip impingement, hip dysplasia, osteoarthritis and other syndromes. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. The Etiology of Osteoarthritis of the Hip

    PubMed Central

    Ganz, Reinhold; Leunig-Ganz, Katharina; Harris, William H.

    2008-01-01

    The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90° flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present. Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196405

  6. The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: prospective study with the EOS imaging system.

    PubMed

    Barbier, O; Skalli, W; Mainard, L; Mainard, D

    2014-10-01

    Computer navigated total hip arthroplasty is mostly based on the use of the anterior pelvic plane (APP) as a reference. EOS is a new imaging system that provides three-dimensional analysis of the pelvis in a functional position with a low dose of radiation. The aim of this study was to evaluate the reliability of the APP for placement of the cup during computer navigated THA using EOS. The reliability of the APP is limited for the placement of the acetabular cup during computer navigated THA. This was a prospective monocentric study using the EOS imaging system evaluating 44 patients in the standing position three months after computer navigated THA (Orthopilot). Reproducibility of EOS measurements were analyzed using SterEOS software and the reliability of the navigation data for the position of the cup were assessed. Intra and interobserver reproducibility of the measurements of the orientation of the cup by EOS were good with correlation coefficients above 93% and 95% and confidence intervals of less than ±5°. Mean cup inclination and anteversion were 41.3° and 20.9° and 44.3° and 29.5° respectively in operatively and post-operatively. The differences between measurements of operative cup inclination using computer assisted navigation and the post-operative EOS measurements were significant (P<0.05) with a correlation coefficient of less than 40%. Our study confirms the lack of precision of the APP as a reference for positioning of the acetabular component, especially in relation to anteversion. Although for many years the APP was considered to be a global reference, in fact, it is subject to significant inter-individual variations and variations during changes in position. These factors, associated with the difficulty of determining the preoperative APP, explain the lack of reliability of this reference. Preoperative evaluation of the orientation of APP by EOS and its integration into the navigation system could help the operator position these components

  7. 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.

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

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up. PMID:27536632

  9. Hip and Knee Osteoarthritis Affects Younger People, Too.

    PubMed

    Ackerman, Ilana N; Kemp, Joanne L; Crossley, Kay M; Culvenor, Adam G; Hinman, Rana S

    2017-02-01

    Synopsis Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. J Orthop Sports Phys Ther 2017;47(2):67-79. doi:10.2519/jospt.2017.7286.

  10. Arthroscopic treatment of pincer-type femoroacetabular impingement performing acetabuloplasty without labral detachment

    PubMed Central

    Comba, Fernando; Slullitel, Pablo; Bronenberg, Pedro; Buttaro, Martin; Zanotti, Gerardo; Piccaluga, Francisco

    2017-01-01

    Objectives: In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. However, when the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. Methods: During the study period, we retrospectively analyzed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average followup of 32 months (range: 27-38). We excluded patients with CAM-type impingement and previous hip pathology. Radiographs were analyzed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of preoperative and postoperative modified Harris Hip Score (mHHS) and WOMAC as well as postoperative Visual Analogue Scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis.. Results: Mean preoperative anterior and lateral center-edge angles were 35º and 29º, respectively. Mean preoperative alfa angle was 52º. Crossover sign was found in 82% of cases. mHHS changed from 51.06 (SD 4.81) preoperatively to 84.97 (SD 12.79) postoperatively. Preoperative WOMAC was 29.18 (SD 8) and postoperative, 13.10 (SD 11). Postoperative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding postoperative mHHS (89.9s vs 77.85, p=0.03), pain VAS (1.5 vs 6.3, p=0.03) and satisfaction VAS (8.2 vs 6.3, p=0.01). Postoperative WOMAC was slightly better for Tönnis 0 patients (8.31 vs 19.3, p=0.05). No differences were found in preoperative WOMAC and mHHS. Three of 44 patients required a second surgical procedure and were considered failures. Survival was 100% at 24 months and 76% at 40 months (95%CI: 35%-98%). Conclusion

  11. MRI for the preoperative evaluation of femoroacetabular impingement.

    PubMed

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

    2016-04-01

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

  12. One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA.

    PubMed

    Lerch, Till Dominic; Steppacher, Simon Damian; Liechti, Emanuel Francis; Tannast, Moritz; Siebenrock, Klaus Arno

    2017-04-01

    . The cumulative survivorship of the hip according to Kaplan-Meier was calculated if any of the three endpoints, including conversion to THA, progression of osteoarthritis by at least one grade according to Tönnis, and/or a Merle d'Aubigné-Postel score < 15, occurred. Hip pain and function were assessed with Merle d'Aubigné-Postel score, Harris hip score, limp, and anterior and posterior impingement tests. Progression of radiographic osteoarthritis was assessed with Tönnis grades. A Cox regression model was used to calculate factors associated with the previously defined endpoints. The cumulative survivorship free from conversion to THA, radiographic progression of osteoarthritis, and/or Merle d'Aubigné-Postel score < 15 was 29% (95% confidence interval, 17%-42%) at 30 years. No improvement was found for either the Merle d'Aubigné-Postel (15 ± 2 versus 16 ± 2, p = 0.144) or Harris hip score (83 ± 11 versus 85 ± 17, p = 0.602). The percentage of a positive anterior impingement test (39% versus 14%, p = 0.005) decreased at 30-year followup, whereas the percentage of a positive posterior impingement test (14% versus 3%, p = 0.592) did not decrease. The percentage of positive limp decreased from preoperatively 66% to 18% at 30-year followup (p < 0.001). Mean osteoarthritis grade (Tönnis) increased from preoperatively 0.8 ± 1 (0-3) to 2.1 ± 1 (0-3) at 30-year followup (p < 0.001). Ten factors associated with poor outcome defined as THA, radiographic progression of osteoarthritis, and/or Merle d'Aubigné-Postel score < 15 were found: preoperative age > 40 years (hazard ratio [HR] 4.3 [3.7-4.9]), a preoperative Merle d'Aubigné-Postel score < 15 (HR 4.1 [3.5-4.6]), a preoperative Harris hip score < 70 (HR 5.8 [5.2-6.4]), preoperative limp (HR 1.7 [1.4-1.9]), presence of a preoperative positive anterior impingement test (HR 3.6 [3.1-4.2]), presence of a preoperative positive posterior impingement test (HR 2.5 [1.7-3.2]), a preoperative internal rotation of < 20

  13. Surgical approaches for cam femoroacetabular impingement: the use of multicriteria decision analysis.

    PubMed

    Diaz-Ledezma, Claudio; Parvizi, Javad

    2013-08-01

    Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available. We therefore executed a multidimensional structured comparison considering the benefits, opportunities, costs, and risk (BOCR) of the different approaches using multicriteria decision analysis (MCDA). A MCDA using analytic hierarchical process (AHP) was conducted to compare SHD, HA, and MO in terms of BOCR on the basis of available evidence, institutional experience, costs, and our understanding of pathophysiology of FAI. A preclinical decision-making model was created for cam FAI to establish the surgical approach that better accomplishes our objectives regarding the surgical treatment. A total score of an alternative's utility and sensitivity analysis was established using commercially available AHP software. The AHP model based on BOCR showed that MO is the best surgical approach for cam FAI (normalized score: 0.38) followed by HA (normalized score: 0.36) and SHD (normalized score: 0.25). The sensitivity analysis showed that HA would turn into the best alternative if the variable risks account for more than 61.8% of the priority during decision-making. In any other decision-making scenario, MO remains as the best alternative. Using a recognized method for decision-making, this study provides supportive data for the use of MO approach as our preferred surgical approach for cam FAI. The latter is predominantly derived from the lower cost of this approach. Our data may be considered a proxy performance measurement for surgical approaches in cam FAI.

  14. Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

    PubMed

    Wang, Cheng-Wei; Wu, Kuan-Wen; Wang, Ting-Ming; Huang, Shier-Chieg; Kuo, Ken N

    2014-03-01

    % CI, 0.70, 1.17], Pemberton procedure, 0.53 [95% CI, 0.40, 0.65]; p < 0.001). Three patients in the Pemberton group had an anterior impingement sign at followup, whereas none in the Salter group did. The SF-36 and Harris hip scores were good and showed no differences between the two groups. Our study suggests the weightbearing zone acetabular index on false profile radiographs of the hip, a parameter focusing on morphologic features of the anterior acetabulum, decreased after Pemberton acetabuloplasty compared with the nonoperated side and after the Salter acetabuloplasty. This suggests that by modifying the shape of the acetabulum with a hinge in the triradiate cartilage, a Pemberton acetabuloplasty may result in increasing acetabular anterior coverage and the risk of hip impingement. However, the functional results with at least 10 years followup were good and similar for both procedures. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

  15. Evaluation of range of motion restriction within the hip joint.

    PubMed

    Turley, Glen A; Williams, Mark A; Wellings, Richard M; Griffin, Damian R

    2013-04-01

    In total hip arthroplasty, determining the impingement free range of motion requirement is a complex task. This is because in the native hip, motion is restricted by both impingement as well as soft tissue restraint. The aim of this study is to determine a range of motion benchmark which can identify motions which are at risk from impingement and those which are constrained due to soft tissue. Two experimental methodologies were used to determine motions which were limited by impingement and those motions which were limited by both impingement and soft tissue restraint. By comparing these two experimental results, motions which were limited by impingement were able to be separated from those motions which were limited by soft tissue restraint. The results show motions in extension as well as flexion combined with adduction are limited by soft tissue restraint. Motions in flexion, flexion combined with abduction and adduction are at risk from osseous impingement. Consequently, these motions represent where the maximum likely damage will occur in femoroacetabular impingement or at most risk of prosthetic impingement in total hip arthroplasty.

  16. Impingement syndrome of the ankle following supination external rotation trauma: MR imaging findings with arthroscopic correlation.

    PubMed

    Schaffler, Gottfried J; Tirman, Phillip F J; Stoller, David W; Genant, Harry K; Ceballos, Cecar; Dillingham, Michael F

    2003-06-01

    Our objective was to identify MR imaging findings in patients with syndesmotic soft tissue impingement of the ankle and to investigate the reliability of these imaging characteristics to predict syndesmotic soft tissue impingement syndromes of the ankle. Twenty-one ankles with chronic pain ultimately proven to have anterior soft tissue impingement syndrome were examined by MR imaging during January 1996 to June 2001. The MR imaging protocol included sagittal and coronal short tau inversion recovery (STIR), sagittal T1-weighted spin echo, axial and coronal proton-density, and T2-weighted spin-echo sequences. Nineteen ankles that underwent MR imaging during the same period of time and that had arthroscopically proven diagnosis different than impingement syndrome served as a control group. Fibrovascular scar formations distinct from the syndesmotic ligaments possibly related to syndesmotic soft tissue impingement were recorded. Arthroscopy was performed subsequently in all patients and was considered the gold standard. The statistical analysis revealed an overall frequency of scarred syndesmotic ligaments of 70% in the group with ankle impingement. Fibrovascular scar formations distinct from the syndesmotic ligaments presented with low signal intensity on T1-weighted images and remained low to intermediate in signal intensity on T2-weighted MR imaging. Compared with arthroscopy, MR imaging revealed a sensitivity of 89%, a specificity of 100%, and a diagnostic accuracy of 93% for scarred syndesmotic ligaments. The frequency of scar formation distinct from the syndesmotic ligaments in patients with impingement syndrome of the ankle was not statistically significantly higher than in the control group. In contrast to that, anterior tibial osteophytes and talar osteophytes were statistically significantly higher in the group with anterior impingement than in the control group. Conventional MR imaging was found to be insensitive for the diagnosis of syndesmotic soft tissue

  17. Total hip arthroplasty via the direct anterior approach with Kerboull-type acetabular reinforcement device for an elderly female with factor XI deficiency

    PubMed Central

    Sano, Kei; Homma, Yasuhiro; Baba, Tomonori; Ando, Jun; Matsumoto, Mikio; Kobayashi, Hideo; Yuasa, Takahito; Kaneko, Kazuo

    2017-01-01

    We present a case of successful and uncomplicated total hip arthroplasty with an acetabular reinforcement device in an elderly patient with hip osteoarthritis already diagnosed with factor XI deficiency, which is a very rare bleeding disorder and at high risk of post-operative haemorrhage, and it poses a substantial challenge to surgeons as a consequence of the specific risks of infection and fixation failure. Moreover, bone fragility in elderly patient increases potential risk of adverse event. Fresh frozen plasma was used to supplement factor XI activity. Importantly, transfusion-transmitted disease such as having factor XI inhibitor was promptly surveyed prior to the supplement since the patient had previous history of the administration of fresh frozen plasma. Under prompt and effective peri-operative haemostasis, rigid implant fixation and rigorous attention to the prevention of infection seem to achieve the best possible outcomes for elderly patients with a bleeding disorder undergoing total hip arthroplasty. PMID:28186870

  18. Capsular Plication for Treatment of Iatrogenic Hip Instability

    PubMed Central

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

    2015-01-01

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

  19. Impinging jets atomization

    NASA Technical Reports Server (NTRS)

    Ibrahim, E. A.; Przekwas, A. J.

    1991-01-01

    An analysis of the characteristics of the spray produced by an impinging-jet injector is presented. Predictions of the spray droplet size and distribution are obtained through studying the formation and disintegration of the liquid sheet formed by the impact of two cylindrical jets of the same diameter and momentum. Two breakup regimes of the sheet are considered depending on Weber number, with transition occurring at Weber numbers between 500 and 2000. In the lower Weber number regime, the breakup is due to Taylor cardioidal waves, while at Weber number higher than 2000, the sheet disintegration is by the growth of Kelvin-Helmholtz instability waves. Theoretical expressions to predict the sheet thickness and shape are derived for the low Weber number breakup regime. An existing mathematical analysis of Kelvin-Helmholtz instability of radially moving liquid sheets is adopted in the predictions of resultant drop sizes by sheet breakup at Weber numbers greater than 2000. Comparisons of present theoretical results with experimental measurements and empirical correlations reported in the literature reveal favorable agreement.

  20. 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

  1. Techniques and Results for Open Hip Preservation

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  3. Concurrent criterion-related validity of physical examination tests for hip labral lesions: a systematic review.

    PubMed

    Leibold, M Rebecca; Huijbregts, Peter A; Jensen, Richard

    2008-01-01

    Hip injuries are prevalent, especially within the athletic population. Of the hip injuries in this population, some 18-55% are lesions to the labrum of the hip. Clinical diagnosis of hip labral lesions is difficult because data on prevalence are varied. In addition, data on the prevalence of internal and external risk factors are absent as are data on the correlation of these risk factors with labral lesions, making it difficult to gauge the diagnostic utility. The mechanism of injury is often unknown or not specific to labral lesions. Internal risk factors may remain hidden to physical therapists because in most jurisdictions, ordering imaging tests is not within their scope of practice. Anterior inguinal pain seems highly sensitive for the diagnosis of patients with labral lesions but can hardly be considered specific; data on other pain-related and mechanical symptoms clearly have little diagnostic utility, making these data collected during the patient history almost irrelevant to diagnosis. By way of a comprehensive literature review and narrative and systematic analysis of the methodological quality of the retrieved diagnostic utility studies, this paper aimed to determine a diagnostic physical examination test or test cluster based on current best evidence for the diagnosis of hip labral lesions. Current best evidence indicates that a negative finding for the flexion-adduction-internal rotation test, the flexion-internal rotation test, the impingement provocation test, the flexion-adduction-axial compression test, the Fitzgerald test, or a combination of these tests provides the clinician with the greatest evidence-based confidence that a hip labral lesion is absent. Currently, research has produced no tests with sufficient specificity to help confidently rule in a diagnosis of hip labral lesion. Suggestions for future research are provided.

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

    PubMed

    Kim, Chan; 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

    2015-12-02

    Is there concordance between hip pain and radiographic hip osteoarthritis? 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. 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. Hip pain was not present in many hips with radiographic

  5. 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

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

    PubMed

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

    2015-10-01

    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.

  7. Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice.

    PubMed

    Tijssen, M; van Cingel, R E H; de Visser, E; Hölmich, P; Nijhuis-van der Sanden, M W G

    2017-03-01

    The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18-65 years) were included if they were referred to a physical therapist to gather pre-operative data and were then diagnosed during arthroscopy. Results of pre-operative patient history and physical tests were collected and compared to arthroscopy. Data of 77 active patients (mean age: 37 years) were included. Groin as main location of pain, the Anterior Impingement test (AIT), Flexion-Abduction-External Rotation (FABER) test, and Fitzgerald test had a high sensitivity (range 0.72-0.91). Sensitivity increased when combining these tests (0.97) as either groin as main location of pain and a positive FABER test or a positive AIT and a positive FABER test were the shortest most sensitive combinations. The results of this study point out that in clinical practice absence of groin as main location of pain combined with a negative FABER test or the combination of a negative AIT and a negative FABER test are suggested to rule out the diagnosis of symptomatic FAI and/or labral pathology.

  8. Radiographic evaluation of hip implants.

    PubMed

    Chang, Connie Y; Huang, Ambrose J; Palmer, William E

    2015-02-01

    Serial radiographs are the mainstay in the longitudinal assessment of hip implants. The prosthesis, periprosthetic bone, and juxta-articular soft tissues are inspected for fracture, periosteal reaction, stress shielding, calcar resorption, osteolysis, bony remodeling, metallic debris, and heterotopic ossification. Comparison radiographs best confirm implant migration, subsidence, and aseptic loosening. Infection, particle disease, reaction to metal, and mechanical impingement are important causes of postsurgical pain, but in their earliest stages they may be difficult to diagnose using radiographs. This article addresses the role of radiography following hip arthroplasty. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Hip Pain

    MedlinePlus

    ... clues about the underlying cause. Problems within the hip joint itself tend to result in pain on the ... tendons and other soft tissues that surround your hip joint. Hip pain can sometimes be caused by diseases ...

  10. Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation.

    PubMed

    Legaye, Jean

    2009-12-01

    The Anterior Pelvic Plane (APP), defined by the anterior superior iliac spines and the pubic tubercle, was commonly used as reference for positioning and postoperative evaluation of the orientation of the acetabular cup in total hip arthroplasty. APP was assumed to be vertical, but was not observed always so, mostly because of associated spinal diseases inducing perturbations in the harmony of the sagittal balance of the pelvi-spinal unit. Consequently a sagittal rotation of the pelvis occurs, and so a tilt of the APP which alters directly the orientation of the cup in upright position. An analysis of the APP tilt related to the sagittal balance of the spine was provided and its implication on the cup orientation. It appeared essential for an individual adjustment of the cup positioning to avoid a functional mal-position which can lead to an increased risk of dislocation and impingement.

  11. 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.

  12. 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.

  13. Review on squeaking hips

    PubMed Central

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

    2015-01-01

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

  14. The Hyperflexible Hip: Managing Hip Pain in the Dancer and Gymnast.

    PubMed

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

    2015-07-01

    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. A search of the entire PubMed database (through December 2013) and additional searches of the reference lists of pertinent articles. Systematic review. Level 3. 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. 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.

  15. Restriction in hip internal rotation is associated with an increased risk of ACL injury.

    PubMed

    Bedi, Asheesh; Warren, Russell F; Wojtys, Edward M; Oh, You Keun; Ashton-Miller, James A; Oltean, Hanna; Kelly, Bryan T

    2016-06-01

    Evidence suggests that femoroacetabular impingement (FAI) in athletes may increase the risk of anterior cruciate ligament (ACL) injury. This study correlates ACL injury with hip range of motion in a consecutive series of elite, contact athletes and tests the hypothesis that a restriction in the available hip axial rotation in a dynamic in silico model of a simulated pivot landing would increase ACL strain and the risk of ACL rupture. Three hundred and twenty-four football athletes attending the 2012 NFL National Invitational Camp were examined. Hip range of internal rotation was measured and correlated with a history of ACL injury and surgical repair. An in silico biomechanical model was used to study the effect of FAI on the peak relative ACL strain developed during a simulated pivot landing. The in vivo results demonstrated that a reduction in internal rotation of the left hip was associated with a statistically significant increased odds of ACL injury in the ipsilateral or contralateral knee (OR 0.95, p = 0.0001 and p < 0.0001, respectively). A post-estimation calculation of odds ratio for ACL injury based on deficiency in hip internal rotation demonstrated that a 30-degree reduction in left hip internal rotation was associated with 4.06 and 5.29 times greater odds of ACL injury in the ipsilateral and contralateral limbs, respectively. The in silico model demonstrated that FAI systematically increased the peak ACL strain predicted during the pivot landing. FAI may be associated with ACL injury because of the increased resistance to femoral internal axial rotation during a dynamic maneuver such as a pivot landing. This insight may lead to better interventions to prevent ACL injury and improved understanding of ACL reconstruction failure. Cohort study, Level IV.

  16. 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.

  17. 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

  18. Ultrasound-guided percutaneous tenotomy for the treatment of iliopsoas impingement: a description of technique and case study.

    PubMed

    Sampson, Matthew J; Rezaian, Nimah; Hopkins, James M K

    2015-04-01

    Iliopsoas impingement is a commonly recognised source of groin pain following total hip replacement. When conservative measures fail, open or arthroscopic iliopsoas tendon release can reliably alleviate pain and improve function. This article describes an alternative ultrasound-guided percutaneous technique, achieving iliopsoas tenotomy utilising a modified 18G coaxial needle and thus minimising the morbidity and cost associated with an open or arthroscopic procedure. This method proved successful with resultant complete resolution of patient symptoms. To the knowledge of the authors, this is the first case of ultrasound-guided percutaneous iliopsoas tenotomy for iliopsoas impingement post total hip replacement. © 2015 The Royal Australian and New Zealand College of Radiologists.

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

    PubMed Central

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

    2016-01-01

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

  20. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis

    PubMed Central

    Oduwole, K. O.; de SA, D.; Kay, J.; Findakli, F.; Duong, A.; Simunovic, N.; Yen, Y-M.

    2017-01-01

    Objectives The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies. Results Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively. Conclusion In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety. Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1. PMID:28790036

  1. 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

  2. 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

  3. Total hip arthroplasty instability in Italy.

    PubMed

    Falez, Francesco; Papalia, Matteo; Favetti, Fabio; Panegrossi, Gabriele; Casella, Filippo; Mazzotta, Gianluca

    2017-03-01

    Hip dislocation is a major and common complication of total hip arthroplasty (THA), which appears with an incidence between 0.3% and 10% in primary total hip arthroplasties and up to 28% in revision THA. The hip dislocations can be classified into three groups: early, intermediate and late. Approximately two-thirds of cases can be treated successfully with a non-operative approach. The rest require further surgical intervention. The prerequisite to developing an appropriate treatment strategy is a thorough evaluation to identify the causes of the dislocation. In addition, many factors that contribute to THA dislocation are related to the surgical technique, mainly including component orientation, femoral head diameter, restoration of femoral offset and leg length, cam impingement and condition of the soft tissues. The diagnosis of a dislocated hip is relatively easy because the clinical situation is very typical. Having identified a dislocated hip, the first step is to perform a closed reduction of the implant. After reduction you must perform a computed tomography scan to evaluate the surgical options for treatment of recurrent dislocation that include: revision arthroplasty, modular components exchange, dual-mobility cups, large femoral heads, constrained cups, elimination of impingement and soft tissue procedures. The objective is to avoid further dislocation, a devastating event which is increasing the number of operations on the hip. To obtain this goal is useful to follow an algorithm of treatment, but the best treatment remains prevention.

  4. Hip disease in the young, active patient: evaluation and nonarthroplasty surgical options.

    PubMed

    Sierra, Rafael J; Trousdale, Robert T; Ganz, Reinhold; Leunig, Michael

    2008-12-01

    As a distinct entity, femoroacetabular impingement has been suggested to be a preosteoarthritic mechanism. The condition occurs when the proximal femur repeatedly comes into contact with the native acetabular rim during normal hip range of motion. Early diagnosis and surgical management are imperative to delay degenerative changes associated with these conditions. Femoroacetabular impingement is most prevalent in young, active patients. Physical examination should include evaluation of gait and foot progression angle, as well as leg length measurement, hip range of motion, and abductor strength. Imaging studies, including plain radiographs and magnetic resonance arthrography, aid in accurate diagnosis. Surgical treatment options include surgical hip dislocation, periacetabular osteotomy, and hip arthroscopy.

  5. Femoroacetabular impingement syndrome management: arthroscopy or open surgery?

    PubMed

    Papalia, Rocco; Del Buono, Angelo; Franceschi, Francesco; Marinozzi, Andrea; Maffulli, Nicola; Denaro, Vincenzo

    2012-05-01

    This review explores the scientific evidence for clinical, functional and imaging outcomes after surgical management of Femoroacetabular Impingement (FAI) syndrome, and assesses the methodological quality of the published literature reporting this issue. The medical literature databases of Pubmed, Medline, Ovid, Google Scholar and Embase were searched for articles published in English, Spanish, French and Italian, using a combination of the keywords 'femoro-acetabular impingement syndrome', 'postoperative outcomes', 'open surgery', and 'arthroscopic management'. To address three main questions, we extracted data on demographic features, operative techniques, postoperative rehabilitation regimens, imaging features, pre and postoperative hip scores. Complications and conversion to arthroplasty were also investigated. Thirty-one studies published have reported clinical, functional and imaging outcomes after open and arthroscopic management of FAI syndrome. The modified Coleman methodology score (CMS) averaged 56.2 (range, 30-81). From extracted data, it was shown that arthroscopy, open surgery and arthroscopic surgery followed by mini open surgery are comparable for functional results, biomechanics, and return to sport. Progression of OA and conversion to hip arthroplasty are dependent on preoperative status of cartilage and osteoarthritis and type of management. Debridement and osteoplasty provide better results than debridement only. Significantly improved outcomes have been recorded in patients undergoing labral refixation than resection. The Coleman methodology score showed great heterogeneity in terms of study design and outcome assessment, and generally low methodological quality. Although open and minimally invasive procedures allow athletes to return to professional sports activity, they are contraindicated in patients with severe osteoarthritis and cartilage degeneration.

  6. Rotational effects on impingement cooling

    NASA Technical Reports Server (NTRS)

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

    1987-01-01

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

  7. Rotational effects on impingement cooling

    NASA Astrophysics Data System (ADS)

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

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

  8. 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

  9. Hip Fracture

    MedlinePlus

    ... make older people more likely to trip and fall — one of the most common causes of hip ... Taking steps to maintain bone density and avoid falls can help prevent hip fracture. Signs and symptoms ...

  10. Rose Hip

    MedlinePlus

    ... with your health provider.AspirinThe body breaks down aspirin to get rid of it. Rose hip contains ... of vitamin C might decrease the breakdown of aspirin. Taking large amount of rose hip along with ...

  11. Hip Replacement

    MedlinePlus

    ... exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk ... and cross-country skiing. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip. ...

  12. Hip Replacement

    MedlinePlus

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

  13. Hip Ultrasound

    MedlinePlus

    ... Index A-Z Hip Ultrasound Hip ultrasound uses sound waves to produce pictures of muscles, tendons, ligaments, ... pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or ...

  14. Statistical Shape Modeling of Cam Femoroacetabular Impingement

    SciTech Connect

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

    2013-10-01

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

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

    PubMed

    Phadke, Vandana; Ludewig, Paula M

    2013-04-01

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

  16. 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

  17. Active Control of Supersonic Impinging Jets

    DTIC Science & Technology

    2001-06-01

    UNCLASSIFIED Defense Technical Information Center Compilation Part Notice ADPO11106 TITLE: Active Control of Supersonic Impinging Jets DISTRIBUTION...component part numbers comprise the compilation report: ADPO11101 thru ADP011178 UNCLASSIFIED 8-1 Active Control of Supersonic Impinging Jets A...Street, Tallahassee, FL 32310, USA krotha &fmrl.fsu.edu Experimental studies of supersonic impinging jet flows suggest that they are greatly influenced

  18. Modelling techniques for jet impingement

    NASA Technical Reports Server (NTRS)

    Haviland, J. K.; Herling, W. W.

    1977-01-01

    A technique for testing scale models for the determination of fluctuating pressure loads due to jet impingement has been investigated using a quarter-scale model of a boilerplate test facility in which a JT-15D engine with a rectangular outer nozzle blows over a small curved airfoil representing the upper-surface of a wing. When model and full-scale spectra of fluctuating surface pressures are reduced to plots of pressure coefficient power-spectral density vs Strouhal number, moderate agreement is obtained, but a shift of spectral peaks is noted. However, when a correction for the ratio of average jet to ambient temperature is applied, the spectral peaks agree.

  19. Externally blown flap impingement noise.

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Wilson, Mark D.; Keene, James S.

    2016-01-01

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

  2. 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

  3. Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers.

    PubMed

    Bak, K

    1996-06-01

    Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20-30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the over-use syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.

  4. Nanofluid impingement jet heat transfer

    PubMed Central

    2012-01-01

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

  5. Boxer's elbow: internal impingement of the coronoid and olecranon process. A report of seven cases.

    PubMed

    Robinson, Paul M; Loosemore, Mike; Watts, Adam C

    2017-03-01

    Boxer's elbow has been described in the literature as an extension and hyperextension injury. However, in our experience, there is a coexisting impingement lesion in the anterior compartment of the elbow that has not previously been described. We report a series of professional boxers with elbow disease treated arthroscopically. The aim of the paper was to accurately describe the pathoanatomy of the condition, the key points in its diagnosis, and the outcomes of surgical treatment. Seven professional boxers were treated for symptomatic elbow disease. Clinical evaluation included range of motion and Disabilities of the Arm, Shoulder, and Hand score. The arthroscopic findings and procedures were documented. Symptoms were mainly those of anterior and posterior impingement; 6 elbows had an anterior impingement lesion and 6 had a posterior impingement lesion. Postoperatively, the mean Disabilities of the Arm, Shoulder, and Hand score was 2.7 (range, 0-13.3) at a median of 15 (range, 6-36) months postoperatively. All boxers returned to their previous level of competition and 5 won their next bout. All of the boxers used an orthodox stance, and in all but 1 case the left elbow was the pathologic elbow. Boxers are prone to development of anterior and posterior elbow impingement. The side of the pathologic process is related to the boxer's stance, with the lead arm being more vulnerable. Arthroscopic débridement is an effective treatment, enabling return to a high competitive level. Surgeons, sports medicine physicians, and physiotherapists should be aware of the condition. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. A Simple Technique for Capsular Repair After Hip Arthroscopy

    PubMed Central

    Camp, Christopher L.; Reardon, Patrick J.; Levy, Bruce A.; Krych, Aaron J.

    2015-01-01

    Capsulotomy is typically performed during arthroscopic treatment for femoroacetabular impingement. As the frequency of hip arthroscopy continues to expand rapidly, increased attention is being paid to the implications of interportal capsulotomy and the need for repair. To minimize the risk of postoperative instability, capsular closure has been recommended to restore the anatomy and biomechanical function of the capsule. We present a reliable, efficient, and effective method for arthroscopic closure of the interportal capsulotomy after hip arthroscopy. PMID:26870655

  7. 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.

  8. New perspectives on femoroacetabular impingement syndrome.

    PubMed

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

    2016-05-01

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

  9. [Clinical or radiological diagnosis of impingement].

    PubMed

    Kloth, J K; Zeifang, F; Weber, M-A

    2015-03-01

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques.

  10. 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.

  11. Externally blown flap impingement noise

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

  12. Partial transmalleolar approach for lateral impingement after total ankle arthroplasty: a case report.

    PubMed

    Matsumoto, Takumi; Nakamura, Ichiro; Miura, Ayumi; Momoyama, Gen; Ito, Katsumi

    2015-01-01

    Advances in implant technology have made total ankle arthroplasty an increasingly popular alternative to arthrodesis for the management of ankle arthritis. However, a frequent complication of the procedure is nerve impingement related to either to heterotrophic bone growth or the prosthesis itself. Successful resolution of this complication presents a challenge to clinicians. We present a case of lateral impingement following total ankle arthroplasty that was successfully treated using a partial transmalleolar approach to effect a partial osteotomy of the lateral malleolus and create a fragment attached to the anterior talofibular and calcaneofibular ligaments. This approach provides a good operative field in the lateral gutter with minimal soft tissue impairment. It also facilitates curettage, and resolution of tissue impingement. The osteotomy site healed fully by 3 months postoperative, and the pain around the lateral malleolus resolved. Furthermore, the patient's score on the Japanese Society for Surgery of the Foot Ankle/Hindfoot Scale improved from 33 preoperatively to 82 at 6 months postoperative.

  13. 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.

  14. Quantitative magnetic resonance arthrography in patients with femoroacetabular impingement.

    PubMed

    Samaan, Michael A; Zhang, Alan L; Gallo, Matthew C; Schwaiger, Benedikt J; Link, Thomas M; Souza, Richard B; Majumdar, Sharmila

    2016-12-01

    Quantitative MRI (QMRI) of the hip with sequences such as T1ρ and T2 mapping has been utilized to detect early changes in cartilage matrix composition. However, QMRI has not been performed in the presence of intra-articular contrast. Thus the purpose of this study was to evaluate the feasibility and use of QMRI during MR-arthrography (MRA) in femoracetabular impingement (FAI) patients. Using a 3 Tesla MR-scanner, 10 FAI patients underwent a unilateral MRA and standard MRI of the hip joint. Global and sub-regional T1ρ and T2 relaxation times of the acetabular and femoral articular cartilage were computed in the MRA and MRI assessments and agreement of these values were assessed using the Krippendorff's alpha (α) coefficient and linear regression (μ). T1ρ and T2 relaxation times between the MRA and MRI were compared using a repeated measures analysis of variance. Both global and sub-regional T1ρ and T2 relaxation times demonstrated strong agreement (α > 0.83; μ > 0.85) independent of intra-articular contrast. Also, global and sub-regional acetabular T1ρ (P = 0.72) and T2 (P = 0.94), as well as femoral T1ρ , relaxation times were similar between MRA and MRI (P = 0.73) yet femoral T2 relaxation times decreased when using intra-articular contrast (P = 0.04). This study demonstrated the feasibility of T1ρ and T2 mapping for use in hip MRA with FAI patients. The inclusion of QMRI in MRA provides a quantitative assessment of the effects of FAI on hip joint articular cartilage while allowing for detailed assessment of labral pathology with the use of intra-articular contrast. J. Magn. Reson. Imaging 2016;44:1539-1545. © 2016 International Society for Magnetic Resonance in Medicine.

  15. 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

  16. 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

  17. Bernese Periacetabular Osteotomy in Males: Is There an Increased Risk of Femoroacetabular Impingement (FAI) After Bernese Periacetabular Osteotomy?

    PubMed Central

    Ziebarth, K.; Balakumar, J.; Domayer, S.; Kim, Y. J.

    2010-01-01

    Background The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. Questions/purposes We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. Patients and Methods We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12–90 months). Results We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Conclusions Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:20848246

  18. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

    PubMed

    Ziebarth, K; Balakumar, J; Domayer, S; Kim, Y J; Millis, M B

    2011-02-01

    The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  19. 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

  20. 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.

  1. Effects of diagonal shoulder training in a closed kinematic chain for secondary impingement syndrome: a case study

    PubMed Central

    Kim, Soo-Han; Park, Du-Jin

    2015-01-01

    [Purpose] This study examined the effects of diagonal shoulder training on an individual with secondary impingement due to scapular dyskinesis. [Subject] A 54 year-old female with secondary impingement participated in this study. [Methods] The patient performed diagonal shoulder training in 4-point kneeling, 3 times per day for 20 minutes over a period of 6 weeks. Evaluations of shoulder pain, range of motion, upper trapezius/lower serratus anterior ratio, and impingement were performed before training and at 2, 4, and 6 weeks. [Results] The patient’s parameters improved gradually. All parameters returned to normal ranges at 4 weeks. [Conclusion] Diagonal shoulder training is effective for improving dysfunction in individuals with secondary impingement. In addition, this training should be applied for more than 4 weeks. PMID:26180371

  2. Associations of markers of matrix metabolism, inflammation markers, and adipokines with superior cam deformity of the hip and their relation with future hip osteoarthritis.

    PubMed

    van Spil, W E; Agricola, R; Drossaers-Bakker, K W; Weinans, H; Lafeber, F P J G

    2015-11-01

    First, to study how markers of matrix metabolism, inflammation markers, and adipokines relate to (superior) cam deformity and (possible) cam impingement of the hip. Second, to investigate whether they can identify subjects with cam deformity that are at risk of future hip osteoarthritis (OA). In a cohort of 1002 subjects (CHECK), (superior) cam deformity was defined by an alpha angle >60° on anteroposterior pelvic radiographs and (possible) cam impingement by a cam deformity together with internal hip rotation ≤20°. Hip OA at 5-year follow-up was defined by Kellgren and Lawrence grade ≥2 or total hip replacement. Subjects with (superior) cam deformity and (possible) cam impingement showed lower levels of bone turnover markers (uCTX-I, uNTX-I, sPINP, sOC) than those without. Cam deformity was positively associated with future hip OA, but associations were weaker at high levels of bone turnover. sCOMP and sHA levels were higher in subjects with cam deformity, while other cartilage and synovium markers were not. Some markers of inflammation (pLeptin, pAdiponectin, and erythrocyte sedimentation rate) were lower in presence of cam deformity and cam impingement, but high-sensitivity C-reactive protein was not. Most associations depended largely on gender differences. Bone metabolism may be relevant in the pathogenesis of (superior) cam deformity and in the development of (superior) cam deformity into hip OA. Subjects with cam deformity and cam impingement surprisingly showed lower levels of inflammation markers and adipokines. Associations of cartilage turnover markers with cam deformity and cam impingement were less obvious. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  3. 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.

  4. Sex Differences in Patients With CAM Deformities With Femoroacetabular Impingement: 3-Dimensional Computed Tomographic Quantification.

    PubMed

    Yanke, Adam B; Khair, M Michael; Stanley, Robert; Walton, David; Lee, Simon; Bush-Joseph, Charles A; Espinoza Orías, Alejandro; Espinosa Orias, Alejandro A; Inoue, Nozomu; Nho, Shane J

    2015-12-01

    To determine if significant differences exist between male and female CAM deformities using quantitative 3-dimensional (3D) volume and location analysis. Retrospective analysis of preoperative computed tomographic (CT) scans for 138 femurs (69 from male patients and 69 from female patients) diagnosed with impingement from November 2009 to November 2011 was completed. Those patients who presented with hip complaints and had a history, physical examination (limited range of motion, positive impingement signs), plain radiographs (anteroposterior pelvis, 90° Dunn view, false profile view), and magnetic resonance images consistent with femoroacetabular impingement (FAI) and in whom a minimum of 6 months of conservative therapy (oral anti-inflammatory agents, physical therapy, and activity modification) had failed were indicated for arthroscopic surgery and had a preoperative CT scan. Scans were segmented, converted to point cloud data, and analyzed with a custom-written computer program. Analysis included mean CAM height and volume, head radius, and femoral version. Differences were analyzed using an unpaired t test with significance set at P < .05. Female patients had greater femoral anteversion compared with male patients (female patients, 15.5° ± 8.3°; male patients, 11.3° ± 9.0°; P = .06). Male femoral head radii were significantly larger than female femoral heads (female patients, 22.0 ± 1.3 mm; male patients, 25.4 ± 1.3 mm; P < .001). Male CAM height was significantly larger than that in female patients (female patients, 0.66 ± 0.61 mm; male patients, 1.51 ± 0.75 mm; P < .001). Male CAM volume was significantly larger as well (male patients, 433 ± 471 mm(3); female patients, 89 ± 124 mm(3); P < .001). These differences persisted after normalizing height (P < .001) and volume (P < .001) to femoral head radius. Average clock face distribution was from the 1:09 o'clock position ± the 2:51 o'clock position to the 3:28 o'clock position ± the 1:59 o

  5. Study of liquid jet impingement on screens

    NASA Technical Reports Server (NTRS)

    Dodge, F. T.; Ricker, R. E.

    1976-01-01

    A model is presented for an unconfined flow, such as a free jet, impinging on a screen which incorporates the influence of liquid deflection by the screen. The boundary layer blockage coefficient is introduced. This coefficient depends on the screen weave geometry and the jet impingement angle, and essentially accounts for the increase in fluid particle trajectory length through the screen resulting from the flow deflection. Comparisons were made with previous experimental studies to determine empirical values of the blockage coefficient. It is concluded that the new model reliably predicts the bulk flow and penetration characteristics of an impinging liquid jet interacting with a screen.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. Supersonic rectangular jet impingement noise experiments

    NASA Astrophysics Data System (ADS)

    Norum, Thomas D.

    1989-04-01

    The discrete frequency sound produced by jets issuing from a convergent, rectangular nozzle of aspect ratio 4.24 was investigated. Experiments were performed both with the free jet and with the jet impinging on a hard ground surface. The impingement tones that dominate the impinging jet spectra show a definite staging behavior which appears to be biased toward the free jet screech frequency once the separation distance exceeds the region of substantial shock cell development. The frequency variation of the impingement tone stages fit the details of a feedback cycle if the disturbance convection velocity is chosen to be 20 percent higher than that necessary to satisfy the screech feedback loop. Phase locked optical records show a flapping mode of jet oscillation with tones at or near the screech frequency, with superimposed symmetric oscillations when a second dominant tone of unrelated frequency appears in the spectrum.

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. Hip arthroscopy

    MedlinePlus

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

  14. Posterior ankle impingement in the dancer.

    PubMed

    Moser, Brad R

    2011-01-01

    Dancers spend a lot of time in the relevé position in demi-pointe and en pointe in their training and their careers. Pain from both osseous and soft tissue causes may start to occur in the posterior aspect of their ankle. This article reviews the potential causes of posterior ankle impingement in dancers. It will discuss the clinical evaluation of a dancer and the appropriate workup and radiographic studies needed to further evaluate a dancer with suspected posterior ankle impingement.

  15. 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.

  16. Achilles Impingement Tendinopathy on Magnetic Resonance Imaging.

    PubMed

    Bullock, Mark J; Mourelatos, Jan; Mar, Alice

    2017-02-28

    Haglund's syndrome is impingement of the retrocalcaneal bursa and Achilles tendon caused by a prominence of the posterosuperior calcaneus. Radiographic measurements are not sensitive or specific for diagnosing Haglund's deformity. Localization of a bone deformity and tendinopathy in the same sagittal section of a magnetic resonance imaging scan can assist with the diagnosis in equivocal cases. The aim of the present cross-sectional study was to determine the prevalence of Haglund's syndrome in patients presenting with Achilles tendinopathy and note any associated findings to determine the criteria for a diagnosis of Haglund's syndrome. We reviewed 40 magnetic resonance imaging scans with Achilles tendinopathy and 19 magnetic resonance imaging scans with Achilles high-grade tears and/or ruptures. Achilles tendinopathy was often in close proximity to the superior aspect of the calcaneal tuberosity, consistent with impingement (67.5%). Patients with Achilles impingement tendinopathy were more often female (p < .04) and were significantly heavier than patients presenting with noninsertional Achilles tendinopathy (p = .014) or Achilles tendon rupture (p = .010). Impingement tendinopathy occurred medially (8 of 20) and centrally (10 of 20) more often than laterally (2 of 20) and was associated with a posterior prominence or hyperconvexity with a loss of calcaneal recess more often than a superior projection (22 of 27 versus 8 of 27; p < .001). Haglund's deformity should be reserved for defining a posterior prominence or hyperconvexity with loss of calcaneal recess because this corresponds with impingement. Achilles impingement tendinopathy might be more appropriate terminology for Haglund's syndrome, because the bone deformity is often subtle. Of the 27 images with Achilles impingement tendinopathy, 10 (37.0%) extended to a location prone to Achilles tendon rupture. Given these findings, insertional and noninsertional Achilles tendinopathy are not mutually

  17. Atomization characteristics of impinging liquid jets

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

    A systematic study is presented of the atomization of impinging liquid jets investigating the effects of jet conditions (laminar versus turbulent), orifice diameter, impingement angle and jet velocity. Results are compared to current theories in terms of sheet breakup length, sheet shape and drop size. Experiments contrasting laminar and turbulent jet conditions clearly show that the jet conditions have a dramatic effect on the atomization process.

  18. Shoulder impingement in the United States military.

    PubMed

    Hsiao, Mark S; Cameron, Kenneth L; Tucker, Christopher J; Benigni, Matthew; Blaine, Theodore A; Owens, Brett D

    2015-09-01

    Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service. The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups. In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively). The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury. Published by Elsevier Inc.

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

    PubMed Central

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

    2015-01-01

    Background: 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. Hypothesis: The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. Study Design: Clinical research. Level of Evidence: Level 5. Methods: 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. Results: 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°). Conclusion: 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

  20. 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/

  1. Subcoracoid impingement and subscapularis tendon: is there any truth?

    PubMed Central

    Osti, Leonardo; Soldati, Francesco; Del Buono, Angelo; Massari, Leo

    2013-01-01

    Summary Subcoracoid impingement and stenosis have been described related to anterior shoulder pain and subscapularis tendon tears, but the pathogenesis and related treatment of this condition has still not been explained properly. Variability of coracoid morphology has been described and both traumatic and iatrogenic factors can modify it. Some authors referred this to a primary narrow coracohumeral distance with different threshold values defined as increased risk factor for subscapularis and antero-superior RC tear; opposite theories stated that the stenosis is secondary to an anterosuperior translation of the humeral head toward the coracoid due to degenerative changes of the rotator cuff tendons. Limited coracoplasty can be performed when related risk factors are identified; however no clear consensus arises from specific literature review and extensive clinical and instrumental examination of the patient should be performed in order to identify specific risk factors for subscapularis tendon pathology and, subsequently, tailor the proper approach. PMID:23888292

  2. Subcoracoid impingement and subscapularis tendon: is there any truth?

    PubMed

    Osti, Leonardo; Soldati, Francesco; Del Buono, Angelo; Massari, Leo

    2013-04-01

    Subcoracoid impingement and stenosis have been described related to anterior shoulder pain and subscapularis tendon tears, but the pathogenesis and related treatment of this condition has still not been explained properly. Variability of coracoid morphology has been described and both traumatic and iatrogenic factors can modify it. Some authors referred this to a primary narrow coracohumeral distance with different threshold values defined as increased risk factor for subscapularis and antero-superior RC tear; opposite theories stated that the stenosis is secondary to an anterosuperior translation of the humeral head toward the coracoid due to degenerative changes of the rotator cuff tendons. Limited coracoplasty can be performed when related risk factors are identified; however no clear consensus arises from specific literature review and extensive clinical and instrumental examination of the patient should be performed in order to identify specific risk factors for subscapularis tendon pathology and, subsequently, tailor the proper approach.

  3. 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

  4. 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

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

    PubMed Central

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

    2014-01-01

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

  6. Trends in hip arthroscopy utilization in the United States.

    PubMed

    Bozic, Kevin J; Chan, Vanessa; Valone, Frank H; Feeley, Brian T; Vail, Thomas P

    2013-09-01

    The purpose of this study was to evaluate the changing incidence of hip arthroscopy procedures among newly trained surgeons in the United States, the indications for hip arthroscopy, and the reported rate of post-operative complications. The ABOS database was used to evaluate the annual incidence of hip arthroscopy procedures between 2006-2010. Procedures were categorized by indication and type of procedure. The rate of surgical complications was calculated and compared between the published literature and hip arthroscopy procedures performed for femoroacetabular impingement (FAI)/osteoarthritis (OA) and for labral tears among the newly trained surgeon cohort taking the ABOS Part II Board exam. The overall incidence of hip arthroscopy procedures performed by ABOS Part II examinees increased by over 600% during the 5-year period under study from approximately 83 in 2006 to 636 in 2010. The incidence of hip arthroscopy for FAI/OA increased steadily over the time period under study, while the incidence of hip arthroscopy for labral tears was variable over time. The rate of surgical complications was 5.9% for hip arthroscopy procedures for a diagnosis of FAI/OA vs. 4.4% for a diagnosis of labral tear (P=0.36). The incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for the indication of FAI/OA. Reported surgical complication rates are relatively low, but appear higher than those rates reported in previously published series. Appropriate indications for hip arthroscopy remain unclear. © 2013 Elsevier Inc. All rights reserved.

  7. Dual mobility total hip replacement in a high risk population

    PubMed Central

    Luthra, Jatinder Singh; Al Riyami, Amur; Allami, Mohamad Kasim

    2016-01-01

    Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement) cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement. PMID:27924742

  8. Current Concepts in Hip Preservation Surgery

    PubMed Central

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

    2015-01-01

    Context: An evolution in conceptual understanding, coupled with technical innovations, has enabled hip preservation surgeons to address complex pathomorphologies about the hip joint to reduce pain, optimize function, and potentially increase the longevity of the native hip joint. Technical aspects of hip preservation surgeries are diverse and range from isolated arthroscopic or open procedures to hybrid procedures that combine the advantages of arthroscopy with open surgical dislocation, pelvic and/or proximal femoral osteotomy, and biologic treatments for cartilage restoration. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, 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: Thoughtful individualized surgical procedures are available to optimize the femoroacetabular joint in the presence of hip dysfunction. Conclusion: A comprehensive understanding of the relationship between femoral and pelvic orientation, morphology, and the development of intra-articular abnormalities is necessary to formulate a patient-specific approach to treatment with potential for a successful long-term result. PMID:26502445

  9. Ultrasound-guided Prolotherapy with Polydeoxyribonucleotide Sodium in Ischiofemoral Impingement Syndrome.

    PubMed

    Kim, Won-Joong; Shin, Hwa-Yong; Koo, Gill-Hoi; Park, Hae-Gyun; Ha, Yong-Chan; Park, Yong-Hee

    2014-09-01

    Ischiofemoral impingement syndrome is an uncommon disorder defined by hip pain caused by the narrowing of the space between the ischial tuberosity and lesser trochanter with associated entrapment of the quadratus femoris muscle. We effectively treated two male patients using ultrasound-guided prolotherapy with polydeoxyribonucleotide sodium mixed with local anesthetics. A 24-year-old male patient with no history of trauma or surgery complained of bilateral hip and groin pain; magnetic resonance imaging demonstrated slight narrowing of the bilateral ischiofemoral spaces with mild enhancement of the left quadratus femoris muscle. A 23-year-old male patient with a history of iliotibial band release and iliopsoas tendon release complained of left hip and groin pain; magnetic resonance imaging revealed swelling of the left quadratus femoris muscle. After the fifth treatment session of prolotherapy, the pain severity score using the visual analog scale was found to be minimal (0-1/10), and follow-up magnetic resonance imaging revealed a slightly decreased enhancement of the quadratus femoris muscle compared with that on previous images. Prolotherapy with polydeoxyribonucleotide sodium was an efficacious treatment for two patients with ischiofemoral impingement syndrome who were not candidates for surgery. © 2014 World Institute of Pain.

  10. 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.

  11. 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.

  12. Spray formation processes of impinging jet injectors

    NASA Astrophysics Data System (ADS)

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

    1993-11-01

    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.

  13. Design an efficient air impingement nozzle array

    SciTech Connect

    Steinberg, N.I.

    1995-08-01

    Direct air impingement is the most commonly used system for heating, cooling,and drying webs and films. Air impingement heat-transfer systems blow jets of air (or other gas) perpendicular to the web from an array of nozzles. These may be slot nozzles positioned across the web or a two-dimensional array of round nozzles, typically holes in a plate. Designing air impingement systems essentially means specifying the key geometric parameters that control the heat-transfer coefficient: slot width, slot-to-slot pitch, and slot-to-web stand-off distance, as well as some secondary parameters that affect heat transfer uniformity in the longitudinal and transverse directions. Slot nozzle array designs based on published optimization correlations usually have a near-maximum heat-transfer coefficient for a given impingement velocity, but an accessibly high nozzle area per unit impinged area. This increase construction and operating cost because the air volumes are too high. This article addresses that problem by providing a systematic design procedure along with the required design data.

  14. Effect of isokinetic training on shoulder impingement.

    PubMed

    Wang, T L; Fu, B M; Ngai, G; Yung, P

    2014-01-31

    The aim of this study was to review the literature evaluating the effect of isokinetic training in patients suffering from shoulder impingement syndrome (SIS). Studies published up to March 2011 were located from the Pubmed, Scopus, Lilacs, Physiotherapy Evidence Database, and Cochrane Library databases using "isokinetic", "shoulder", and "impingement" as key words. Referenced studies were also checked. Studies were included if isokinetic training was employed as at least one of the treatments in the therapeutic program to treat shoulder impingement or other shoulder pathologies leading to impingement-related pain. All eligible studies described the level of evidence, patient characteristics, interventions, outcome evaluation, results, complications, and return to work. There were 2 randomized control trials (RCTs) and 4 studies with level 4 evidence that met the inclusion criteria. All of the studies included showed a statistically or clinically significant outcome after isokinetic training. However, most of the studies could not identify the isolated effect of isokinetic training. There was not enough evidence to support or refute the effectiveness of isokinetic training for SIS. This result does not reflect a true lack of effect, but rather a lack of RCTs. A consensus definition of the different types and stages of SIS is urgently needed. More RCTs are also essential to clarify the value of this technique. The homogeneity of treatment interventions, study populations, and outcome measures should be prioritized. Further studies are also needed to clarify the differences in isokinetic data across different types and stages of shoulder impingement.

  15. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?

    PubMed

    Kim, Jin Ah; Park, Ji Seon; Jin, Wook; Ryu, Kyungnam

    2011-02-01

    The purpose was to assess the significance of herniation pits in the femoral neck for radiographic diagnosis of femoroacetabular impingement (FAI). Eighty hips in 62 patients (bilateral in 18) with neutral pelvic orientation were enrolled. Herniation pits were diagnosed when they were located at the anterosuperior femoral neck, close to the physis, and with a diameter of >3 mm. The five radiographic signs of FAI were used: lateral center edge angle (LCE) >39°, acetabular index (AI) ≤0, extrusion index (EI) <25%, acetabular retroversion, and pistol-grip deformity. Patients with radiographs suggesting FAI were retrospectively correlated with their clinical symptoms. Positive radiographic signs were observed in 7 hips with LCE, 7 with AI, and 80 with EI criteria. Only 3 hips out of 80 (3.8%) showed all of the signs. The acetabular retroversion and pistol-grip deformity were seen in 12/80 and 3/80 hips, respectively. The total number of hips that met radiographic criteria for FAI, including pincer type and cam type, was 18 (23%). However, none of these hips were clinically diagnosed with FAI. All symptomatic hips (11/80) presented only with nonspecific pain, and 2 hips out of 11 showed radiographic signs of FAI. The low frequency of positive radiographic signs suggesting FAI with related symptoms among patients with herniation pits suggests that herniation pits have limited significance in the diagnosis of FAI. Therefore it can be concluded that an incidental finding of herniation pits does not necessarily imply a correlation with FAI.

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

    PubMed Central

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

    2014-01-01

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

  17. 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

  18. 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

  19. Industrial stator vane with sequential impingement cooling inserts

    SciTech Connect

    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.

  20. Improved Stirling engine performance using jet impingement

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

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

  1. Microtextured Surfaces for Turbine Blade Impingement Cooling

    NASA Technical Reports Server (NTRS)

    Fryer, Jack

    2014-01-01

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

  2. Calculations of slurry pump jet impingement loads

    SciTech Connect

    Wu, T.T.

    1996-03-04

    This paper presents a methodology to calculate the impingement load in the region of a submerged turbulent jet where a potential core exits and the jet is not fully developed. The profile of the jet flow velocities is represented by a piece-wise linear function which satisfies the conservation of momentum flux of the jet flow. The adequacy of the of the predicted jet expansion is further verified by considering the continuity of the jet flow from the region of potential core to the fully developed region. The jet impingement load can be calculated either as a direct impingement force or a drag force using the jet velocity field determined by the methodology presented.

  3. Improved Stirling engine performance using jet impingement

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

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

  4. Factors associated with the failure of arthroscopic surgery treatment in patients with femoroacetabular impingement: A cohort study.

    PubMed

    Martínez, D; Gómez-Hoyos, J; Márquez, W; Gallo, J

    2015-01-01

    The aim of this study was to evaluate the association of the anatomical and functional characteristics with therapeutic failure in patients with femoroacetabular impingement, who underwent hip arthroscopy. A cohort study was performed on 179 patients with femoroacetabular impingement who underwent hip arthroscopy between 2004 and 2012. The demographic, anatomical, functional, and clinical information were recorded. A logistic regression model and ANCOVA were used in order to compare the described characteristics with the treatment outcomes of the hip arthroscopy. The median time of follow-up for symptoms was 13 months (8-30), and the mean time of follow-up after surgery was 23.83 ± 9.8 months. At the end of the follow-up 3.91% of the patients were considered as a therapeutic failure. The WOMAC score in pain and functional branches, as well as the total WOMAC score, showed significant differences (P<.05). The mean WOMAC score was higher (0 to 100 with 0 being a perfect score) in the group of patients who failed after surgery as compared with the group who meet the requirements for a successful treatment, 65.9 vs 48.8, respectively (mean difference 17.0; 95% CI; 1.3-32.6; P=.033). The poor functional state prior to arthroscopic treatment of femoroacetabular impingement, mainly due to preoperative pain, assessed using the WOMAC scale, is associated with a higher therapeutic failure rate. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Plume impingement forces on inclined flat plates

    NASA Astrophysics Data System (ADS)

    Legge, H.

    Plume impingement from spacecraft control thrusters on vehicles in space is simulated in wind tunnel scale experiments. Pressure and shear stress are measured on flat plates inclined to the plume axis between 0 and 90 deg. In addition to a nozzle of a 0.5N thruster, a free jet from a thin plate orifice was used, by which the flow regime from nearly free molecular flow to continuum flow was covered. Simple pressure and shear stress laws are given by which the impingement pressure and shear stress can be estimated for engineering applications.

  6. Acoustics measurements in normal jet impingement

    NASA Technical Reports Server (NTRS)

    Kleis, S. J.

    1977-01-01

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

  7. Optimal management of shoulder impingement syndrome

    PubMed Central

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

    2014-01-01

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

  8. Femoro-acetabular impingement clinical research: is a composite outcome the answer?

    PubMed

    Ayeni, Olufemi R; Sansone, Mikael; de Sa, Darren; Simunovic, Nicole; Bedi, Asheesh; Kelly, Bryan T; Farrokhyar, Forough; Karlsson, Jon

    2016-01-01

    Femoro-acetabular impingement (FAI) is increasingly recognized as an important cause of hip pain in the young adult. However, the methods of evaluating the efficacy of surgical intervention are often not validated and/or inconsistently reported. Important clinical, gait, radiographic and biomarker outcomes are discussed. This article (1) presents the rationale for considering a composite outcome for FAI patients; (2) examines a variety of important end points currently used to evaluate FAI surgery; (3) discusses a strategy to generate a composite outcome by combining these end points; and (4) highlights the challenges and current areas of controversy that such an approach to evaluating symptomatic FAI patients may present.

  9. 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

  10. Endoscopic treatment of calcaneo-fibular impingement.

    PubMed

    Bauer, T; Deranlot, J; Hardy, Ph

    2011-01-01

    The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture and is linked to the decreased space between the tip of the fibula and the lateral wall of the calcaneus. The reasons for the painful symptoms are mixed with both bony and soft tissue involvement. The abnormal bony contact between the lateral calcaneal cortex and the tip of the fibula depends mainly on the size and localization of the lateral exostosis of the calcaneal wall. The soft tissue impingement is due to the fibrosis and scar tissues in the lateral gutter and to the compression of the peroneal tendons in the retromalleolar groove and under the tip of the malleolus. A 2-portal endoscopic technique is described for the treatment of calcaneo-fibular impingement with bone resection, soft tissue debridement and peroneal tendons release. One of the advantages of this endoscopic technique is the possibility of an assessment and treatment of associated lesions in the same procedure. A subtalar joint fusion can be done before if needed under arthroscopic control. As this endoscopic technique is very efficient to relieve symptoms of calcaneo-fibular impingement and is focused on the most relevant symptoms, it can thus be indicated for most of cases of calcaneal malunions, whatever the type of malunion and depending of the painful symptoms.

  11. 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

  12. [Arthroscopy of the hip joint].

    PubMed

    Pasa, L; Hart, R; Kocis, J; Muzík, V; Veselý, R

    2005-01-01

    Arthroscopic examination of joints has recently gained wide application. Due to hip joint shape and a difficult approach to it, hip arthroscopy has long remained outside the attention and abilities of arthroscopists. The authors present their first experience with operative hip arthroscopy that offers new options for the treatment of intra-articular pathology of the hip joint. In the years 2001-2003, 24 hip arthroscopies were performed. The following pathological conditions were diagnosed and treated: loose bodies, chondral lesions of the femoral head and acetabulum, ruptures of the labrum acetabuli and ligamentum teres, impingement syndrome of the labrum acetabuli, and coxitis. No post-operative neurologic symptoms or vascular complications were observed. All procedures were carried out on patients in a supine position, with the treated joint in traction. A standard 30 degrees device and common instruments for arthroscopic surgery were used. The instruments were inserted in the articular fissure with the use of an X-ray intensifier. Movement in the hip joint during surgery is very limited due to traction, joint shape and the length of working canals. After traction is released, it is possible to examine also the intra-articular part of the femoral neck. The pre-operative complaints (clunking, painful joint) were relieved up to 4 to 6 weeks after surgery in 23 patients. In one patient primarily diagnosed with coxitis, infection was not eradicated after lavage and debridement and, because inflammation deeply affected the femoral head, the hip was eventually treated by Girdlestone arthroplasty. The results were evaluated clinically and on the basis of the Merle d'Aubigne and Postel questionnaire assessing pain and walking abilities by both the patients and the surgeon. All 24 patients reported poor or average conditions before surgery and, after surgery, 23 experienced improvement to a very good or average condition. One patient's state failed to improve and was

  13. Contributions of individual muscles to hip joint contact force in normal walking.

    PubMed

    Correa, Tomas A; Crossley, Kay M; Kim, Hyung J; Pandy, Marcus G

    2010-05-28

    The human hip joint withstands high contact forces during daily activity and is therefore susceptible to injury and structural deterioration over time. Knowledge of muscle-force contributions to hip joint loading may assist in the development of strategies to prevent and manage conditions such as osteoarthritis, femoro-acetabular impingement and fracture. The main aim of this study was to determine the contributions of individual muscles to hip contact force in normal walking. Muscle contributions to hip contact force were calculated based on a previously published dynamic optimization solution for normal walking, which provided the time histories of joint motion, ground reaction forces, and muscle forces during the stance and swing phases of gait. The force developed by each muscle plus its contribution to the ground reaction force were used to determine the muscle's contribution to hip contact force. Muscles were the major contributors to hip contact force, with gravitational and centrifugal forces combined contributing less than 5% of the total contact force. Four muscles that span the hip - gluteus medius, gluteus maximus, iliopsoas, and hamstrings - contributed most significantly to the three components of the hip contact force and hip contact impulse (integral of hip contact force over time). Three muscles that do not span the hip - vasti, soleus, and gastrocnemius - also contributed substantially to hip joint loading. These results provide additional insight into lower-limb muscle function during walking and may also be relevant to studies of cartilage degeneration and bone remodelling at the hip.

  14. Validity of magnetic resonance arthrography as a diagnostic tool in femoroacetabular impingement syndrome.

    PubMed

    González Gil, A B; Llombart Blanco, R; Díaz de Rada, P

    2015-01-01

    Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adult and a contributory factor for development of early primary osteoarthritis. An accurate clinical diagnosis, supported by imaging studies, is important to determine the best treatment for the patient. The aim of this study is to determine the diagnostic correlation between direct magnetic resonance imaging (MRI) arthrography and the arthroscopic findings. A review was performed on a series of 36 patients diagnosed with FAI, and who underwent hip arthroscopy surgery between 2009 and 2012. All of them had a direct MRI arthrography performed in our hospital. The presence of labral lesions, CAM deformity, and acetabular and femoral cartilage damage, were evaluated in both imaging techniques. After analysing the results and taking the hip arthroscopy as 'gold standard', a sensitivity of 87% and a specificity of 77% were obtained, with a PPV of 87% for the diagnosis of labral lesions by direct MR arthrography. The specificity for CAM deformity was 100%, with a sensitivity of 79% and PPV of 100%. For chondral disorders lower values were found for both acetabulum and femoral head. For acetabular lesions the sensitivity was 78.5%, and specificity was 82% with a PPV of 73% and NPV of 80%. For femoral lesions, there was a sensitivity of 71.5%, a specificity of 73%, with a PPV of 62.5% and NPV of 80%. Due to the high sensitivity for the detection of labral lesions and the high specificity to detect CAM deformity, hip MR arthrography is a useful diagnostic tool for femoroacetabular impingement. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Return to Play Following Hip Arthroscopy.

    PubMed

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

    2016-10-01

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

  16. Sources and quality of literature addressing femoroacetabular impingement.

    PubMed

    Ayeni, Olufemi R; Chan, Kevin; Al-Asiri, Jamal; Chien, Teresa; Sprague, Sheila; Liew, Susan; Bhandari, Mohit

    2013-02-01

    In the last 5 years, there has been an increasing interest in the concepts, pathoanatomy, and management of femoroacetabular impingement (FAI). The aim of this study was to determine the trends in FAI literature with specific emphasis on the quality and source of publications in the literature. A systematic review of two electronic databases (MEDLINE, EMBASE) was conducted to identify FAI-related publications from 2005 to 2010. Studies were included if they were published in peer-review journals and were written in English. Abstracted data included year of publication, study design, type of study, level of evidence, number of patients and hips, gender, weighted mean age of patients, and type of journal. There were 298 relevant studies. Between 2005 and 2010, there was an approximate fivefold increase in the number of FAI-related publications. Most of these studies came from the orthopaedic literature (197 articles or 66 %), while the remainder arose from other medical specialties. The majority of publications consisted of level 4 and 5 studies (248 articles). There were no level 1 studies identified. Between 2005 and 2010, there has been a dramatic increase in FAI-related publications, but high-quality studies are still lacking. IV.

  17. [Bernese periacetabular osteotomy for the treatment of severe hip dysplasia].

    PubMed

    Huang, Ye; Zhang, Hong; Liu, Qing; Jiang, Zeng-hui; Dou, Yong

    2010-02-15

    To analyze the mid-term clinical and radiographic results obtained with the Bernese periacetabular osteotomy for the treatment of severe hip dysplasia. From October 1997 to December 2002 20 hips of 18 patients were classified as having severe acetabular dysplasia (Severin classification Grade IVb). Preoperatively, all patients had hip pain, and sufficient hip joint congruency on functional radiographs. All 20 hips underwent Bernese periacetabular osteotomy. Postoperatively, the hips were assessed radiographically on center edge angle (CE), acetabular roof obliquity and the progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 6.2 years follow-up. Comparison of preoperative and follow-up radiographs demonstrated significant improvements in the lateral CE angle, the anterior CE angle, and roof obliquity. The average Harris hip score improved from 78.5 points preoperatively to 91.1 points at the time of the latest follow-up. Fourteen of 18 patients were satisfied with the result of the surgery, and 16 of 20 hips had a good or excellent clinical result. Under-correction occurred in 5 hips. The Bernese periacetabular osteotomy is an effective procedure for surgical correction of the severe dysplastic hip. This osteotomy can predictably obtain major reorientation of the acetabulum in all planes. The clinical results in the mid-term follow-up are encouraging.

  18. 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.

  19. SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES

    PubMed Central

    2011-01-01

    Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from glenohumeral instability and muscle imbalance. The purpose of this review is to describe the role of muscle imbalance in subacromial impingement in order to guide sports physical therapy evaluation and interventions. PMID:21655457

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

    PubMed

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

    2015-10-16

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

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

    PubMed Central

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

    2015-01-01

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

  2. 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.

  3. Iliotibial band syndrome following hip arthroscopy: An unreported complication

    PubMed Central

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

    2016-01-01

    Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:27746490

  4. Static and dynamic mechanical causes of hip pain.

    PubMed

    Bedi, Asheesh; Dolan, Mark; Leunig, Michael; Kelly, Bryan T

    2011-02-01

    Mechanical hip pain typically has been associated either with dynamic factors resulting in abnormal stress and contact between the femoral head and acetabular rim when the hip is in motion or with static overload stresses related to insufficient congruency between the head and acetabular socket in the axially loaded (standing) position. Compensatory motion may adversely affect the dynamic muscle forces in the pelvic region, leading to further strain and pain. Hip pain related to static overload stresses may also be localized to the anteromedial groin, but compensatory dysfunction of the periarticular musculature may lead to muscular fatigue and associated pain throughout the hip. As our understanding of hip joint mechanics has advanced, it has become increasingly apparent that hip pain in the absence of osteoarthritis may be due to a complex combination of mechanical stresses, both dynamic and static. With an emphasis on findings in the recent literature, this review will describe the dynamic and static factors associated with mechanical hip pain, the combinations of dynamic and static stresses that are commonly identified in hip pain, and common patterns of compensatory injury in patients with femoroacetabular impingement. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement – the FAIR trial: a randomised controlled trial protocol

    PubMed Central

    2014-01-01

    Background Femoroacetabular impingement is a common cause of hip/groin symptoms and impaired functional performance in younger sporting populations and results from morphological abnormalities of the hip in which the proximal femur abuts against the acetabular rim. Many people with symptomatic femoroacetabular impingement undergo arthroscopic hip surgery to correct the bony abnormalities. While many case series over the past decade have reported favourable surgical outcomes, it is not known whether formal rehabilitation is needed as part of the management of patients undergoing this surgical procedure. This randomised controlled trial will investigate the efficacy of a progressive physiotherapist-supervised rehabilitation program (Takla-O’Donnell Protocol) in improving health-related quality of life, physical function and symptoms in individuals undergoing arthroscopic management of femoroacetabular impingement. Methods/design 100 people aged 16–35 years undergoing hip arthroscopy for symptomatic femoroacetabular impingement will be recruited from surgical practices in Melbourne, Australia and randomly allocated to either a physiotherapy or control group. Both groups will receive written information and one standardised post-operative physiotherapy visit whilst in hospital as per usual care. Those in the physiotherapy group will also receive seven individual 30-minute physiotherapy sessions, including one pre-operative visit (within 2 weeks of surgery) and six post-operative visits at fortnightly intervals (commencing two weeks after surgery). The physiotherapy intervention will incorporate education and advice, manual techniques and prescription of a progressive rehabilitation program including home, aquatic and gym exercises. The control group will not receive additional physiotherapy management. Measurements will be taken at baseline (2 weeks pre-operatively) and at 14 and 24 weeks post-surgery. Primary outcomes are the International Hip Outcome Tool and

  6. Femoroacetabular impingement and its implications on range of motion: a case report

    PubMed Central

    2011-01-01

    Introduction Femoroacetabular impingement leads to limited hip motion, pain and progressive damage to the labrum. Assessment of the amount and location of excessive ossification can be difficult, and removal does not always lead to pain relief and an increase of function. One of the challenges ahead is to discover why certain cases have poor outcomes. Case presentation The technical and clinical results of two consecutive arthroscopic shavings of an osseous cam protrusion are described in our patient, a 50-year-old Caucasian man with complaints of femoroacetabular impingement. At 12 weeks after the first arthroscopic shaving, our patient still experienced pain. Using a range of motion simulation system based on computed tomography images the kinematics of his hip joint were analyzed. Bone that limited range of motion was removed in a second arthroscopic procedure. At six months post-operatively our patient is almost pain free and has regained a range of motion to a functional level. Conclusion This case demonstrates the relevance of range of motion simulation when the outcome of primary arthroscopic management is unsatisfactory. Such simulations may aid clinicians in determining the gain of a second operation. This claim is supported by the correlation of the simulations with clinical outcome, as shown in this case report. PMID:21477363

  7. Disease severity classification using quantitative magnetic resonance imaging data of cartilage in femoroacetabular impingement.

    PubMed

    Henn, Lisa L; Hughes, John; Iisakka, Eleena; Ellermann, Jutta; Mortazavi, Shabnam; Ziegler, Connor; Nissi, Mikko J; Morgan, Patrick

    2017-04-30

    Femoroacetabular impingement (FAI) is a condition in which subtle deformities of the femoral head and acetabulum (hip socket) result in pathological abutment during hip motion. FAI is a common cause of hip pain and can lead to acetabular cartilage damage and osteoarthritis. For some patients with FAI, surgical intervention is indicated, and it can improve quality of life and potentially delay the onset of osteoarthritis. For other patients, however, surgery is contraindicated because significant cartilage damage has already occurred. Unfortunately, current imaging modalities (X-rays and conventional MRI) are subjective and lack the sensitivity to distinguish these two groups reliably. In this paper, we describe the pairing of T2* mapping data (an investigational, objective MRI sequence) and a spatial proportional odds model for surgically obtained ordinal outcomes (Beck's scale of cartilage damage). Each hip in the study is assigned its own spatial dependence parameter, and a Dirichlet process prior distribution permits clustering of said parameters. Using the fitted model, we produce a six-color, patient-specific predictive map of the entire acetabular cartilage. Such maps will facilitate patient education and clinical decision making. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Intra-Articular Hip Injection Using Anatomic Surface Landmarks

    PubMed Central

    Masoud, Mohammad A.; Said, Hatem G.

    2013-01-01

    Intra-articular hip injection is a frequently used technique for diagnostic and therapeutic purposes and is gaining more importance for the early diagnosis of hip disease. It is commonly performed with imaging guidance such as ultrasonographic or fluoroscopic control. We describe our technique of injection of the hip using relative distances from anatomic surface landmarks, with the needle insertion point at the site of the proximal anterolateral portal for hip arthroscopy, with a posterior direction of 30° and targeted toward a junctional point between 2 perpendicular lines, 1 distal from the anterior superior iliac spine and the second anterior from the tip of the greater trochanter. This technique can be used without imaging guidance in the outpatient clinic. Moreover, it minimizes the need for radiographic exposure for more critical injections, such as the injection of contrast material before conducting magnetic resonance arthrogaphy of the hip. PMID:23875141

  9. [Resurfacing arthroplasty of the hip].

    PubMed

    Rudert, M; Gerdesmeyer, L; Rechl, H; Juhnke, P; Gradinger, R

    2007-04-01

    Resurfacing arthroplasty is regarded as an attractive method, especially for the young patient who needs a hip replacement. However, the high expectations regarding this new technique in THR must first be met. Earlier experiences with similar forms of surface replacement have led to high revision rates with early aseptic wear induced component loosening and neck fractures. Technical progresses in production techniques for metal-on-metal articulations with minimized wear have enabled the introduction of new surface replacements for the hip joint. Long-term results of these resurfacing arthroplasties are still due. Femoral neck fractures and femoro-acetabular impingement are possible early complications which require revision. The implantation of these systems requires a high degree of operative skill and experience on the part of the surgeon. Approach dependent trauma to the musculature and endangering of the blood supply to the femoral head is balanced with the positive effect of the preservation of femoral bone stock and better options in case of revision. Whether the younger patient with a higher activity profile and an increased chance of implant loosening actually profits from the resurfacing arthroplasty will be determined in the future.

  10. 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

  11. Understanding and Treating the Snapping Hip

    PubMed Central

    Yen, Yi-Meng; Lewis, Cara L.; Kim, Young-Jo

    2016-01-01

    Snapping hip, or coxa saltans is a palpable or auditory snapping with movement of the hip joint. Extra-articular snapping is divided into external and internal types, and is caused laterally by the iliotibial band and anteriorly by the iliopsoas tendon. Snapping of the iliopsoas usually requires contraction of the hip flexors and may be difficult to distinguish from intra-articualar coxa saltans. Ultrasound can be a useful modality to dynamically detect tendon translation during hip movement to support the diagnosis of extra-articular snapping. Coxa saltans is typically treated with conservative measures including anti-inflammatories, stretching and avoidance of inciting activities. Recalcitrant cases are treated with surgery to lengthen the iliopsoas or iliotibial band. PMID:26524554

  12. Vortex rings impinging on permeable boundaries

    NASA Astrophysics Data System (ADS)

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

    2015-01-01

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

  13. Hip flexor strain - aftercare

    MedlinePlus

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

  14. Hip: Anatomy and US technique

    PubMed Central

    Molini, L.; Precerutti, M.; Gervasio, A.; Draghi, F.; Bianchi, S.

    2011-01-01

    Ultrasound (US) has always had a relatively limited role in the evaluation of the hip due to the deep location of this joint. However, many hip diseases are well detectable at US, but before approaching such a study it is necessary to be thoroughly familiar with the normal anatomy and related US images. The study technique is particularly important as optimization of various parameters is required, such as probe frequency, focalization, positioning of the probe, etc. Also the patient’s position is important, as it varies according to the area requiring examination. For the study of the anterior structures, the patient should be in the supine position; for the medial structures, the leg should be abducted and rotated outward with the knee flexed; for the lateral structures, the patient should be in the controlateral decubitus position; for the posterior structures the patient must be in the prone position. US study of the hip includes assessment of the soft tissues, tendons, ligaments and muscles, and also of the bone structures, joint space and serous bursae. The purpose of this article is to review the normal anatomy of the hip as well as the US anatomy of this joint. PMID:23397030

  15. Gas turbine bucket with impingement cooled platform

    DOEpatents

    Jones, Raphael Durand

    2002-01-01

    In a turbine bucket having an airfoil portion and a root portion, with a substantially planar platform at an interface between the airfoil portion and root portion, a platform cooling arrangement including at least one bore in the root portion and at least one impingement cooling tube seated in the bore, the tube extending beyond the bore with an outlet in close proximity to a targeted area on an underside of the platform.

  16. An approximation technique for jet impingement flow

    SciTech Connect

    Najafi, Mahmoud; Fincher, Donald; Rahni, Taeibi; Javadi, KH.; Massah, H.

    2015-03-10

    The analytical approximate solution of a non-linear jet impingement flow model will be demonstrated. We will show that this is an improvement over the series approximation obtained via the Adomian decomposition method, which is itself, a powerful method for analysing non-linear differential equations. The results of these approximations will be compared to the Runge-Kutta approximation in order to demonstrate their validity.

  17. Crater Formation Due to Lunar Plume Impingement

    NASA Technical Reports Server (NTRS)

    Marsell, Brandon

    2011-01-01

    Thruster plume impingement on a surface comprised of small, loose particles may cause blast ejecta to be spread over a large area and possibly cause damage to the vehicle. For this reason it is important to study the effects of plume impingement and crater formation on surfaces like those found on the moon. Lunar soil, also known as regolith, is made up of fine granular particles on the order of 100 microns.i Whenever a vehicle lifts-off from such a surface, the exhaust plume from the main engine will cause the formation of a crater. This crater formation may cause laterally ejected mass to be deflected and possibly damage the vehicle. This study is a first attempt at analyzing the dynamics of crater formation due to thruster exhaust plume impingement during liftoff from the moon. Though soil erosion on the lunar surface is not considered, this study aims at examining the evolution of the shear stress along the lunar surface as the engine fires. The location of the regions of high shear stress will determine where the crater begins to form and will lend insight into how big the crater will be. This information will help determine the probability that something will strike the vehicle. The final sections of this report discuss a novel method for studying this problem that uses a volume of fluid (VOF)ii method to track the movement of both the exhaust plume and the eroding surface.

  18. Impingement Heat Transfer of Reciprocating Jet Array

    NASA Astrophysics Data System (ADS)

    Su, Lo May; Chang, Shyy Woei; Chiou, Shyr Fuu

    This paper describes an experimental study of impingement heat transfer of reciprocating jet-array with piston cooling application for marine heavy-duty diesel engine. A selection of heat transfer measurements illustrates the manner by which the individual and interactive influences of reciprocating force and buoyancy on heat transfer for the impinging jet-array. It is demonstrated that the reciprocating force coupled with buoyancy interaction causes considerable heat transfer modifications from the static results. The isolated reciprocating force effect could initially reduce heat transfer to a level about 0.45 of static level with weak reciprocation but recovers when the reciprocating force increases. Heat transfer improvement and impediment could be aided by the location-dependent buoyancy effect in addition to the reciprocating force effect. An empirical heat transfer correlation, which is physically consistent, has been developed to permit the evaluation of the individual and synergistic effects of reciprocating force and buoyancy interaction on local heat transfer of the impinging jet-array.

  19. Nozzle cavity impingement/area reduction insert

    DOEpatents

    Yu, Yufeng Phillip; Itzel, Gary Michael; Osgood, Sarah Jane

    2002-01-01

    A turbine vane segment is provided that has inner and outer walls spaced from one another, a vane extending between the inner and outer walls and having leading and trailing edges and pressure and suction sides, the vane including discrete leading edge, intermediate, aft and trailing edge cavities between the leading and trailing edges and extending lengthwise of the vane for flowing a cooling medium; and an insert sleeve within at least one of the cavities and spaced from interior wall surfaces thereof. The insert sleeve has an inlet for flowing the cooling medium into the insert sleeve and has impingement holes defined in first and second walls thereof that respectively face the pressure and suction sides of the vane. The impingement holes of at least one of those first and second walls are defined along substantially only a first, upstream portion thereof, whereby the cooling flow is predominantly impingement cooling along a first region of the insert wall corresponding to the first, upstream portion and the cooling flow is predominantly convective cooling along a second region corresponding to a second, downstream portion of the at least one wall of the insert sleeve.

  20. Circular and Elliptic Submerged Impinging Water Jets

    NASA Astrophysics Data System (ADS)

    Claudey, Eric; Benedicto, Olivier; Ravier, Emmanuel; Gutmark, Ephraim

    1999-11-01

    Experiments and CFD have been performed to study circular and elliptic jets in a submerged water jet facility. The tests included discharge coefficient measurement to evaluate pressure losses encountered in noncircular nozzles compared to circular ones. Three-dimensional pressure mappings on the impingement surface and PIV measurement of the jet mean and turbulent velocity have been performed at different compound impingement angles relative to the impingement surface and at different stand-off distances. The objective was to investigate the effect of the non-circular geometry on the flow field and on the impact region. The tests were performed in a close loop system in which the water was pumped through the nozzles into a clear Plexiglas tank. The Reynolds numbers were typically in the range of 250000. Discharge coefficients of the elliptic nozzle was somewhat lower than that of the circular jet but spreading rate and turbulence level were higher. Pressure mapping showed that the nozzle exit geometry had an effect on the pressure distribution in the impact region and that high-pressure zones were generated at specific impact points. PIV measurements showed that for a same total exit area, the elliptic jets affected a surface area that is 8the equivalent circular. The turbulence level in the elliptic jet tripled due to the nozzle design. Results of the CFD model were in good agreement with the experimental data.

  1. Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players.

    PubMed

    Degen, Ryan M; Fields, Kara G; Wentzel, C Sally; Bartscherer, Bethanne; Ranawat, Anil S; Coleman, Struan H; Kelly, Bryan T

    2016-11-01

    Femoroacetabular impingement (FAI) has been increasingly recognized in cutting sports including soccer, hockey and football. More recently, the prevalence among overhead athletes has also been recognized. The purpose of this study was to review impingement patterns, return-to-play rates and clinical outcome following arthroscopic treatment of FAI among high-level baseball players. Between 2010 and 2014, 70 competitive baseball players (86 hips; age 22.4 ± 4.5 years) were identified. Demographics and return-to-play rates were recorded. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), the Sport-specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected pre-operatively at 6 months and 1year (n = 34, 49% of cohort). The cohort included professional (27.1%), college (57.1%), high-school (8.6%) and club-team athletes (7.1%). Infielder (37.5%), pitcher (22.9%) and catcher (16.7%) were the most common positions. Average follow-up was 16.8 months (range 12.1-34.2). There was no relationship between playing position and impingement pattern (p ≥ 0.459), or between symptom laterality and handedness, batting position or playing position (p ≥ 0.179). One patient required revision surgery (infection). Return to sport rate was 88%, at a mean of 8.6 ± 4.2 months, with 97.7% returning at/above their pre-injury level of play. There was significant improvement in all outcome measures: mHHS (60.1 ± 11.9 to 93 ± 9.5), HOS-ADL (71.3 ± 16.7 to 96.3 ± 3.6), HOS-SSS (51.3 ± 24.8 to 92.3 ± 8.2) and iHOT-33 (40.7 ± 19.9 to 85.9 ± 14) (p < 0.001). Arthroscopic treatment of FAI in competitive baseball players resulted in high return-to-play rates at short-term follow-up, with significant improvements in clinical outcome scores.

  2. 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

  3. [EFFECTIVENESS OF ARTHROSCOPY FOR ANKLE IMPINGEMENT SYNDROME].

    PubMed

    Han, Guansheng; Xu, Bin; Geng, Chunhui; Cheng, Xinde

    2014-06-01

    To explore the effectiveness of arthroscopy for ankle impingement syndrome. Between March 2009 and April 2013, 30 patients with ankle impingement syndrome were treated. Among them, there were 22 males and 8 females with an average age of 28.6 years (range, 16-55 years). Twenty-six patients had a history of obvious ankle sprains. The disease duration was 6-62 months (mean, 21.5 months). All cases had ankle pain, limitation of activity, and positive results of ankle impact test. According to Meislin scoring criteria, 5 cases were rated as good, 8 cases as medium, and 17 cases as poor; the excellent and good rate was 16.7%. American Orthopedic Foot and Ankle Society (AOFAS) score was 43.3 ± 5.1. Visual analogue scale (VAS) score was 6.7 ± 2.3. Preoperative X-ray film showed ankle loose bodies and hyperplasia osteophyte in 6 cases, and lateral malleolus old avulsion fracture in 4 cases. MRI showed soft tissue in the ankle joint in the 17 cases, and articular cartilage injury of tibiotalar joint and bone marrow edema in 7 cases. The location, degree, and organization of the impact were observed under arthroscopy. The joint debridement, removal of loose body and osteophyte, plasty of articular cartilage, and plasma radiofrequency ablation of lateral and medial ligaments were performed. All incisions healed primarily. No infection of skin and joint, or neurological and vascular injury was found. All patients were followed up 6-32 months (mean, 19.5 months). According to Meislin scoring criteria at last follow-up, 16 cases were rated as excellent, 11 cases as good, and 3 cases as medium; the excellent and good rate was 90.0%, showing significant difference when compared with preoperative value (Z = 6.045, P = 0.000). AOFAS score was 89.8 ± 4.3, showing significant difference when compared with preoperative score (t = 38.180, P = 0.000). VAS score was 2.8 ± 1.6, showing significant difference when compared with preoperative score (t = 7.624, P = 0.000). A clear

  4. Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial.

    PubMed

    Mansell, Nancy S; Rhon, Daniel I; Marchant, Bryant G; Slevin, John M; Meyer, John L

    2016-02-04

    As the prevalence of hip pathology in the younger athletic population rises, the medical community continues to investigate effective intervention options. Femoracetabular impingement is the morphologically abnormal articulation of the femoral head against the acetabulum, and often implicated in pre-arthritic hip conditions of musculoskeletal nature. Arthroscopic surgical decompression and non-surgical rehabilitation programs focused on strengthening and stability are common interventions. However, they have never been directly compared in clinical trials. The primary purpose of this study will be to assess the difference in outcomes between these 2 commonly utilized interventions for femoracetabular impingement. The study will be a single site, non-inferiority, randomized controlled trial comparing two different treatment approaches (surgical and nonsurgical) for FAI. The enrollment goal is for a total of 80 subjects with a diagnosis of Femoracetabular impingement that are surgical candidates and have failed 6 weeks of conservative treatment. This will be a convenience sample of consecutive patients that are Tricare beneficiaries and seeking care at Madigan Army Medical Center. Patients that meet the criteria will be screened, provide written consent before enrollment, and then randomized into one of two arms (Group I = hip arthroscopy, Group II = physical therapy). Group I will undergo hip arthroscopy with or without labral repair. Group II will follow an impairment based physical therapy program consisting of 2 sessions per week for 6 weeks. The primary outcome will be the Hip Outcome Score and secondary measures will include the International Hip Outcome Tool and the Global Rating of Change. Measures will be taken at baseline, 6 months, 1 and 2 years. Hip-related healthcare utilization between both groups will also be assessed at the end of 2 years. The current evidence to support both surgical and conservative interventions for femoroacetabular impingement is

  5. Posterior ankle impingement syndrome: A systematic four-stage approach

    PubMed Central

    Yasui, Youichi; Hannon, Charles P; Hurley, Eoghan; Kennedy, John G

    2016-01-01

    Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem. PMID:27795947

  6. The approach to the evaluation and surgical treatment of mechanical hip pain in the young patient: AAOS exhibit selection.

    PubMed

    Skendzel, Jack G; Weber, Alexander E; Ross, James R; Larson, Christopher M; Leunig, Michael; Kelly, Bryan T; Bedi, Asheesh

    2013-09-18

    The mechanical causes of hip pain in a young athlete often reflect a complex combination of static and dynamic factors. A comprehensive diagnostic approach is paramount to the development of a rational treatment strategy that will address all underlying pathologic factors. The goals of this paper are to highlight the pertinent biomechanical factors of the hip joint in femoroacetabular impingement and to discuss the clinical history, physical examination, and radiographic findings that are essential to formulating a proper diagnosis and an effective treatment plan. In addition, the current literature and reported outcomes of femoroacetabular impingement surgery in athletic patients are reviewed.

  7. Hip psychometrics.

    PubMed

    Baldwin, Peter; Bernstein, Joseph; Wainer, Howard

    2009-07-30

    When data are abundant relative to the number of questions asked of them, answers can be formulated using little more than those data. But when data grow more sparse, so too does our tendency to lean on strong models to help us draw inferences. In this research we show how a strong item response model embedded within a fully Bayesian framework allows us to answer two important questions about the reliability and consistency of the clinical diagnosis of hip fractures from very limited data. We also show how the model automatically adjusts diagnoses for biases among the surgeons judging the radiographs. This research illustrates how a Bayesian approach expands the range of problems on which item response models can profitably be used.

  8. 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.

  9. Subacromial impingement syndrome as a consequence of botulinum therapy to the upper trapezii: a case report.

    PubMed

    Abbott, Zachary; Richardson, James K

    2007-07-01

    Scapular upward rotation is predominantly achieved via a force coupling involving the upper and lower trapezius and the serratus anterior. Although studies have shown a relationship between abnormal scapular motion and subacromial impingement, it has been unclear whether the altered scapular biomechanics represent a cause, or consequence, of impingement. We present a 49-year-old woman with refractory myofascial pain of many years duration who developed subacromial impingement syndrome (SIS) following a series of botulinum toxin injections to the bilateral upper trapezii. Although botulinum therapy effectively reduced the patient's refractory myofascial pain, signs and symptoms of SIS developed in association with the upper trapezii weakness after the third set of injections. Botulinum therapy was discontinued and nonsteroidal anti-inflammatory medication markedly reduced the new symptoms, which completely resolved within 3 months. This case, which afforded a unique opportunity to follow the consequences of weakening scapular stabilizers over time, provides evidence for the etiologic role of scapular dyskinesis in SIS and shows that SIS is a potential complication of botulinum therapy for myofascial pain involving the scapular stabilizers.

  10. 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

  11. 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.

  12. Total hip arthroplasty.

    PubMed Central

    Siopack, J S; Jergesen, H E

    1995-01-01

    Total hip arthroplasty, or surgical replacement of the hip joint with an artificial prosthesis, is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. In this review we briefly summarize the evolution of total hip arthroplasty, the design and development of prosthetic hip components, and the current clinical indications for this procedure. The possible complications of total hip arthroplasty, its clinical performance over time, and future directions in hip replacement surgery are also discussed. Images PMID:7725707

  13. 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

  14. 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.

  15. 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

  16. Active Control of Supersonic Impinging Jets Using Supersonic Microjets

    DTIC Science & Technology

    2005-01-01

    impinging jet experiments . control technique, which utilizes supersonic microjets and significantly alleviates the...an Obstacle", NASA TT F-15719, 1974. 15. Phalnikar, K. A., Alvi, F. S. and Shih, C. "Behavior of Free and Impinging Supersonic Microjets ," AIAA Paper...S., "Active Control of Supersonic Impingement Tones Using Steady and Pulsed Microjets ," submitted to Experiments in Fluids, August 2005, under

  17. Optimization of a GO2/GH2 Impinging Injector Element

    NASA Technical Reports Server (NTRS)

    Tucker, P. Kevin; Shyy, Wei; Vaidyanathan, Rajkumar

    1999-01-01

    An existing injector optimization methodology, method i, is used to investigate optimal design points for a GO2/GH2 impinging injector element. The impinging element, an F-O-F triplet, is optimized in terms of such relevant design variables as fuel pressure drop, DELTA-P(sub f), oxidizer pressure drop, DELTA-P(sub o), combustor length, L(sub comb), and impingement angle, alpha, for a given mixture ratio and chamber pressure.

  18. Meralgia paresthetica and femoral acetabular impingement: a possible association.

    PubMed

    Ahmed, Aiesha

    2010-12-11

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies.

  19. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  20. Hindfoot endoscopy for posterior ankle impingement.

    PubMed

    Scholten, P E; Sierevelt, I N; van Dijk, C N

    2008-12-01

    The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less morbidity and facilitates a quick recovery compared with open surgery. Fifty-five consecutive patients with posterior ankle impingement were treated with an endoscopic removal of bone fragments and/or scar tissue. The symptoms were caused by trauma (65%) or overuse (35%). All patients were enrolled in a prospective protocol. At baseline, the age, sex, work and sports activities, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, and preinjury Tegner scores were determined for all patients. At the time of follow-up, AOFAS hindfoot scores and Tegner scores were assessed and the time to return to work and sports activities was determined. Complications were recorded. Patients scored the overall result as poor, fair, good, or excellent by means of a 4-point Likert scale. The median duration of follow-up was thirty-six months, and no patient was lost to follow-up. The median AOFAS hindfoot score increased from 75 points preoperatively to 90 points at the time of final follow-up. The median time to return to work and sports activities was two and eight weeks, respectively. At the time of follow-up, patients in the overuse group were more satisfied than those in the posttraumatic group, and the AOFAS hindfoot scores were higher in patients in the overuse group (median, 100 points) compared with patients in the posttraumatic group (median, 90 points). A complication occurred in one patient who had a temporary loss of sensation of the posteromedial aspect of the heel. The outcome after endoscopic treatment of posterior ankle impingement compares favorably with the results of open surgery reported in the literature. Hindfoot endoscopy appears to cause less morbidity than open

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

    PubMed Central

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

    2016-01-01

    Summary Background 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. Materials and methods 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). Results 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. Conclusion 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. PMID:28066746

  2. Evaluation of Impingement Syndromes in the Overhead-Throwing Athlete

    PubMed Central

    Jobe, Christopher M.; Coen, Michael J.; Screnar, Pat

    2000-01-01

    Objective: We outline impingement entities, describe the history and physical examination, and provide an overview of treatment beyond that routinely used in glenohumeral and scapulothoracic dysfunction. Background: In the athlete, pain and dysfunction due to excessive overhead use or abnormal positioning of the shoulder is common and can result from multiple etiologies, including impingement syndromes. Primary, secondary, internal, and coracoid impingement have all been described. Description: These entities will be discussed, including pathology, evaluation, and treatment. Clinical Advantages: Incorporating a systematic evaluation and treatment of impingement syndromes optimizes care for the patient with shoulder pain. PMID:16558643

  3. Reduced hip strength is associated with increased hip motion during running in young adult and adolescent male long-distance runners.

    PubMed

    Taylor-Haas, Jeffery A; Hugentobler, Jason A; DiCesare, Christopher A; Hickey Lucas, Kathryn C; Bates, Nathaniel A; Myer, Gregory D; Ford, Kevin R

    2014-08-01

    Controlled laboratory study. Anterior knee pain is one of the most common running symptoms reported in the literature. While the exact etiology is unknown, a lack of hip strength is suggested to contribute to abnormal running mechanics. The purpose of this research study was to evaluate the association between isokinetic hip strength and 3-D running kinematics. 33 male high school and collegiate cross country runners participated in this study. Peak isokinetic hip abductor and hip extensor strength were assessed. Each subject also completed a treadmill running protocol at a self-selected speed (mean = 3.8 m/s). 3-D kinematic data were collected at 240 Hz using a 10-camera motion capture system. Pearson correlation coefficients were used to determine the relationship between hip strength and hip range of motion (ROM) during the stance phase of running (p<0.05). Peak isokinetic hip extensor torque was inversely correlated with transverse plane hip ROM (r = -.387, p = .026) but was not significantly related to sagittal plane hip ROM or frontal plane hip ROM. Peak isokinetic hip abductor torque was inversely correlated with frontal plane hip ROM (r=-.462, p=.008) but was not significantly related to either sagittal plane hip ROM or transverse plane hip ROM. Peak isokinetic hip extensor torque and peak isokinetic hip abductor torque were not significantly related to knee kinematics in any plane. Peak isokinetic hip extensor torque and peak isokinetic hip abductor torque are associated with transverse plane and frontal plane hip kinematics, but not knee kinematics. Level 3b.

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

    PubMed Central

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

    2016-01-01

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

  5. Droplet Impingement Boiling on Heated Superhydrophobic Surfaces

    NASA Astrophysics Data System (ADS)

    Crockett, Julie; Clavijo, Cristian; Maynes, Daniel

    2015-11-01

    When a droplet impinges on a solid surface at a temperature well above the saturation temperature, vaporization of the liquid begins immediately after contact. Different boiling regimes may result depending on the surface temperature and volatility of the liquid. The nucleate boiling regime is characterized by explosive atomization, which occurs when vapor bubbles burst causing an extravagant shower of small micro droplets as well as the well-known ``sizzling'' sound. In this work, we show that the vapor is surprisingly re-directed during impingement on a superhydrophobic surface such that atomization is completely suppressed. We hypothesize that this occurs because vapor escapes through the superhydrophobic interface such that the top of the droplet remains free of bursting vapor bubbles. We explore a wide range of surface patterning with feature spacing of 8 to 32 microns and solid area fractions of 10 to 50 percent; surface temperatures from 100 C to 400 C; and Weber numbers of 1 to 100. Atomization is found to decrease with increasing feature spacing and decreasing solid fraction, and vanishes completely for large spacing. It may be that large feature spacing promotes early transition to the Leidenfrost regime.

  6. Confined Impinging Jets in Porous Media

    NASA Astrophysics Data System (ADS)

    Buonomo, B.; Cirillo, L.; Manca, O.; Mansi, N.; Nardini, S.

    2016-09-01

    Impinging jets are adopted in drying of textiles, paper, cooling of gas turbine components, freezing of tissue in cryosurgery and manufacturing, electronic cooling. In this paper an experimental investigation is carried out on impinging jets in porous media with the wall heated from below with a uniform heat flux. The fluid is air. The experimental apparatus is made up of a fun systems, a test section, a tube, to reduce the section in a circular section. The tube is long 1.0 m and diameter of 0.012 m. The test section has a diameter of 0.10 m and it has the thickness of 10, 20 and 40 mm. In the test section the lower plate is in aluminum and is heated by an electrical resistance whereas the upper plate is in Plexiglas. The experiments are carried out employing a aluminum foam 40 PPI at three thickness as the test section. Results are obtained in a Reynolds number range from 5100 to 15300 and wall heat flux range from 510 W/m2 to 1400 W/m2. Results are given in terms of wall temperature profiles, local and average Nusselt numbers, pressure drops, friction factor and Richardson number.

  7. Posture in people with shoulder impingement syndrome.

    PubMed

    Skolimowski, Jarosław; Barczyk, Katarzyna; Dudek, Krzysztof; Skolimowska, Beata; Demczuk-Włodarczyk, Ewa; Anwajler, Joanna

    2007-01-01

    The posture of people with shoulder impingement syndrome (SIS) is a result of adaptive defensive posturing to decrease the intensity of pain in the affected joint. The aim of this work is to characterise trunk and shoulder girdle positioning in patients with SIS. The study involved 58 patients treated for SIS in the years 2004-2006. Symptoms had been present for 40 months on average. A photogrammetric study was performed with the use of a MORA 4G system. It consisted in measuring lordosis and kyphosis, as well as the symmetry of some selected anthropometric points in the frontal plane. Changes in posture presenting as an increased angle of trunk inclination in the sagittal plane and in the frontal plane were observed in all patients. There was asymmetry of bony points as regards the position of the scapula and the waist triangles. The impingement syndrome is associated with displacement of all bony points analysed. Changes in posture are a result of adaptive mechanisms. Trunk asymmetry is secondary to changes in the spatial position of the scapula.

  8. Sessile drop deformations under an impinging jet

    NASA Astrophysics Data System (ADS)

    Feng, James Q.

    2015-08-01

    The problem of steady axisymmetric deformations of a liquid sessile drop on a flat solid surface under an impinging gas jet is of interest for understanding the fundamental behavior of free surface flows as well as for establishing the theoretical basis in process design for the Aerosol direct-write technology. It is studied here numerically using a Galerkin finite-element method, by computing solutions of Navier-Stokes equations. For effective material deposition in Aerosol printing, the desired value of Reynolds number for the laminar gas jet is found to be greater than ~500. The sessile drop can be severely deformed by an impinging gas jet when the capillary number is approaching a critical value beyond which no steady axisymmetric free surface deformation can exist. Solution branches in a parameter space show turning points at the critical values of capillary number, which typically indicate the onset of free surface shape instability. By tracking solution branches around turning points with an arc-length continuation algorithm, critical values of capillary number can be accurately determined. Near turning points, all the free surface profiles in various parameter settings take a common shape with a dimple at the center and bulge near the contact line. An empirical formula for the critical capillary number for sessile drops with contact angle is derived for typical ranges of jet Reynolds number and relative drop sizes especially pertinent to Aerosol printing.

  9. Total hip arthroplasty in the ankylosed hip.

    PubMed

    Swanson, Megan A; Huo, Michael H

    2011-12-01

    Altered biomechanics secondary to hip ankylosis often result in degeneration of the lumbar spine, ipsilateral knee, and contralateral hip and knee. Symptoms in these joints may be reduced with conversion total hip arthroplasty (THA) of the ankylosed hip. THA in the ankylosed hip is a technically challenging procedure, and the overall clinical outcome is generally less satisfactory than routine THA performed for osteoarthritis and other etiologies. Functional integrity of the hip abductor muscles is the most important predictor of walking ability following conversion THA. Many patients experience persistent limp, and it can take up to 2 years to fully assess final functional outcome. Risk factors cited for increased risk of failed THA include prior surgical ankylosis and age <50 years at the time of conversion THA.

  10. Long-term follow-up of open reduction surgery for developmental dislocation of the hip.

    PubMed

    Holman, Joel; Carroll, Kristen L; Murray, Kathleen A; Macleod, Lynne M; Roach, James W

    2012-03-01

    We posed 2 questions: what is the long-term result of open reduction surgery in developmental dysplasia of the hip, and is there an age at surgery above which the outcome was too poor to recommend the operation? Between 1955 and 1995, 148 patients with 179 dislocated hips had open reduction surgery for developmental dysplasia of the hip (141 anterior and 38 Ludloff medial approaches). We attempted to locate all 148 patients for the follow-up evaluation. Fifty-three patients (36%) with 66 hips (37%) were located and participated in the study. These 66 hips represented 34% of the anterior open reductions and 47% of the Ludloff medial reductions. Twenty-two of the 66 hips had Severin IV or worse outcomes and included 7 with total hip arthroplasties and 2 with hip fusions. Age at surgery was significantly lower for Severin I, II, and III, compared with Severin IV and above (P=0.003, 0.001, 0.003) with outcomes deteriorating substantially after age 3. Approximately half of the hips required further surgery for dysplasia. All hips that sustained osseous necrosis had Severin IV or worse outcomes, and hips that redislocated and required revision surgery only achieved Severin I or II ratings 18% of the time. Nine "normal" hips became dysplastic and 3 had pelvic osteotomies as teenagers. Two other normal hips developed osseous necrosis during treatment of the contralateral hip. Results deteriorate as the age at surgery increases. Osseous necrosis and redislocation predict a poor functional and radiographic result. The "normal" hip may develop insidious dysplasia and also may be injured during treatment of the involved hip. Above age 3, some patients may not have sufficient acetabular growth to remodel a surgically reduced hip. Level IV--case series.

  11. Clinical biomechanics of wear in total hip arthroplasty.

    PubMed

    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 sliding-distance-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

  12. 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

  13. The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL: Implications for Graft Impingement.

    PubMed

    Thein, Ran; Spitzer, Elad; Doyle, John; Khamaisy, Saker; Nawabi, Danyal H; Chawla, Harshvardhan; Lipman, Joseph D; Pearle, Andrew D

    2016-08-01

    Impingement of anterior cruciate ligament (ACL) grafts against the femoral notch and the posterior cruciate ligament (PCL) is thought to be influenced primarily by tunnel position and graft orientation. Recent data have implied that the native ACL is ribbon-shaped. To evaluate the 3-dimensional shape and cross-sectional area of the native ACL versus the ACL graft and to compare the degree of impingement against the femoral notch and PCL. Cross-sectional study; Level of evidence, 3. Bilateral knee magnetic resonance images were analyzed for 27 patients with unilateral bone-patellar tendon-bone (BPTB) ACL reconstruction performed via transtibial or anteromedial portal femoral tunneling techniques. Three-dimensional models of the ACL, PCL, femur, and tibia were digitally rendered. The cross-sectional area and dimensions of the native ACL and the reconstructed graft were determined at 3 equally spaced locations and compared via Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. In addition, impingement of the ACL on the PCL and femoral notch was graded in 3 groups. Chi-square or Fisher exact tests were used to compare the proportional differences of impingement of the native and reconstructed ACL on the PCL and femoral notch, respectively. All analyses were performed using 2-sided hypothesis testing, with statistical significance at P < .05. Cross-sectional areas at all 3 points on the ACL graft were significantly greater than those of the native ACL (P < .001). The long- to short-axis ratio for the native ACL was significantly greater at each location compared with the corresponding locations along the ACL graft (P < .001), implying that the native ACL is "flatter" than is an ACL graft. There were 19 operated knees (70%) with contact or impingement between the ACL graft and the femoral notch compared with zero knees with a native ACL (P < .001). In addition, 22 operated knees (81%) showed contact or impingement between the ACL graft and the PCL, compared with 7 knees (26

  14. Occult hemoglobin as an indicator of impingement stress in fishes

    SciTech Connect

    Not Available

    1980-01-01

    During the process of impingement on cooling system intake screens, fish may be subject to different types of stress, the total of which often results in the death of individual fish. This report assesses the use of occult hemoglobin in fish demand mucus as an indicator of impingement stress. (ACR)

  15. Round impinging jets with relatively large stand-off distance

    NASA Astrophysics Data System (ADS)

    Shademan, Mehrdad; Balachandar, Ram; Roussinova, Vesselina; Barron, Ron

    2016-07-01

    Large eddy simulation and particle image velocimetry measurements have been performed to evaluate the characteristics of a turbulent impinging jet with large nozzle height-to-diameter ratio (H/D = 20). The Reynolds number considered is approximately 28 000 based on the jet exit velocity and nozzle diameter. Mean normalized centerline velocity in both the free jet and impingement regions and pressure distribution over the plate obtained from simulations and experiments show good agreement. The ring-like vortices generated due to the Kelvin-Helmholtz instabilities at the exit of the nozzle merge, break down and transform into large scale structures while traveling towards the impingement plate. A Strouhal number of 0.63 was found for the vortices generated at the exit of the nozzle. However, this parameter is reduced along the centerline towards the impingement zone. A characteristic frequency was also determined for the large scale structures impinging on the plate. The expansion, growth, tilt, and three-dimensionality of the impinging structures cause dislocation of the impinging flow from the centerline, which is significantly larger when compared with flows having small H/D ratios. Contrary to the behavior of impinging jets with small stand-off distance, due to the loss of coherence, the large scale structures do not result in significant secondary vortices in the wall jet region and consequently less fluctuations were observed for wall shear stress.

  16. Current Concepts in Hip Preservation Surgery: Part I.

    PubMed

    Adler, Kelly L; Cook, P Christopher; Yen, Yi-Meng; Giordano, Brian D

    2015-01-01

    An evolution in conceptual understanding, coupled with technical innovations, has enabled hip preservation surgeons to address complex pathomorphologies about the hip joint to reduce pain, optimize function, and potentially increase the longevity of the native hip joint. Technical aspects of hip preservation surgeries are diverse and range from isolated arthroscopic or open procedures to hybrid procedures that combine the advantages of arthroscopy with open surgical dislocation, pelvic and/or proximal femoral osteotomy, and biologic treatments for cartilage restoration. PubMed and CINAHL databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Clinical review. Level 4. Thoughtful individualized surgical procedures are available to optimize the femoroacetabular joint in the presence of hip dysfunction. A comprehensive understanding of the relationship between femoral and pelvic orientation, morphology, and the development of intra-articular abnormalities is necessary to formulate a patient-specific approach to treatment with potential for a successful long-term result. © 2015 The Author(s).

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

    PubMed

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

    2016-01-01

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

  18. Multispecies impingement in a tropical power plant, Straits of Malacca.

    PubMed

    Azila, A; Chong, V C

    2010-07-01

    Marine organisms comprised about 70% of the total impinged materials by weight at water intake screens in the Kapar Power Station (KPS), Malaysia. The general groupings of 'fish', 'shrimp', 'crab', 'cephalopod' and 'others' contributed 26% (87 species), 65% (29), 2% (17), 2% (3) and 5% (42) of the total number of impinged organisms, respectively. In general, higher impingement occurred during spring tide, at nighttime and in shallow water. The glass perchlet, anchovies, ponyfishes, mojarra, catfishes, hairtail, scat and young croakers were the most vulnerable fishes. Vulnerable invertebrates included cephalopods, sea urchin, rockshells and jellyfishes, but penaeid shrimps were the most susceptible in terms of both mortality and body injury. Annually, KPS is estimated to kill 8.5 x 10(6) marine organisms (42 tons) by impingement. This amount, however, is minimal compared to commercial fishery harvests. Multispecies impingement at Malaysian power plants poses the problem of finding the best mitigation options for tropical situations.

  19. Regeneratively cooled transition duct with transversely buffered impingement nozzles

    DOEpatents

    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 the 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.

  20. 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.

  1. 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.

  2. 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.

  3. MAASH Technique for Total Hip Arthroplasty: A Capsular Work.

    PubMed

    Delgado, Felipe G; Broch, Albert; Reina, Francisco; Ximeno, Lluís; Torras, David; García, Francesc; Salvador, Antoni

    2013-07-01

    Dislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure. Modified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the "weak area" of the capsule, in the so called "internervous safe zone" and introducing the "box concept" for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier. From November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique. MAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development. MAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.

  4. Hip fracture surgeries

    MedlinePlus

    ... References Goulet JA. Hip dislocations. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: ... Baumgaertner MR. Intertrochanteric hip fractures. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: ...

  5. Hip Injuries and Disorders

    MedlinePlus

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

  6. Hip Implant Systems

    MedlinePlus

    ... Medical Devices Products and Medical Procedures Implants and Prosthetics Metal-on-Metal Hip Implants Hip Implants Share ... femoral head) is removed and replaced with a prosthetic ball made of metal or ceramic, and the ...

  7. Hip replacement - discharge

    MedlinePlus

    ... surgery to replace all or part of your hip joint with an artificial joint called a prosthesis. This ... You're in the Hospital You had a hip joint replacement surgery to replace all or part of ...

  8. Hip joint injection

    MedlinePlus

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

  9. A Traffic Light Grading System of Hip Dysplasia to Predict the Success of Arthroscopic Hip Surgery.

    PubMed

    Grammatopoulos, George; Davies, Owain L I; El-Bakoury, Ahmed; Gill, Harinderjit S; Pollard, Tom C B; Andrade, Antonio J

    2017-10-01

    the greatest chance of failure (odds ratio, 10; P < .001) was the red zone, with an AIf of 20° to 100° and an LCEAf of 0° to 10°. Overall, the 7-year hip survival rate in hip dysplasia appears inferior compared with that reported in femoroacetabular impingement (78%). Hip arthroscopic surgery is associated with an excellent chance of hip preservation in mild dysplasia (green zone: AI = 0°-15°, LCEA = 15°-25°) and no articular wear. The authors advise that the greatest caution should be used when considering arthroscopic options in cases of severe dysplasia (red zone: AI >20° and/or LCEA <10°).

  10. The influence of spine-hip relations on total hip replacement: A systematic review.

    PubMed

    Rivière, C; Lazennec, J-Y; Van Der Straeten, C; Auvinet, E; Cobb, J; Muirhead-Allwood, S

    2017-06-01

    Sagittal pelvic kinematics along with spino-pelvic angular parameters have recently been studied by numerous investigators for their effect on total hip replacement (THR) clinical outcomes, but many issue of spine-hip relations (SHR) are currently unexplored. Therefore, our review aims at clarifying the following questions: is there any evidence of a relationship between articular impingement/dislocation risk in primary THR and (1) certain sagittal pelvic kinematics patterns, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilising PubMed and Google search engines was performed in January 2017. Only clinical or computational studies published in peer-reviewed journals over the last five years in either English or French were reviewed. We identified 769 reports, of which 12 met our eligibility criteria. A review of literature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement/dislocation. We found no study having assessed the relationship between this risk and the types of SHRs. Sagittal pelvic kinematics is highly variable among individuals and certain kinematic patterns substantially influences the risk of prosthetic impingement/dislocation. Recommendations for cup positioning are therefore switching from a systematic to a patient-specific approach, with the standing cup orientation Lewinneck safe zone progressively giving way to a new parameter of interest: the functional orientation of the cup. Based on a recently published classification for SHRs, We propose a new concept of "kinematically aligned THR" for the purposes of THR planning. Further studies are needed to investigate the relevance of such a classification towards the assumptions and hypothesis we have made. Level of evidence,- Level IV, systematic review of level III and IV studies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Comparison of anterior gluteus medius fiber activation during general exercises and PNF exercises

    PubMed Central

    Ju, Sung-kwang; Yoo, Won-gyu

    2017-01-01

    [Purpose] This study compared the activation of anterior gluteus medius fibers during general exercises and proprioceptive neuromuscular facilitation exercises. [Subjects and Methods] The study enrolled 15 healthy adults. The participants performed general hip abductor strengthening exercises and proprioceptive neuromuscular facilitation exercises; during both types of exercise, electromyography activity was recorded. [Results] Greater anterior gluteus medius fiber activation was observed during the proprioceptive neuromuscular facilitation exercises compared with the general hip abductor strengthening exercises. The anterior gluteus medius fibers exhibited greater activity during pattern 2 exercises compared with any other type of exercise. [Conclusion] The results suggest that pattern 2 exercises can selectively activate anterior gluteus medius fibers. PMID:28356634

  12. Comparison of anterior gluteus medius fiber activation during general exercises and PNF exercises.

    PubMed

    Ju, Sung-Kwang; Yoo, Won-Gyu

    2017-03-01

    [Purpose] This study compared the activation of anterior gluteus medius fibers during general exercises and proprioceptive neuromuscular facilitation exercises. [Subjects and Methods] The study enrolled 15 healthy adults. The participants performed general hip abductor strengthening exercises and proprioceptive neuromuscular facilitation exercises; during both types of exercise, electromyography activity was recorded. [Results] Greater anterior gluteus medius fiber activation was observed during the proprioceptive neuromuscular facilitation exercises compared with the general hip abductor strengthening exercises. The anterior gluteus medius fibers exhibited greater activity during pattern 2 exercises compared with any other type of exercise. [Conclusion] The results suggest that pattern 2 exercises can selectively activate anterior gluteus medius fibers.

  13. 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.

  14. Investigations of scaling laws for jet impingement

    NASA Technical Reports Server (NTRS)

    Morton, J. B.; Haviland, J. K.; Catalano, G. D.; Herling, W. W.

    1976-01-01

    The statistical properties of tangential flows over surfaces were investigated by two techniques. In one, a laser-Doppler velocimeter was used in a smoke-laden jet to measure one-point statistical properties, including mean velocities, turbulent intensities, intermittencies, autocorrelations, and power spectral densities. In the other technique, free stream and surface pressure probes connected to 1/8 inch microphones were used to obtain single point rms and 1/3 octave pressures, as well as two point cross correlations, the latter being converted to auto spectra, amplitude ratios, phase lags, and coherences. The results of these studies support the vortex model of jets, give some insights into the effects of surface impingement, and confirm that jet diameter and velocity are the scaling parameters for circular jets, while Reynolds number is relatively unimportant.

  15. Removal of biofilms by impinging water droplets

    NASA Astrophysics Data System (ADS)

    Cense, A. W.; van Dongen, M. E. H.; Gottenbos, B.; Nuijs, A. M.; Shulepov, S. Y.

    2006-12-01

    The process of impinging water droplets on Streptococcus mutans biofilms was studied experimentally and numerically. Droplets were experimentally produced by natural breakup of a cylindrical liquid jet. Droplet diameter and velocity were varied between 20 and 200 μm and between 20 and 100 m/s, respectively. The resulting erosion process of the biofilm was determined experimentally with high-speed recording techniques and a quantitative relationship between the removal rate, droplet size, and velocity was determined. The shear stress and the pressure on the surface during droplet impact were determined by numerical simulations, and a qualitative agreement between the experiment and the simulation was obtained. Furthermore, it was shown that the stresses on the surface are strongly reduced when a water film is present.

  16. Investigation of scrubbing and impingement noise

    NASA Technical Reports Server (NTRS)

    Fink, M. R.

    1975-01-01

    Tests were conducted in an acoustic wind tunnel to determine surface pressure spectra and far field noise caused by turbulence impinging on an airfoil and turbulence convected past a sharp trailing edge. Measured effects of flow velocity and turbulence intensity were compared with predictions from several theories. Also, tests were conducted in an anechoic chamber to determine surface pressure spectra and far field noise caused by a deflected airfoil scrubbed by a subsonic jet. This installation simulated both an under-the-wing and an upper-surface-blowing externally blown flap, depending on the deflection angle. Surface and far field spectra, and cross correlation coherence and delay time, were utilized to infer the major noise-producing mechanisms.

  17. How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

    PubMed

    Castañeda, Pablo; Vidal-Ruiz, Carlos; Méndez, Alfonso; Salazar, Diego Pérez; Torres, Armando

    2016-05-01

    Femoroacetabular impingement is increasingly recognized as a cause of hip pain but its incidence after an innominate osteotomy for the correction of acetabular dysplasia has not been determined. This information would be essential for the orthopaedic surgeon because it has the potential to produce a poor outcome in the long term when trying to balance acetabular instability and overcorrection. The purposes of our study were (1) to determine the frequency with which clinically relevant femoroacetabular impingement (FAI) occurs after an innominate osteotomy for the treatment of acetabular dysplasia; (2) to determine risk factors for the development of FAI; and (3) to compare postoperative radiographic and clinical outcomes in patients having undergone an innominate osteotomy for the correction of acetabular dysplasia both with and without FAI. This was a retrospective review of 154 hips (132 patients) that had undergone an innominate osteotomy for acetabular dysplasia and were evaluated at a minimum followup of 10 years (mean = 12 years). Mean age at the time of surgery was 3 years, 114 hips had a concomitant open reduction, and 54 hips also had femoral shortening. One hundred eight hips had a Salter osteotomy and 46 had a Pemberton osteotomy. Radiographs were analyzed to determine the lateral center-edge angle (CE angle) and the presence of a crossover sign. The diagnosis of FAI was established when the CE angle was greater than 40°, there was a positive crossover sign, and the patient had groin pain when flexing the hip less than 90°. Comparisons between nonparametric variables were performed with a Mann-Whitney's U test. Categorical variables were compared with a chi-square test. Change in acetabular index (correction) was dichotomized considering 20° of correction as the cutoff point. Association is presented as odds ratio (95% confidence interval), and logistic regression was performed. According to our criteria, 18 of 154 hips had FAI (12%). Of the 18

  18. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis.

    PubMed

    Sink, Ernest L; Zaltz, Ira; Heare, Travis; Dayton, Michael

    2010-01-01

    Surgical hip dislocation allows the surgeon full visualization of the proximal femur and acetabulum. It also makes it possible to directly observe the pathologic relationship between the proximal femur and acetabular rim with hip motion. The purpose of this study is to classify acetabular cartilage and labral damage that is present at the time of surgical hip dislocation for the treatment of symptomatic stable slipped capital femoral epiphysis (SCFE) hips. A retrospective study was performed at 2 North American centers on patients with a stable SCFE who had a surgical hip dislocation for chronic symptoms. The severity of SCFE (slip angle) was measured as mild (0-30 degrees), moderate (30-60 degrees), and severe (60-90 degrees). The degree of acetabular and labral damage was classified in each patient according to the Beck classification used for femoroacetabular impingement. Thirty-nine hips in 36 patients that underwent open surgical dislocation for diagnosis of stable SCFE were included. The breakdown of the radiographic severity of the SCFE was 8 mild, 20 moderate, and 11 severe. Labral injury was observed in 34 of 39 hips. Using the Beck classification for labral injury, there were 21 type 1 injuries, 9 type 2 injuries, and 4 type 3 injuries. Cartilage injury was present in 33 of 39 hips. Using Beck classification for cartilage damage, there were 6 grade 0, 5 grade 1, 10 grade 2, 4 grade 3, 10 grade 4, and 4 grade 5 injuries. The average depth of cartilage damage was 5 mm (range, 2-10 mm). In this study, significant chondromalacia and labral injury was observed in hips afflicted with SCFE. Surgical hip dislocation allowed direct confirmation of the impingement of the prominent metaphysis on the acetabular labrum and cartilage.

  19. Thermodynamics of flame impingement heat transfer

    NASA Astrophysics Data System (ADS)

    Som, S. K.; Agrawal, G. K.; Chakraborty, Suman

    2007-08-01

    A theoretical model for entropy generation and utilization of work potential (exergy) in flame impingement (both premixed and diffusion) heat transfer has been developed in this article, to offer physical insights on the optimal operational regimes, depicting high values of the surface heat flux with minimal exergy destruction, within the practical constraints. The irreversibility components due to different physical processes have been evaluated from a general entropy transport equation. The velocity, temperature, and species concentration fields required for the solution of entropy transport equation have been determined from the numerical computation of flow-field in the flame. Global two-step chemical kinetics has been considered with methane (CH4) and air as fuel and oxidizer, respectively. The results have been predicted in terms of average nondimensional heat flux, expressed as Nusselt number at the target plate, the irreversibility components, and second law efficiency, as functions of the pertinent input parameters such as the jet Reynolds number and the ratio of plate separation distance to nozzle diameter (H /d). The average Nusselt number has been found to increase with an increase in jet Reynolds number and a decrease in H /d ratio, up to a value of 8. The dominant source of thermodynamic irreversibility in a premixed flame has been attributed to the thermal energy exchange whereas, in a diffusion flame, the same has been attributed to an uncontrolled exchange of electrons accompanying the reactive kinetics. The second law efficiency has been found to increase with an increase in jet Reynolds number and an increase in the H /d ratio, up to a value of 20. Values of the jet Reynolds number greater than 10 000 and H /d ratio in the tune of 15 have been observed to pertain to the regime of optimum flame impingement heat transfer, consistent with the energy and exergy balance constraints.

  20. Turbine vane segment and impingement insert configuration for fail-safe impingement insert retention

    DOEpatents

    Burdgick, Steven Sebastian; Kellock, Iain Robertson

    2003-05-13

    An impingement insert sleeve is provided that is adapted to be disposed in a coolant cavity defined through a stator vane. The insert has a generally open inlet end and first and second pairs of diametrically opposed side walls, and at least one fail-safe tab defined at a longitudinal end of the insert for limiting radial displacement of the insert with respect to the stator vane.

  1. 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

  2. Bilateral iliopsoas muscle contracture and spinous process impingement in a German Shepherd dog.

    PubMed

    Ragetly, Guillaume R; Griffon, Dominique J; Johnson, Ann L; Blevins, William E; Valli, Victor E

    2009-12-01

    To report diagnosis and treatment of bilateral iliopsoas muscle contracture in a dog with spinous process impingement. Case report. German Shepherd dog. A dog with chronic progressive lameness, flexion contracture of the coxofemoral joints, severe pain, and decreased femoral reflexes had severe spondylosis bridging the vertebral bodies from L1 to L4 and enlarged dorsal spinous processes from T8 to L6 with impingement and bony proliferation. Ultrasonographic and magnetic resonance imaging (MRI) findings were consistent with fibrosis, mineralization, and atrophy of the iliopsoas muscles bilaterally which was treated by staged tenectomy of the insertions of the iliopsoas muscles. Because of severe perivascular fibrosis, the femoral vessels required ligation. Bilateral iliopsoas muscle tenectomy improved gait and provided pain relief. Histologic findings were consistent with fibrotic myopathy. Slow progression of severe clinical signs observed bilaterally in this dog differs from previous reports of iliopsoas myopathy. Findings were similar to the fibrotic myopathy of the gracilis or semitendinosus muscles described in dogs. Iliopsoas muscle abnormalities should be considered in dogs with limited hip extension and pain. MRI is useful for diagnosing muscle fibrosis. Iliopsoas tenectomy may improve clinical function in dogs with fibrotic myopathy.

  3. The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

    PubMed

    Blizzard, Daniel J; Nickel, Brian T; Seyler, Thorsten M; Bolognesi, Michael P

    2016-01-01

    Concurrent spine and hip disease is common. Spinal deformities can restrict lumbar range of motion and lumbar lordosis, leading to pelvic obliquity and increased pelvic tilt. A comprehensive preoperative workup and component templating ensure appropriate compensation for altered pelvic parameters for implantation of components according to functional positioning. Pelvic obliquity from scoliosis must be measured to calculate appropriate leg length. Cup positioning should be templated on standing radiograph to limit impingement from cup malposition. In spinal deformity, the optimal position of the cup that accommodates pelvic parameters and limits impingement may lie outside the classic parameters of the safe zone.

  4. The Hip Restoration Algorithm

    PubMed Central

    Stubbs, Allston Julius; Atilla, Halis Atil

    2016-01-01

    Summary Background Despite the rapid advancement of imaging and arthroscopic techniques about the hip joint, missed diagnoses are still common. As a deep joint and compared to the shoulder and knee joints, localization of hip symptoms is difficult. Hip pathology is not easily isolated and is often related to intra and extra-articular abnormalities. In light of these diagnostic challenges, we recommend an algorithmic approach to effectively diagnoses and treat hip pain. Methods In this review, hip pain is evaluated from diagnosis to treatment in a clear decision model. First we discuss emergency hip situations followed by the differentiation of intra and extra-articular causes of the hip pain. We differentiate the intra-articular hip as arthritic and non-arthritic and extra-articular pain as surrounding or remote tissue generated. Further, extra-articular hip pain is evaluated according to pain location. Finally we summarize the surgical treatment approach with an algorithmic diagram. Conclusion Diagnosis of hip pathology is difficult because the etiologies of pain may be various. An algorithmic approach to hip restoration from diagnosis to rehabilitation is crucial to successfully identify and manage hip pathologies. Level of evidence: V. PMID:28066734

  5. Hip Labral Tear

    MedlinePlus

    ... the outside rim of the socket of your hip joint. In addition to cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes who participate in such sports as ...

  6. 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

  7. An overview of hip injuries in running.

    PubMed

    Paluska, Scott A

    2005-01-01

    Running has steadily gained in worldwide popularity and is the primary exercise modality for many individuals of all ages. Its low cost, versatility, convenience and related health benefits appeal to men and women of broad cultural, ethnic and economic backgrounds. With more children and adults participating in recreational and competitive running, the incidence of injuries has steadily increased. Most running-related injuries affecting the lower extremities are due to preventable training errors, and some may necessitate medical evaluation or a significant reduction in training. Hip injuries in runners are due to interactions of intrinsic and extrinsic factors that adversely affect the complex regional anatomy. Acute or chronic hip pain presents a diagnostic and therapeutic challenge because the vague, nonspecific symptoms and signs may originate from local, regional or distant foci. Muscle strains and tendonitis are the most common aetiologies of hip pain and typically result from sudden acceleration/deceleration manoeuvres, direction changes or eccentric contractions. Apophysitis and avulsion fractures may affect younger runners and produce localised pain at muscle attachment sites. Iliotibial band syndrome is a common cause of lateral hip and knee symptoms characterised by sharp or burning pain that is exacerbated by activity. Bursitis, due to repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursae. Hip osteoarthritis may also produce persistent pain that worsens with running. Stress fractures are potentially serious conditions that affect women more frequently than men. Snapping hip syndrome is a benign condition that results from tight connective tissues' passing repeatedly over the greater trochanter, anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence. Acetabular labral tears, sports hernias and nerve entrapment syndromes are also potential causes of persistent hip pain in runners

  8. CERVICAL CONTRIBUTION TO FUNCTIONAL SHOULDER IMPINGEMENT: TWO CASE REPORTS

    PubMed Central

    2016-01-01

    Background Subacromial impingement is a common condition among overhead athletes. The cause of subacromial impingement can be multifactorial and often involves impaired rotator cuff function. Case Description The following cases outline the presentation, examination and intervention of two overhead athletes, a high school football quarterback and a collegiate swimmer, each presenting with signs and symptoms of subacromial impingement. The unique feature in each case was the manifestation of the cervical spine as the apparent source of rotator cuff weakness, which contributed to functional subacromial impingement although other overt signs of cervical or associated nerve root involvement were absent. Outcome Subsequent to this finding, the athletes demonstrated a rapid recovery of rotator cuff strength and resolution of impingement symptoms in response to cervical retraction and retraction with extension range of motion exercises along with posture correction. They both returned to unrestricted sporting activities within a week, with maintenance of strength and without reoccurrence of symptoms. Discussion The signs of functional subacromial impingement often include weakness of the supraspinatus and infraspinatus. The cause of the weakness in the two cases appeared to be the result of stresses associated with forward head posture contributing to a possible intermittent C5 nerve root compression. The findings in the two cases would suggest the cervical spine should be considered as a potential cause of rotator cuff weakness in individuals presenting with subacromial impingement. Future research should examine the influence of cervical postures and shoulder muscle strength. Level of Evidence 4 PMID:27904800

  9. Shoulder impingement syndrome in relation to shoulder intensive work

    PubMed Central

    Frost, P.; Andersen, J. H.

    1999-01-01

    OBJECTIVES: To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. METHODS: A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by questionnaire and by physical examinations. Impingement syndrome was diagnosed when shoulder symptoms had been present for at least 3 months during the past year and there were signs of subacromial impingement in the corresponding shoulder at physical examination. Shoulder function was assessed at the same occasion with the Constant scoring technique. Prevalence of shoulder impingement syndrome was analysed according to job title and cumulative exposure. RESULTS: Prevalence ratio for shoulder impingement syndrome was 5.27 (95% confidence interval (95% CI), 2.09 to 12.26) among currently working and 7.90 (95% CI, 2.94 to 21.18) among former slaughterhouse workers. Transformed model based prevalence ratios according to years in slaughterhouse work showed an overall association between cumulative exposure and risk for shoulder impingement syndrome. CONCLUSIONS: This study supports the hypothesis that shoulder intensive work is a risk factor for impingement syndrome of the shoulder. Despite the historical cohort design healthy worker selection may have influenced the exposure- response relation found.   PMID:10472322

  10. Surgical hip dislocation in treatment of slipped capital femoral epiphysis

    PubMed Central

    Elmarghany, Mohammed; Abd El-Ghaffar, Tarek M.; Seddik, Mahmoud; Akar, Ahmed; Gad, Yousef; Ragheb, Eissa; Aprato, Alessandro; Massè, Alessandro

    2017-01-01

    Background: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666–679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499–507]. Objective: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function. Patients and methods: This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10–18 years). The mean follow-up period was 14.5 months (6–36 months). Results: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip

  11. [History of hip arthroplasty].

    PubMed

    Płomiński, Janusz; Kwiatkowski, Krzysztof

    2007-02-01

    The authors present the history of hip prosthesis in treatment of coxarthrosis. Despite eighty years of experience the problem of gaining good and long-term results still exist and is difficult to solve. Even changing the way on cementless stabilization of prosthesis doesn't has result in solving the problem of aseptic loosening of hip arthroplasty. Problems of wear derbies made the producers find new to reduce particulate debris. The future of hip arthroplasty is connected with hip resurfacing. Moreover, the higher number of primary hip plasty the more prosthesis are loosening. The treatment is far more difficult and more expensive.

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

    PubMed Central

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

    2016-01-01

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

  13. Intrapelvic protrusion of the acetabular component following total hip replacement.

    PubMed

    Salvati, E A; Bullough, P; Wilson, P D

    1975-09-01

    Protrusion of the acetabular component into the true pelvis following total hip replacement has occurred in 5 patients, 4 with severe rheumatoid arthritis and 1 with a destructive type of degenerative hip disease. Preoperatively all hips had severe protrusio acetabuli, a markedly thin acetabular medial wall and advanced osteoporosis. Four had a McKee-Farrar prosthesis, a metal-to-metal device with high frictional torque, particularly when the contact is equatorial, and no damping capacity against marginal impingement in the extreme range of motion. In order to reduce the incidence of intrapelvic protrusion, extreme care should be given to preserve the medial bone stock of the acetabulum, more so when it is already damaged or defective. If anchoring holes are used they should be restricted to the superior ilium, pubis and ischium and should not perforate the medial wall. Once loosening is present, reoperation is indicated to avoid progressive bone reabsorption by the abrasive motion of the loosened prosthesis, that might lead to irreparable bone loss. To reduce the stress transmitted to an already weakened acetabulum, select a total prosthetic device with low friction; fix it with acrylic cement in order to distribute the stress over a large surface; carefully orient both components to avoid marginal impingement; be certain to preserve the medial wall as much as possible and if it is already defective reinforce it by bone grafting and/or wire mesh.

  14. Experimental and Computational Study of Underexpanded Jet Impingement Heat Transfer

    NASA Technical Reports Server (NTRS)

    Rufer, Shann J.; Nowak, Robert J.; Daryabeigi, Kamran; Picetti, Donald

    2009-01-01

    An experiment was performed to assess CFD modeling of a hypersonic-vehicle breach, boundary-layer flow ingestion and internal surface impingement. Tests were conducted in the NASA Langley Research Center 31-Inch Mach 10 Tunnel. Four simulated breaches were tested and impingement heat flux data was obtained for each case using both phosphor thermography and thin film gages on targets placed inside the model. A separate target was used to measure the surface pressure distribution. The measured jet impingement width and peak location are in good agreement with CFD analysis.

  15. Scaling laws for drop impingement on porous films and papers.

    PubMed

    Joung, Young Soo; Buie, Cullen R

    2014-01-01

    This study investigates drop impingement on highly wetting porous films and papers. Experiments reveal previously unexplored impingement modes on porous surfaces designated as necking, spreading, and jetting. Dimensional analysis yields a nondimensional parameter, denoted the Washburn-Reynolds number, relating droplet kinetic energy and surface energy. The impingement modes correlate with Washburn-Reynolds number variations spanning four orders of magnitude and a corresponding energy conservation analysis for droplet spreading shows good agreement with the experimental results. The simple scaling laws presented will inform the investigation of dynamic interactions between porous surfaces and liquid drops.

  16. Hip labral repair: options and outcomes.

    PubMed

    Harris, Joshua D

    2016-12-01

    The importance of the acetabular labrum has been increasingly recognized, playing a critical role in both normal anatomy and abnormal pathology of the hip joint. The labrum increases acetabular surface area and volume, providing a stable and durable articulation. The fibrocartilaginous composition affords a tissue capable of a lifetime of normal function in the absence of significant osseous pathology. In the setting of femoroacetabular impingement (FAI) or dysplasia, bony biomechanics may cause labral injury, which may translate to patient symptoms. Long-term consequences of labral tears may include joint degeneration. Labral preservation surgery emphasizes retention of the form and function of the labrum, prioritizing labral repair (in the presence of reparable tissue) and reconstruction (in the absence of reparable tissue) over debridement. Patient-reported outcomes have consistently demonstrated significantly better results following labral repair versus debridement. In conjunction with correction of osseous abnormalities, labral surgery can improve short-term outcomes and potentially reduce the risk of long-term osteoarthritis.

  17. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    PubMed Central

    Jørgensen, R. Wejnold; Dippmann, C.; Dahl, L.; Stürup, J.

    2016-01-01

    Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies. PMID:27583059

  18. THE ASSOCIATIONS BETWEEN HIP STRENGTH AND HIP KINEMATICS DURING A SINGLE LEG HOP IN RECREATIONAL ATHLETES POST ACL RECONSTRUCTION COMPARED TO HEALTHY CONTROLS.

    PubMed

    Tate, Jeremiah; Suckut, Tell; Wages, Jensen; Lyles, Heather; Perrin, Benjamin

    2017-06-01

    Only a small amount of evidence exists linking hip abductor weakness to dynamic knee valgus during static and dynamic activities. The associations of hip extensor strength and hip kinematics during the landing of a single leg hop are not known. Purpose: To determine if relationships exist between hip extensor and abductor strength and hip kinematics in both involved and uninvolved limb during the landing phase of a single leg hop in recreational athletes post anterior cruciate ligament (ACL) reconstruction. The presence of similar associations was also evaluated in healthy recreational athletes. Controlled Laboratory Study; Cross-sectional. Twenty-four recreational college-aged athletes participated in the study (12 post ACL reconstruction; 12 healthy controls). Sagittal and frontal plane hip kinematic data were collected for five trials during the landing of a single leg hop. Hip extensor and abductor isometric force production was measured using a hand-held dynamometer and normalized to participants' height and weight. Dependent and independent t-tests were used to analyze for any potential differences in hip strength or kinematics within and between groups, respectively. Pearson's r was used to demonstrate potential associations between hip strength and hip kinematics for both limbs in the ACL group and the right limb in the healthy control group. Independent t-tests revealed that participants post ACL reconstruction exhibited less hip extensor strength (0.18 N/Ht*BW vs. 0.25 N/Ht*BW, p=<.01) and landed with greater hip adduction (9.0 º vs. 0.8 º, p=<.01) compared with their healthy counterparts. In the ACL group, Pearson's r demonstrated a moderate and indirect relationship (r=-.62, p=.03) between hip extensor strength and maximum hip abduction/adduction angle in the involved limb. A moderate and direct relationship between hip abductor strength and maximum hip flexion angle was demonstrated in the both the involved (r=.62) and uninvolved limb (r=.65

  19. Visual scapular dyskinesis: kinematics and muscle activity alterations in patients with subacromial impingement syndrome.

    PubMed

    Lopes, Andrea Diniz; Timmons, Mark K; Grover, Molly; Ciconelli, Rozana Mesquita; Michener, Lori A

    2015-02-01

    To characterize scapular kinematics and shoulder muscle activity in patients with subacromial impingement syndrome, with and without visually identified scapular dyskinesis. Cross-sectional study. Laboratory. Participants with subacromial impingement syndrome (N=38) were visually classified using a scapular dyskinesis test with obvious scapular dyskinesis (n=19) or normal scapular motion (n=19). Not applicable. An electromagnetic motion capture system measured 3-dimensional kinematics of the thorax, humerus, and scapula. Simultaneously, surface electromyography was used to measure muscle activity of the upper, middle, and lower trapezius; serratus anterior; and infraspinatus during ascending and descending phases of weighted shoulder flexion. Separate mixed-model analyses of variance for the ascending and descending phases of shoulder flexion compared kinematics and muscle activity between the 2 groups. Shoulder disability was assessed with the Pennsylvania Shoulder Score (Penn). The group with obvious dyskinesis reported 6 points lower on Penn shoulder function (0-60 points), exhibited a main group effect of less scapular external rotation of 2.1° during ascent and 2.5° during descent, and had 12.0% higher upper trapezius muscle activity during ascent in the 30° to 60° interval. Patients with obvious dyskinesis and subacromial impingement syndrome have reduced scapular external rotation and increased upper trapezius muscle activity, along with a greater loss of shoulder function compared with those without dyskinesis. These biomechanical alterations can lead to or be caused by scapular dyskinesis. Future studies should determine if correction of these deficits will eliminate scapular dyskinesis and improve patient-rated shoulder use. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Arthroscopic acetabuloplasty without labral detachment for focal pincer-type impingement: a minimum 2-year follow-up.

    PubMed

    Comba, Fernando M; Slullitel, Pablo A; Bronenberg, Pedro; Zanotti, Gerardo; Buttaro, Martin A; Piccaluga, Francisco

    2017-07-01

    In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. When the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. During the study period, we retrospectively analysed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average follow-up of 32 months (range: 27-38). We excluded patients with isolated CAM-type impingement and previous hip pathology. Radiographs were analysed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of pre-operative and post-operative modified Harris hip score (mHHS) and WOMAC as well as post-operative visual analogue scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Mean mHHS changed from 51.06 (SD 4.81) pre-operatively to 84.97 (SD 12.79) post-operatively. Pre-operative WOMAC was 29.18 (SD 8) and post-operative, 13.10 (SD 11). Post-operative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding post-operative mHHS (89.9 s versus 77.85, P = 0.03), pain VAS (1.5 versus 6.3, P = 0.03) and satisfaction VAS (8.2 versus 6.3, P = 0.01). Survival was 100% at 24 months and 76% at 40 months (95% CI: 35-98%). Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes. Slight degenerative changes on radiographs correlated with poorer clinical outcomes.

  1. Arthroscopic acetabuloplasty without labral detachment for focal pincer-type impingement: a minimum 2-year follow-up

    PubMed Central

    Comba, Fernando M.; Bronenberg, Pedro; Zanotti, Gerardo; Buttaro, Martin A.; Piccaluga, Francisco

    2017-01-01

    Abstract In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. When the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. During the study period, we retrospectively analysed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average follow-up of 32 months (range: 27–38). We excluded patients with isolated CAM-type impingement and previous hip pathology. Radiographs were analysed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of pre-operative and post-operative modified Harris hip score (mHHS) and WOMAC as well as post-operative visual analogue scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Mean mHHS changed from 51.06 (SD 4.81) pre-operatively to 84.97 (SD 12.79) post-operatively. Pre-operative WOMAC was 29.18 (SD 8) and post-operative, 13.10 (SD 11). Post-operative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding post-operative mHHS (89.9 s versus 77.85, P = 0.03), pain VAS (1.5 versus 6.3, P = 0.03) and satisfaction VAS (8.2 versus 6.3, P = 0.01). Survival was 100% at 24 months and 76% at 40 months (95% CI: 35–98%). Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes. Slight degenerative changes on radiographs correlated with poorer clinical outcomes. PMID:28630735

  2. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist.

    PubMed

    Telleria, Jessica J M; Lindsey, Derek P; Giori, Nicholas J; Safran, Marc R

    2011-05-01

    To examine and describe the normal anatomic intra-articular locations of the hip capsular ligaments in the central and peripheral compartments of the hip joint. Eight paired fresh-frozen human cadaveric hips (mean age, 73.3 years) were carefully dissected free of soft tissue to expose the hip capsule. Needles were placed through the capsule along the macroscopic borders of the hip capsular ligaments. Arthroscopy was performed on each hip, and the relations of the needles, and thus the ligaments, to the arthroscopic portals and other soft-tissue and osseous landmarks in the hip were recorded by use of a clock-face reference system. The iliofemoral ligament (ILFL) ran from 12:45 to 3 o'clock. The ILFL was pierced by the anterolateral and anterior portals just within its lateral and medial borders, respectively. The pubofemoral ligament was located from the 3:30 to the 5:30 clock position; the lateral border was at the psoas-U perimeter, and the medial border was at the junction of the anteroinferior acetabulum and the cotyloid fossa. The ischiofemoral ligament (ISFL) ran from the 7:45 to the 10:30 clock position. The posterolateral portal pierced the ISFL just inside its superior/lateral border, and the inferior/lateral border was located at the posteroinferior acetabulum. In the peripheral compartment the lateral ILFL and superior/lateral ISFL borders were in proximity to the lateral synovial fold. The medial ILFL and lateral pubofemoral ligament borders were closely approximated to the medial synovial fold. The hip capsular ligaments have distinct and consistent arthroscopic locations within the hip joint and are associated with clearly identifiable landmarks in the central and peripheral compartments. The standard hip arthroscopy portals are closely related to the borders of the hip capsular ligaments. These findings will help orthopaedic surgeons know which structures are being addressed during arthroscopic surgery and may help in the development of future hip

  3. Anterior instability in the throwing shoulder.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2014-06-01

    The disabled throwing shoulder is a multifactorial problem. Laxity of the glenohumeral joint is necessary to achieve a satisfactory velocity. Normal wear and tear with throwing may convert this normal amount of excessive translation into instability. Instability in the throwing athlete manifests itself in 2 forms: traumatic anterior instability that happens to occur in a throwing athlete and excessive anterior subluxation because of overuse that occurs in conjunction with the disabled throwing shoulder. In most cases, it is difficult to determine by physical examination or imaging how much laxity is too much; therefore, the managing physician should always err on the side of caution. A trial of rest and rehabilitation should always be attempted before any consideration of surgery. The multifactorial issues in the disabled throwing athlete should be corrected during this phase of treatment, including assessment and treatment of hip abnormalities, restoration of satisfactory core strength, correction of scapular dyskinesis, and an evaluation and correction of any biomechanical abnormalities in the throwing mechanism. Surgical management of anterior instability in the throwing shoulder depends on the mechanism of injury. The traumatic anterior instability patient is managed by acute surgical repair without a shift, utilizing mattress sutures to prevent suture chondromalacia on the humeral head or glenoid. The anterior laxity management centers on the posterior superior labrum, although occasionally the anterior labrum or capsule may be involved as well. Overall, symptomatic anterior instability is less common in the throwing shoulder. Jobe and colleagues are credited with the first successful technique for the correction of anterior instability in the throwing athlete, the anterior capsulolabral reconstruction by a subscapularis split. The success of this technique paved the way for the adoption of the current arthroscopic techniques that are utilized to correct

  4. Wenzel to Cassie transition for droplet impingement

    NASA Astrophysics Data System (ADS)

    Clavijo, Cristian; Crockett, Julie; Maynes, Daniel

    2015-11-01

    Advantages posed by self-cleaning, superhydrophobic surfaces quickly diminish as the liquid penetrates gas-filled cavities resulting in the so-called Wenzel state. To prevent penetration, surfaces must exhibit nanoscale features since penetrating pressure increases significantly for decreasing feature size. However, certain applications require microscale roughness such as those seeking to relax the no-slip condition and thus penetration reversal in microscale features remains of interest. Unfortunately, recent efforts to accomplish such reversal are complicated or locally-disruptive to the flow such as electrically-tunable surfaces and boiling. Here, we show that a Wenzel-to-Cassie transition is possible with a modest surface temperature increase. Dynamics are discussed for a water droplet impinging (We =100) on a wide range of superhydrophobic surfaces with features varying in height from 4 microns to 18 microns and separation distance of 8 microns to 16 microns. Results reveal that dewetting rates increase with increasing feature height and temperature up to 30 mL/s. A first order model is constructed to validate our hypothesis that surface tension and triple line dissipation are the two dominating forces during dewetting. Good agreement is found between the model and experimental results. We gratefully acknowlege the National Science Foundation for funding this work.

  5. Treatment of pincer-type femoroacetabular impingement

    PubMed Central

    SABETTA, ETTORE; SCARAVELLA, EDOARDO

    2015-01-01

    Pincer femoroacetabular impingement (FAI) consists of pathological contact between the acetabular labrum and rim and the femoral head-neck junction. Manifold conditions underlie pincer FAI: anatomical abnormalities, malorientation of the acetabulum, torsional abnormalities of the neck and femoral shaft (these defects can be constitutional, post-traumatic or post-surgical), and involvement in sports characterized by repeated and sudden maximum joint excursions. In a high percentage of cases, pincer FAI is associated with cam FAI. The aims of surgical treatment of pincer FAI are to eliminate the cause of the contact and repair the joint damage; the surgery may be open or arthroscopic, performed with an articular or extra-articular approach. Recently, arthroscopic treatment of FAI had a rapid and widespread diffusion due to the advantages it offers compared with the open technique. Arthroscopic treatment can repair the joint damage and in some cases, characterized by minor deformity, compensate for extra-articular defects. The acetabular labrum must always be preserved and sutured; only in extreme cases can it be sacrificed. Post-operative mobilization must respect the healing time of the labral repair. PMID:26605255

  6. Control of Impingement Heat Transfer Using Mist

    NASA Astrophysics Data System (ADS)

    Kanamori, Azusa; Hiwada, Munehiko; Mimatsu, Junji; Sugimoto, Hiraku; Oyakawa, Kenyuu

    Impingement heat transfer from a circular orifice jet by using latent heat of water mists was studied experimentally. The amounts of mists of about Zauter's mean diameter 14 µm were from 60 to 200 g/h within a range where liquid films were not formed on the target plate and mists were added near the orifice edge. Experiments covered Reynolds numbers from 12,500 to 50,000 and a heat flux is 1,400 W/m2. The experimental results indicate that adding mists had little influence on free jet mean velocity profiles and target plate pressure coefficients. On the other hand, mists had a strong influence on temperature and humidity profiles of a free jet and they also influenced Nusselt number distributions on the target plate. Increases of mists and Reynolds number caused increases in Nusselt number on the developed region. In addition, we investigated influence of the way mists were added and these results showed that Nusselt number was influenced not only by the amounts of mists but also by the adding method. Local Nusselt number profiles with mists were closely related to temperature distributions of the free jet at the location corresponding to the target plate.

  7. Mixing Characteristics of Turbulent Twin Impinging Axisymmetric Jets at Various Impingement Angles

    NASA Astrophysics Data System (ADS)

    Landers, Brian Donn

    An experimental study is first presented on the comparison between two commonly used velocity measurement techniques applied in experimental fluid dynamics: Constant Temperature Anemometry (CTA) and Particle Image Velocimetry (PIV). The comparison is performed in the near-field region of an axisymmetric circular turbulent jet where the flow field contains large scale turbulent structures. The comparison was performed for five Reynolds numbers, based on diameter, between 5,000 and 25,000. The Reynolds numbers selected cover the critical Reynolds number range, 10,000 to 20,000 where the characteristics of the flow transition to a fully developed turbulent mixing layer. A comparison between these two measurement techniques was performed in order to determine the differences between an intrusive (CTA) and non-intrusive (PIV) method when applied to a practical application. The results and observations obtained from the comparison between the two techniques were applied to better characterize the time-averaged characteristics of a single axisymmetric turbulent jet with a Reynolds number of 7,500. The mean and fluctuating velocities, turbulent kinetic energy (TKE), and vorticity were measured as a baseline case. Additionally, smoke visualization was utilized to determine the mixing characteristics of the transient start of an axisymmetric turbulent jet. The shedding frequencies, also known as, the `preferred mode were investigated for a single jet. Particle Image Velocimetry (PIV) was also utilized to characterize the pre-and post-regions of the interaction region of two axisymmetric, incompressible turbulent jets at included angles: 30, 45, and 60 degrees. The Reynolds number selected (7,500) was within the range of critical Reynolds numbers and the geometrical distance to twin jet impingement, X0, remained constant at 10.33D for each impingement angle. The mean and fluctuating velocities, vorticity, and turbulent kinetic energy (TKE) were measured. Smoke Visualization

  8. Effect of impinging plate geometry on the self-excitation of subsonic impinging jets

    NASA Astrophysics Data System (ADS)

    Vinoth, B. R.; Rathakrishnan, E.

    2011-11-01

    In the generation of discrete tones by subsonic impinging jets, there exists a difference of opinion as how the feedback is achieved, i.e., the path of the feedback acoustic waves is whether inside the jet or outside the jet? The only available model (Tam and Ahuja model) for the prediction of an average subsonic jet impingement tone frequency assumes that the upstream part of the feedback loop is closed by an upstream propagating neutral wave of the jet. But, there is no information about the plate geometry in the model. The present study aims at understanding the effect of the plate geometry (size and co-axial hole in the plate) on the self-excitation process of subsonic impinging jets and the path of the acoustic feedback to the nozzle exit. The present results show that there is no effect of plate diameter on the frequency of the self-excitation. A new type of tones is generated for plates with co-axial hole (hole diameter is equal to nozzle exit diameter) for Mach numbers 0.9 and 0.95, in addition to the axisymmetric and helical mode tones observed for plates without co-axial hole. The stability results show that the Strouhal number of the least dispersive upstream propagating neutral waves match with the average Strouhal number of the new tones observed in the present experiments. The present study extends the validity of the model of Tam and Ahuja to a plate with co-axial hole (annular plate) and by doing so, we indirectly confirmed that the major acoustic feedback path to the nozzle exit is inside the jet.

  9. Current Concepts in Hip Preservation Surgery: Part II--Rehabilitation.

    PubMed

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

    2016-01-01

    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. 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. Clinical review. Level 4. Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. 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. © 2015 The Author(s).

  10. Shoulder Impingement Syndromes: Implications on Physical Therapy Examination and Intervention

    PubMed Central

    2005-01-01

    A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed. PMID:25792938

  11. Impinging jet separators for liquid metal magnetohydrodynamic power cycles

    NASA Technical Reports Server (NTRS)

    Bogdanoff, D. W.

    1973-01-01

    In many liquid metal MHD power, cycles, it is necessary to separate the phases of a high-speed liquid-gas flow. The usual method is to impinge the jet at a glancing angle against a solid surface. These surface separators achieve good separation of the two phases at a cost of a large velocity loss due to friction at the separator surface. This report deals with attempts to greatly reduce the friction loss by impinging two jets against each other. In the crude impinging jet separators tested to date, friction losses were greatly reduced, but the separation of the two phases was found to be much poorer than that achievable with surface separators. Analyses are presented which show many lines of attack (mainly changes in separator geometry) which should yield much better separation for impinging jet separators).

  12. Two stage serial impingement cooling for isogrid structures

    SciTech Connect

    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.

  13. A flash photographic method for droplet impingement studies

    SciTech Connect

    Hart, V.

    1999-07-01

    This paper describes an experimental method to visualize the impingement process of a liquid droplet onto a solid surface with sufficient clarity to reveal fine details of the droplet surface structure and rim jet produced during the impingement process. The method incorporates a 35 mm SLR camera with bellows, motor drive, macro lens, backlighting by a short duration flash lamp, diffusers and a commercially available timing control unit to trigger the flash. Results using the experimental arrangement are demonstrated for a water droplet striking a horizontal surface at a velocity of about 1 m/s, though the photographic method may be applied to any other condition and liquid. A series of photographs are presented that show the repeatability of the impingement process, image clarity, surface structure of the droplet during impingement.

  14. Coracoid impingement syndrome due to intensive rock climbing training.

    PubMed

    Schöffl, Volker; Schneider, Hans; Küpper, Thomas

    2011-06-01

    Overuse and acute injuries to the upper body are common in rock climbing. Such injuries primarily affect the fingers; but shoulder problems are increasingly common, especially among more experienced and older climbers who climb at a high ability level. Such shoulder problems are often due to subacromial impingement, shoulder dislocations with bankart lesions, hyperlaxity, SLAP lesions or irritations of the long biceps tendon. In contrast to these known conditions, we describe a case of an ambitious female rock climber who trained intensively and developed a coracoid impingement caused by hypertrophied subscapularis tendon and muscle following sport-specific training. Diagnosis was made through clinical evaluation and confirmed by magnetic resonance tomography. Coracoid impingement syndrome is a less common cause of shoulder pain and occurs when the subscapularis tendon impinges between the coracoid and the lesser tuberosity of the humerus. The patient was treated successfully with a conservative therapy and returned to full activity within 6 weeks.

  15. Experimental water droplet impingement data on modern aircraft surfaces

    NASA Technical Reports Server (NTRS)

    Papadakis, Michael; Breer, Marlin D.; Craig, Neil C.; Bidwell, Colin S.

    1991-01-01

    An experimental method has been developed to determine the water droplet impingement characteristics on two- and three-dimensional aircraft surfaces. The experimental water droplet impingement data are used to validate particle trajectory analysis codes that are used in aircraft icing analyses and engine inlet particle separator analyses. The aircraft surface is covered with thin strips of blotter paper in areas of interest. The surface is then exposed to an airstream that contains a dyed-water spray cloud. The water droplet impingement data are extracted from the dyed blotter paper strips by measuring the optical reflectance of each strip with an automated reflectometer. Preliminary experimental and analytical impingement efficiency data are presented for a NLF(1)-0414F airfoil, s swept MS(1)-0317 airfoil, a swept NACA 0012 wingtip and for a Boeing 737-300 engine inlet model.

  16. Measurements in a large angle oblique jet impingement flow

    NASA Technical Reports Server (NTRS)

    Foss, J. F.

    1978-01-01

    The flow field associated with the oblique impingement of an axisymmetric jet was investigated in the externally blown flap configuration for the STOL aircraft. The passive and active spreading characteristics of the shallow angle (a greater than or = approximately to 15 degrees) oblique impingement flow, the role of the initially azimuthal vorticity field, and the stagnation point region were studied, and compared to the large